scholarly journals A Possible Definition of Oligometastases in Pancreatic Cancers and Their Survival Outcomes

2021 ◽  
Author(s):  
Masaya Yamanaka ◽  
Masamichi Hayashi ◽  
Suguru Yamada ◽  
Fuminori Sonohara ◽  
Hideki Takami ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Pancreatic Head ◽  
Metastatic Pancreatic Cancer ◽  
Survival Outcomes ◽  
Curative Surgery ◽  
Staging Laparotomy ◽  
Organ Metastasis ◽  
Definition Of ◽  
Low Serum ◽  
Single Organ

Abstract Background: Among advanced metastatic cancers, oligometastatic cancers (OM) are defined as having limited visible metastases, possibly associated with relatively better survival outcomes. We attempted to identify cases that are in line with the concept of OM among unresectable metastatic pancreatic cancer, using a retrospective cohort.Methods: A total of 130 cases with unresectable metastatic pancreatic cancer received non-curative surgery (palliative surgery or staging laparotomy) from April 2001 to December 2019. Metastatic sites, clinicopathological information, and surgical outcomes were collected to reveal definition of OM.Results: Primary tumor sites were pancreatic head in 80 cases and others in 50 cases. Performed operations were gastrointestinal tract bypass in 68 cases and staging laparotomy in 62 cases. Based on the survival outcome differences, OM criteria were defined as single organ metastasis, a few countable lesions (4 or fewer organ metastases or limited peritoneal metastases) and low serum CA19-9 level (< 2000 U/ml). The median overall survival time (MST) after non-curative surgery of OM cases (n=54) was 13.0 months and was significantly better than non-OM cases (n=76) (MST:8.4months, P = 0.003).Conclusion: We propose single organ metastasis of limited tumor volume (H1 or P1-2 by the Japanese Society of Cancer of the Colon and Rectum classification) and low serum CA19-9 (< 2000 U/ml) as a new criteria for OM.

scholarly journals Long-Term Survival Outcomes of Metabolically Supported Chemotherapy with Gemcitabine-Based or FOLFIRINOX Regimen Combined with Ketogenic Diet, Hyperthermia, and Hyperbaric Oxygen Therapy in Metastatic Pancreatic Cancer

2019 ◽  
Vol 27 (1) ◽  
pp. 31-39 ◽  
Author(s):  
Mehmet Salih Iyikesici
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Ketogenic Diet ◽  
Hyperbaric Oxygen ◽  
Hyperbaric Oxygen Therapy ◽  
Oxygen Therapy ◽  
Metastatic Pancreatic Cancer ◽  
Survival Outcomes ◽  
Pancreatic Ductal Carcinoma ◽  
Term Survival

Background: Despite introduction of new chemotherapeutic agents, outcomes of patients with metastatic pancreatic cancer are still poor. Metabolically supported chemotherapy (MSCT) is a novel approach targeting dysregulated energy mechanism of the tumor cell. Objectives: This study aimed to examine the efficacy of metabolically supported administration of chemotherapy combined with ketogenic diet, hyperthermia, and hyperbaric oxygen therapy (HBOT) in patients with metastatic pancreatic cancer. Method: This retrospective observational study included 25 patients with metastatic pancreatic ductal carcinoma (stage IV) who received MSCT (either gemcitabine-based or FOLFIRINOX regimen administered concomitantly with induced hypoglycemia) plus ketogenic diet, hyperthermia, and HBOT combination. Survival outcomes were evaluated. Results: During the mean follow-up duration of 25.4 ± 19.3 months, median overall survival and median progression-free survival were 15.8 months (95% CI, 10.5–21.1) and 12.9 months (95% CI, 11.2–14.6), respectively. Age and gender did not have any effect on overall survival (p > 0.05 for all). Conclusions: MSCT administered together with ketogenic diet, hyperthermia, and HBOT appears to be a viable option with the potential to improve survival outcomes in patients diagnosed with metastatic pancreatic cancer. Further research, particularly with larger comparative clinical trials, is warranted.

A Possible Definition of Oligometastasis in Pancreatic Cancer and Associated Survival Outcomes

2021 ◽  
Vol 41 (8) ◽  
pp. 3933-3940
Author(s):  
MASAYA YAMANAKA ◽  
MASAMICHI HAYASHI ◽  
SUGURU YAMADA ◽  
FUMINORI SONOHARA ◽  
HIDEKI TAKAMI ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Survival Outcomes ◽  
Definition Of

Outcomes of patients with borderline-resectable pancreatic cancer treated with FOLFIRINOX versus gemcitabine plus nab-paclitaxel.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 299-299
Author(s):  
Shaina D'Lee Templeton ◽  
Michael Moser ◽  
Haji I. Chalchal ◽  
John Shaw ◽  
Yigang Luo ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Performance Status ◽  
Advanced Pancreatic Cancer ◽  
Pancreatic Head ◽  
Progression Free Survival ◽  
Incomplete Resection ◽  
Resectable Pancreatic Cancer ◽  
Curative Surgery ◽  
Borderline Resectable ◽  
Borderline Resectable Pancreatic Cancer

299 Background: Pancreatic cancer is a major cause of cancer-related death. Less than 20% of patients have resectable disease at diagnosis. Patients with borderline-resectable pancreatic cancer (BRPC) are at high risk of incomplete resection with upfront surgery. Currently there is no standard induction chemotherapy regimen exists for BRPC. Both FOLFIRINOX (5-FU, irinotecan, oxaliplatin) and gemcitabine/nab-paclitaxel (GnP) have shown better efficacy than gemcitabine in advanced pancreatic cancer. The current study aims to assess outcomes of real-world patients with BRCP who received induction FOLFIRINOX or GnP. Methods: In this population-based multicenter retrospective cohort study patients with biopsy proven BRPC as defined by the pancreatic surgical team diagnosed from 2011-2017, in the province of Saskatchewan, Canada, who received FOLFIRINOX or GnP were assessed. Kaplan Meier methods and log rank tests were performed for survival analyses. Results: Of 161 patients with pancreatic cancer who received FOLFIRINOX or GnP during the study period, 20 eligible patients with BRPC, with median age of 65 yrs (54-79) and M:F 14:6, were identified. 85% had pancreatic head tumours with a median CA19-9 of 470 u/mL. Of eligible patients, 10 each received FOLFIRINOX or GnP. No significant differences were found between the two groups, except more patients in FOLFIRINOX group had a WHO performance status of 0 (50% vs. 10%, p = 0.057) and had a higher body mass index (27.0 vs. 23.0, p = 0.027). Eleven patients showed partial response (5–FOLFIRINOX and 6–GnP), three progressed during treatment. Five patients (4–FOLFIRINOX, 1–GnP, p = NS) underwent curative surgery. Five patients (1–FOLFIRINOX, 4–Gnp) had radiation and four underwent Nanoknife procedure (3–FOLFIRINOX, 1–GnP). The median progression free survival was 17 months in FOLFIRINOX (95% CI: 5.3-28.6) versus nine months (3.0-15) in GnP group (p = 0.26). The median overall survival was 32 months in FOLFIRINOX (not reach) versus 16 months (9.3-22.7) in GnP group (p = 0.15). Conclusions: The current study suggests that patients with BRPC who received FOLFIRINOX tends to have better outcomes. Future study are warranted to establish a preferred systemic therapy for BRPC.

scholarly journals Metastasis Patterns and Prognosis of Elderly Patients With Esophageal Adenocarcinoma in Stage IVB: A Population-Based Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Guanghao Qiu ◽  
Hanlu Zhang ◽  
Fuqiang Wang ◽  
Yu Zheng ◽  
Zihao Wang ◽  
...  
Keyword(s):  
Population Based ◽  
Survival Outcomes ◽  
Multiple Site ◽  
Population Based Study ◽  
Site Group ◽  
Organ Metastasis ◽  
Metastasis Patterns ◽  
Stage Ivb ◽  
Metastasis Site ◽  
Single Organ

BackgroundEsophageal adenocarcinoma (EAC) is the most common kind of esophageal cancer. Age at diagnosis of advanced EAC is greater. Studies about practice patterns for elderly EAC patients with distant metastasis (DM) in stage IVB are limited. This retrospective, population-based study was conducted using data from the Surveillance, Epidemiology, and End Results (SEER) to evaluate 855 elderly EAC patients with DM in stage IVB from 2010 to 2015.Methods855 elderly EAC patients with DM in stage IVB between 2010 and 2015 were included in this study. Univariate and multivariate Cox-regression and Kaplan-Meier analyses were used to assess prognosis. These patients were classified to bone-only, brain-only, lung-only, liver-only, and multiple (patients with two or more organs in metastasis)-site group according to the site of metastasis. Overall survival (OS), cancer-specific survival (CSS), median survival time (MST), and survival rate (SR) were evaluated to analyze the survival outcomes.ResultsThe most common metastasis site was the liver among the single-organ metastasis population, followed by lung, bone, and brain. Compared with the bone-only group, the multiple-site group was associated with worst OS (HR: 1.037, 95% CI: 0.811–1.327, p = 0.770) and CSS (HR: 1.052, 95% CI: 0.816–1.357, p = 0.695). The multiple-site group also had the lowest MST in the population (MST: 2 months in OS and 3 months in CSS) and SR (6-month SR: 27.1% in OS, 29.9% in CSS, 1-year SR: 10.7% in OS, 12.0% in CSS, 3-year SR: 2.5% in OS, 2.8% in CSS). Compared to untreated patients (N) in the total population, other patients who were treated with surgery (S), radiotherapy (R), and chemotherapy (C) are beneficial for the prognosis (OS and CSS: p &lt; 0.001).ConclusionThis population-based study was conducted to ascertain metastasis patterns and survival outcomes of EAC patients with DM in stage IVB. Elderly patients with multiple-site metastasis exhibited the worst OS and CSS among all the populations, and patients with bone-only metastasis had the worst OS and CSS among single-organ metastasis populations. Active treatment is beneficial for elderly EAC patients with DM in stage IVB, especially chemotherapy. This study also shows that more than one third of the patients had not received any therapy.

scholarly journals Activity and Safety of NAB-FOLFIRI and NAB-FOLFOX as First-Line Treatment for metastatic Pancreatic Cancer (NabucCO Study)

2021 ◽  
Vol 28 (3) ◽  
pp. 1761-1772
Author(s):  
Elisa Giommoni ◽  
Evaristo Maiello ◽  
Vanja Vaccaro ◽  
Ermanno Rondini ◽  
Caterina Vivaldi ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Phase I ◽  
Phase Ii ◽  
Phase 1 ◽  
Progression Free Survival ◽  
Metastatic Pancreatic Cancer ◽  
Line Treatment ◽  
First Line ◽  
Definition Of ◽  
First Line Treatment

Background: Relevant improvement in first-line treatment of metastatic pancreatic cancer (mPC) was provided by FOLFIRINOX and by gemcitabine (gem) plus nab-paclitaxel (Nab-p) regimens. Regardless of the first-line treatment survival benefit, most patients survive less than 1 year. Aim: The objectives of this multicenter phase I/II study were to evaluate as first-line chemotherapy (CT) two modified regimens of FOLFIRINOX, replacing either oxaliplatin (Oxa) or irinotecan with Nab-p, in patients with mPC. Methods: The primary objectives of phase 1 were the definition of the dose limit binations, while for phase II they were the characterization of safety and activity of Nab-FOLFIRI and Nab-FOLFOX in mPC. Results: Sixty-three patients received Nab-FOLFIRI or Nab-FOLFOX in phase I. We defined MTD at 120 mg/m2 for Nab-p with FOLFIRI and 160 mg/m2 with FOLFOX. In phase II, we randomized 42 patients for each arm with the following results: (1) overall response rate (ORR) was 31% for both schedules; (2) a clinical benefit rate (CBR) of 69% and 71%; (3) 1-year survival was 41% and 50%; (4) progression free survival (PFS) was 6 months and 5.6 months; (5) median overall survival (OS) was 10.2 and 10.4 months for Nab-FOLFIRI and Nab-FOLFOX, respectively. (6) Neutropenia was the most common grade ≥3 adverse event in our regimens, significantly lower than that reported for the FOLFIRINOX triplet. Conclusion: Nab-FOLFIRI and Nab-FOLFOX might be hopeful first-line CT options for mPC patients, with promising activity and a good safety profile.

Survival outcomes in patients with early-stage, resectable pancreatic cancer: A comparison of gemcitabine and 5-fluorouracil based chemotherapy and chemoradiation regimens.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14608-e14608
Author(s):  
Sani Haider Kizilbash ◽  
Kevin Ward ◽  
Ishmael A. Jaiyesimi ◽  
Joseph Lipscomb
Keyword(s):  
Pancreatic Cancer ◽  
Early Stage ◽  
Tumor Grade ◽  
Study Endpoint ◽  
Survival Outcomes ◽  
Low Grade ◽  
High Grade ◽  
Resectable Pancreatic Cancer ◽  
Curative Surgery ◽  
Medicare Database

e14608 Background: Beyond curative surgery, the optimal treatment for early stage pancreatic cancer is still a matter of debate. We conducted a comparative survival analysis between patients with resectable pancreatic cancer who received adjuvant treatment with either gemcitabine or 5-fluorouracil based chemotherapy and chemoradiation regimens. Methods: The Surveillance, Epidemiology and End Results (SEER)-Medicare database was used to identify patients with pancreatic cancer diagnosed from 1998 to 2005 who received curative surgery and adjuvant chemotherapy with either 5-fluorouracil or gemcitabine. These groups were subdivided by treatment with radiotherapy. Patients were followed until death, study endpoint or a maximum of five years after diagnosis. Results: 359 patients received 5-fluorouracil and 346 received gemcitabine. Compared to chemoradiation with 5-fluorouracil, outcomes for patients who received chemoradiation with gemcitabine did not differ. Patients who received gemcitabine without radiation had increased hazards (hazard ratio (HR) = 1.50 for high grade tumors (HGT), HR = 1.32 for low grade tumors (LGT)). However, outcomes of patients who received 5-fluorouracil without radiation varied with tumor grade. In LGT, patients had better outcomes with 5-fluorouracil when compared with chemoradiation with 5-fluorouracil (HR = 0.43). In HGT, the opposite was true (HR 2.10). Conclusions: Patients with low grade resectable pancreatic cancer may have better outcomes with 5-fluorouracil based chemotherapy without radiation when compared to 5-fluorouracil with radiation.

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