scholarly journals Role of radio‑ablative technique for optimizing the survival of patients with locally advanced pancreatic adenocarcinoma (Review)

2021 ◽  
Vol 22 (2) ◽  
Author(s):  
Ioana Iancu ◽  
Adrian Bartoș ◽  
Cristian Cioltean ◽  
Caius Breazu ◽  
Cornel Iancu ◽  
...  
Keyword(s):  
Pancreatic Adenocarcinoma ◽  
Locally Advanced ◽  
Locally Advanced Pancreatic Adenocarcinoma ◽  
Advanced Pancreatic Adenocarcinoma

scholarly journals Prognostic Predicting Role of Contrast-Enhanced Computed Tomography for Locally Advanced Pancreatic Adenocarcinoma

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Chien-shan Cheng ◽  
Wei Liu ◽  
Liangping Zhou ◽  
Wei Tang ◽  
Ailing Zhong ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pancreatic Adenocarcinoma ◽  
Locally Advanced ◽  
Tumour Volume ◽  
Contrast Enhanced ◽  
Locally Advanced Pancreatic Adenocarcinoma ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography ◽  
Advanced Pancreatic Adenocarcinoma

Introduction. Contrast-enhanced computed tomography (CECT) imaging is commonly used to assess pancreatic adenocarcinoma (PAC). However, the value of semiquantitative and quantitative assessments of CECT parameters used to predict survival in PAC remains unknown. This study aims to investigate the prognostic role of pretreatment CECT imaging in patients with locally advanced pancreatic adenocarcinoma (LAPAC). Materials and Methods. From June 2013 to May 2017, eighty-six newly diagnosed patients with pathologically and radiologically confirmed LAPAC were retrospectively recruited. All patients were evaluated by CECT and experienced gemcitabine-based chemotherapy. The relationship between overall survival (OS) and clinical factors including age, sex, serum carbohydrate antigen 19-9 value, and CECT findings (including tumour location, tumour volume, peripancreatic involvement, blood vessel involvement, tumour enhanced rate, and distance liver metastasis) was determined using Cox proportional hazard regression models, and a nomogram was constructed for the prediction of 1- and 1.5-year survival rates of patients with LAPAC. Results. On univariate analysis, patients who had a tumour enhanced rate (TER) less than 80.465% and those who had a TER ≥ 80.465% are with a 3.587-fold increase in OS (p<0.001). After multivariate Cox regression, a nomogram was established based on a new model containing the predictive variables of high Ca19-9 level, higher clinical stages, larger tumour volume, the presence of peripancreatic involvement, and liver metastases. The model displayed good accuracy in predicting OS with a C-index of 0.614. The calibration plots also showed a good discrimination and calibration of the nomogram between the predicted and observed survival probabilities. Conclusion. Our results showed that TER can be used to predict survival in LAPAC, and we developed a nomogram for determining the prognosis of patients with LAPAC. However, the purposed nomogram still requires external data verification in future applications.

scholarly journals Outcomes of Patients with Initially Locally Advanced Pancreatic Adenocarcinoma who did not Benefit from Resection: A Prospective Cohort Study

2020 ◽  
Author(s):  
Jonathan Garnier ◽  
Jacques Ewald ◽  
Ugo Marchese ◽  
Marine Gilabert ◽  
Simon Launay ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Pancreatic Adenocarcinoma ◽  
Metastatic Disease ◽  
Performance Status ◽  
Locally Advanced ◽  
Wilcoxon Test ◽  
Stepwise Logistic Regression ◽  
Short Term Treatment ◽  
Locally Advanced Pancreatic Adenocarcinoma ◽  
Advanced Pancreatic Adenocarcinoma

Abstract Background: The current study aimed to evaluate the outcomes of patients with unresectable non-metastatic locally advanced pancreatic adenocarcinoma (LAPA) who did not benefit from resection considering the treatment strategy in the clinical settings. Methods: Between 2010 and 2017, a total of 234 patients underwent induction chemotherapy for LAPA that could not be treated with surgery. After oncologic restaging, continuous chemotherapy or chemoradiation (CRT) was decided for patients without metastatic disease. The Kaplan–Meier method was used to determine overall survival (OS), and the Wilcoxon test to compare survival curves. Multivariate analysis was performed using the stepwise logistic regression method. Results: FOLFIRINOX was the most common induction regimen (168 patients, 72%), with a median of 6 chemotherapy cycles and resulted in higher OS, compared to gemcitabine (19 vs. 16 months, hazard ratio (HR)=1.2, 95% confidence interval: 0.86–1.6, P =.03). However, no difference was observed after adjusting for age (≤75 years) and performance status score (0–1). At restaging, 187 patients (80%) had non-metastatic disease: CRT was administered to 126 patients (67%) while chemotherapy was continued in 61 (33%). Patients who received CRT had characteristics comparable to those who continued with chemotherapy, with similar OS. They also had longer progression-free survival (median 13.3 vs. 9.6 months, HR=1.38, 95% confidence interval: 1–1.9, P <.01) and limited short-term treatment-related toxicity. Conclusions: The median survival of patients who could not undergo surgery was 19 months. Hence, CRT should not be eliminated as a treatment option and may be useful as a part of optimised sequential chemotherapy for both local and metastatic disease.

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