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NCI CANCERLIT® Search: Therapy of Pancreatic Cancer - September 2001
Last Modified: November 1, 2001

Table of Contents

CancerMail from the National Cancer Institute

1
UI - 21339743
AU - Barlehner E; Anders S; Schwetling R
TI - [Laparoscopic left pancreas resection in tumors. Initial clinical experiences]
SO - Zentralbl Chir 2001 Jun;126(6):482-5
AD - Chirurgische Klinik, Klinikum Buch, Berlin. ebaerlehner@klinikumbuch.de
Laparoscopic pancreatic resections are rare procedures with left resections considered as a special subject. In animal trials and in 26 operations performed so far, this laparoscopic procedure was assessed positively. The operations were carried out mainly for benign diseases. From November 1998 to July 2000, five laparoscopic left pancreatic resections were performed in our hospital for the following diseases: adenocarcinoma (2), neuroendocrine carcinoma, highly malignant T-cell lymphoma, and cyst adenoma. In 3 patients the pancreatic resection was completed by other procedures: the case of T-cell lymphoma by gastrectomy and left side hemihepatectomy, the case of advanced pancreatic carcinoma by resection of a liver metastasis, and the case of cyst adenoma by a partial adrenalectomy. There was no patient suffering from intra- or postoperative complications. The benefit is mainly noticed in the early postoperative period. All required oncosurgical criterias were fulfilled.

2
UI - 21362742
AU - Koslowsky TC; Wilke J; Voiss W; Michaelis S; Balta D; Siedek M
TI - [Surgical palliation of pancreatic carcinoma. Results of a 7 year period]
SO - Chirurg 2001 Jun;72(6):704-9
AD - Chirurgische Klinik, St. Elisabeth Krankenhaus, Koln-Hohenlind.
INTRODUCTION: High perioperative complication rates in the 1980s led to preferred use of endoscopic therapy for surgical palliation of pancreatic cancer. This encouraged us to analyse our own patients retrospectively. MATERIAL AND METHODS: In the period from 1 January 1992 to 31 December 1998, 253 patients with an exocrine carcinoma of the pancreas were operated on at the St. Elisabeth Hospital Cologne-Hohenlind: 73 patients (28.9%) underwent curative resection (R0) while 180 patients (71.1%) had palliative operative treatment (R1/R2). Palliative resection was performed in 22 patients (8.7%). Intestinal bypass surgery was done in 113 patients (44.7%) as a gastrojejunostomy and in 16 patients (6.3%) as a duodenojejunostomy. A biliodigestive anastomosis was performed in 85 patients (33.6%). This procedure was combined with a gastroenterostomy in 78 patients (30.8%). In 18 patients (7.1%) no surgical palliation was possible and the operation finished as a diagnostic laparotomy. RESULTS: The overall mortality rate within the first 30 (60) days was 5.5% (12.7%). Patients whose carcinoma had been resected curatively had a 30 (60)-day mortality rate of 2.7% (4.1%), compared to a rate in palliatively treated patients (resection/bypass/probatoria) of 6.7% (16.1%). Patients with palliatively resected tumor had perioperative mortality of 4.5% (4.5%), whereas patients who did not undergo resection had 6.9% (17.7%). The survival rate for curatively resected patients after Kaplan-Meier extrapolation was 64.7% after 1 year and 31.2% and 26.2% after 3 and 5 years, with a median survival time of 552 days. Palliatively operated patients had a survival rate of 19.4%, 2.5% and 0% for 1, 3 and 5 years. Median survival time was 171 days in this situation. Compared to patients without resection (17.4% and 2.0%), patients with palliative resection had survival rates for 1 and 3 years of 40% und 5.9%. After 5 years none of these patients were alive. CONCLUSIONS: Our data show a high success of surgical palliation in pancreatic cancer in centers with a high frequency of pancreatic surgery. Patients that could not be cured (R1/R2), although undergoing extensive procedures, had better survival rates than patients treated with bypass surgery. Perioperative mortality rate was comparatively low. This justifies aggressive surgical management of pancreatic carcinoma.

3
UI - 21370459
AU - Halloran CM; Ghaneh P; Neoptolemos JP; Costello E
TI - Gene therapy for pancreatic cancer--current and prospective strategies.
SO - Surg Oncol 2000 Dec;9(4):181-91
AD - Department of Surgery, Royal Liverpool University Hospital, 5th Floor UCD Building, Daulby Street, Liverpool, L69 3GA, UK. halloran@liverpool.ac.uk
Pancreatic ductal adenocarcinoma is one of the most common causes of cancer death in the developed world. Long-term survival is currently only achieved through surgical resection. Most patients have locally advanced or metastatic disease at the time of diagnosis and are therefore not amenable to resection, whilst chemotherapy and radiotherapy are by and large ineffective. Gene therapy offers an alternative to current adjuvant strategies. With approximately two-thirds of all gene therapy trials worldwide directed at cancer, the gene therapy approaches that are currently being explored for pancreatic cancer are specifically examined. Gene delivery systems, genetic targets, and combined gene delivery with chemotherapy are discussed in the context of pancreatic cancer treatment.

4
UI - 21376188
AU - Pipas JM; Mitchell SE; Barth RJ Jr; Vera-Gimon R; Rathmann J; Meyer LP; Wagman RS; Lewis LD; McDonnell C; Colacchio TA; Perez RP
TI - Phase I study of twice-weekly gemcitabine and concomitant external-beam radiotherapy in patients with adenocarcinoma of the pancreas.
SO - Int J Radiat Oncol Biol Phys 2001 Aug 1;50(5):1317-22
AD - Dartmouth Hitchcock Medical Center/Norris Cotton Cancer Center, Lebanon, NH 03756, USA. j.marc.pipas@hitchcock.org
PURPOSE: To determine the maximum tolerated dose and dose-limiting toxicity associated with twice-weekly gemcitabine and concomitant external-beam radiotherapy in patients with adenocarcinoma of the pancreas. METHODS AND MATERIALS: Twenty-one patients with biopsy-proven adenocarcinoma of the pancreas were treated with external-beam radiotherapy to a dose of 50.4 Gy in 28 fractions, concurrent with gemcitabine, infused over 30 min before irradiation on a Monday and Thursday schedule. The dose of gemcitabine was escalated in 5 cohorts of 3--6 patients each. Initial gemcitabine dose was 10 mg/m(2), with dose escalation until dose-limiting toxicity was observed. RESULTS: The maximum tolerated dose of gemcitabine was 50 mg/m(2), when given in a twice-weekly schedule with radiation. Dose-limiting toxicity was seen in 2 patients at 60 mg/m(2), and consisted of severe upper gastrointestinal bleeding approximately 1 month after completion of treatment. Six patients had radiographic evidence of response to treatment, and 5 of these underwent complete surgical resection. Three patients who underwent complete resection had been deemed to have unresectable tumors before enrollment on trial. Four patients are alive, including 2 without evidence of disease more than 1 year after resection. CONCLUSION: The combination of external-beam radiation and twice-weekly gemcitabine at a dose of 50 mg/m(2) is well tolerated and shows promising activity for the treatment of pancreatic cancer. Our data suggest a higher maximum tolerated dose and different dose-limiting toxicity than previously reported. Further investigation of this regimen is warranted.

5
UI - 21388238
AU - Seki T; Ohba N; Makino R; Funatomi H; Mitamura K
TI - Mechanism of growth-inhibitory effect of cisplatin on human pancreatic cancer cells and status of p53 gene.
SO - Anticancer Res 2001 May-Jun;21(3B):1919-24
AD - Second Department of Internal Medicine, Showa University School of Medicine, Tokyo, Japan.
Pancreatic cancer is a devastating malignant tumor in humans and the development of new modalities of treatment is needed. We studied the mechanism of the growth-inhibitory effect of cisplatin (CDDP) on human pancreatic cancer cells in connection with the status of the p53 gene and expression of the bcl-2 family. COLO-357 cells with wild-type p53 gene and T3M4, Panc-1 and AsPC-1 cells with mutant-p53 gene were used. Growth of these cells was inhibited by CDDP in a dose-dependent manner in both serum-deprived and serum-supplemented conditions. CDDP induced apoptosis of COLO-357 and T3M4 cells in the serum-supplemented condition, whereas necrosis of these cells was induced by CDDP at high concentrations in the serum-deprived condition. Although expression of bax mRNA and its protein product were enhanced, while bcl-2 protein was decreased by CDDP in COLO-357 cells, expression of mRNA of the bcl-2 family and protein product were not influenced by CDDP in T3M4 cells. Increased expression of bax and reduced expression of bcl-2 are involved in the growth-inhibitory effect of CDDP on pancreatic cancer cells with wild-type p53 gene.

6
UI - 21401138
AU - Crane CH; Wolff RA; Abbruzzese JL; Evans DB; Milas L; Mason K; Charnsangavej C; Pisters PW; Lee JE; Lenzi R; Lahoti S; Vauthey JN; Janjan NA
TI - Combining gemcitabine with radiation in pancreatic cancer: understanding important variables influencing the therapeutic index.
SO - Semin Oncol 2001 Jun;28(3 Suppl 10):25-33
AD - Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA.
We compared and evaluated available laboratory and clinical data on the use of concurrent gemcitabine (Gemzar; Eli Lilly and Company, Indianapolis, IN) and radiation in pancreatic cancer to provide guidance for subsequent prospective research initiatives. Preclinical data suggest that the timing of administration of gemcitabine with respect to radiotherapy is important, but this issue has not yet been confirmed by clinical data. Phase I clinical data indicate that the amount of acute toxicity from the combination of gemcitabine and radiotherapy is strongly related to the dose and schedule of administration of gemcitabine, as well as to the radiation field size. There also appears to be an inverse linear relationship between the maximum tolerated gemcitabine dose and radiation dose. Also important, but less clear, is the infusion rate of gemcitabine as it relates to the systemic efficacy of the drug. The combination of additional agents with gemcitabine and radiation appears to be feasible. Finally, the addition of radioprotectors may enable chemotherapy dose escalation, but safe escalation of the radiotherapy dose with newer techniques has not been established. Semin Oncol 28 (suppl 10):25-33. Copyright 2001 by W.B. Saunders Company.

7
UI - 21401140
AU - Marantz A; Jovtis S; Almira E; Balbiani L; Castilla JL; Fein L; Lewi D; Pasccon G; Pinckevicius R; Uranga G; Abal M; Muino M; Reale M; Agusto S; Grupo de Tumores Gastrointestinales
TI - Phase II study of gemcitabine, 5-fluorouracil, and leucovorin in patients with pancreatic cancer.
SO - Semin Oncol 2001 Jun;28(3 Suppl 10):44-9
AD - Grupo de Tumores Gastrointestinales, Hospital Fernandez, Servicio de Oncologia, Cervino 3356 CP 1425, Buenos Aires, Argentina.
The primary goal of this phase II study was to determine the efficacy of gemcitabine (Gemzar; Eli Lilly and Company, Indianapolis, IN) plus 5-fluorouracil in patients with pancreatic cancer. Eligibility criteria included nonresectable locally advanced or metastatic pancreatic adenocarcinoma and measurable disease. Gemcitabine at 1,000 mg/m(2) and leucovorin at 20 mg/m(2) were administered intravenously 30 minutes before 5-fluorouracil 600 mg/m(2), weekly for 3 of every 4 weeks. Twenty nine patients were enrolled. The overall response rate was 21% (95% confidence interval: 8% to 40%), consisting of one complete response and five partial responses; 16 patients (55%) had stable disease. Median survival was 8.4 months (95% confidence interval: 2.6 to 14.2), and actuarial 1-year survival was 36%. Neutropenia (grade 3 only) was reported in 3.4% of patients, but was generally of short duration. No thrombocytopenia or evidence of cumulative myelosuppression was observed. The only significant nonhematologic events were grade 3 diarrhea and alopecia (both 3.4%). Gemcitabine plus 5-fluorouracil is active and well tolerated compared with results reported for each of these single agents. Thus, this combination justifies future comparative clinical trials. Semin Oncol 28 (suppl 10):44-49. Copyright 2001 by W.B. Saunders Company.

8
UI - 21411137
AU - Mizrahi S; Bayme MJ
TI - Prophylactic gastroenterostomy for unresectable pancreatic carcinoma.
SO - Isr Med Assoc J 2001 Aug;3(8):603-4

9
UI - 21400913
AU - Gapstur SM; Gann P
TI - Is pancreatic cancer a preventable disease?
SO - JAMA 2001 Aug 22-29;286(8):967-8

10
UI - 21227815
AU - Shinchi H; Takao S; Noma H; Mataki Y; Iino S; Aikou T
TI - Hand-assisted laparoscopic distal pancreatectomy with minilaparotomy for distal pancreatic cystadenoma.
SO - Surg Laparosc Endosc Percutan Tech 2001 Apr;11(2):139-43
AD - First Department of Surgery, Kagoshima University School of Medicine, Japan. hiro@med3.kufm.kagoshima-u.ac.jp
Two patients with cystic tumors of the pancreas treated by laparoscopic distal pancreatectomy are presented. The first patient was a 34-year-old woman with a 6-cm cystadenoma of the tail of the pancreas treated with a complete laparoscopic distal pancreatectomy. After mobilization of the distal pancreas and spleen, the pancreas was transected proximally together with the splenic artery and vein using an endoscopic linear stapler. The second patient was a 71-year-old woman with a 6-cm cystadenoma of the body of the pancreas, treated by hand-assisted laparoscopic distal pancreatectomy with minilaparotomy because the tumor was adjacent to the portal vein and celiac axis. Using an upper median minilaparotomy, dissection of the gastrocolic ligament, division of the splenic artery, and transection and closure of the pancreas were performed. Division of the splenic vein and mobilization of the distal pancreas and spleen were performed via a hand-assisted laparoscopic approach. There were no postoperative complications (such as pancreatic fistulas) in either patient, and the postoperative courses were uneventful. The patients returned to normal activity within 1 week after the operation. Complete laparoscopic and hand-assisted laparoscopic distal pancreatectomy are preferable to conventional open surgery for benign tumors of the pancreas because of their less-invasive nature. Additionally, in tumors of the body of the pancreas, hand-assisted laparoscopic distal pancreatectomy might have the advantages of laparotomy and laparoscopy in terms of handling the splenic artery and vein just below the minilaparotomy site, suggesting an easier and safer procedure than complete laparoscopic distal pancreatectomy. Therefore, hand-assisted laparoscopic distal pancreatectomy can be recommended as a useful alternative to complete laparoscopic distal pancreatectomy for selected patients with benign tumors of the body and tail of the pancreas.

11
UI - 21241390
AU - Wakabayashi T; Kawaura Y; Morimoto H; Watanabe K; Toya D; Asada Y; Satomura Y; Watanabe H; Okai T; Sawabu N
TI - Clinical management of intraductal papillary mucinous tumors of the pancreas based on imaging findings.
SO - Pancreas 2001 May;22(4):370-7
AD - Department of Gastroenterology, Saiseikai Kanazawa Hospital, Japan.
The aim of this study was to assess the imaging findings of pathologically proven intraductal papillary-mucinous tumors of the pancreas and the natural history of follow-up cases, and to optimize the therapeutic management of patients with these tumors according to their imaging findings. All nine patients with main duct type tumors were histologically diagnosed as having adenocarcinoma or adenoma, with no hyperplastic lesion. The images failed to discriminate between the two histologic types. In 26 patients with branch duct type tumors, all but one with intraductal mural nodules or tumors of > or = 30 mm had adenocarcinoma or adenoma, regardless of the caliber of the main duct. Of the nine patients with tumors < 30 mm and no mural nodules. three had adenoma, and six had hyperplasia. All of four patients had hyperplasia, with the additional caliber of the main duct being < 6 mm. In a series of 23 cases in which the patient was followed-up, no apparent progression was found in 17 patients who had no mural nodules and tumors of < 30 mm. Given these results, patients with main duct type tumors, and those with branch duct type tumors showing mural nodules or a tumor diameter of > or = 30 mm, are at high risk of developing neoplasms, including adenocarcinoma, for which surgical resection should be considered, whereas those patients with tumors < 30 mm and no mural nodules can be followed.

12
UI - 21356474
AU - Wagner M; Z'graggen K; Vagianos CE; Redaelli CA; Holzinger F; Sadowski C; Kulli C; Zimmermann H; Baer HU; Buchler MW
TI - Pylorus-preserving total pancreatectomy. Early and late results.
SO - Dig Surg 2001;18(3):188-95
AD - Department of Visceral and Transplantation Surgery, University of Bern, Inselspital, Bern, Switzerland.
BACKGROUND/AIMS: Preservation of the pylorus is an accepted alternative procedure to the classical Whipple operation for pancreatic head resection but data describing its value for total pancreatectomy are sparse. METHODS: A prospective analysis of 22 total pancreatectomies performed in a consecutive series of 436 pancreatic resections from 1.11.93 to 1.5.99. RESULTS: 11 patients underwent total pancreatectomy with preservation of the pylorus. Histopathological examination revealed pancreatic adenocarcinoma in 16 cases and duodenal adenocarcinoma in 1 patient, 5 patients had other types of pancreatic neoplasm. In-hospital mortality was 4.5% (n = 1), cumulative morbidity was 59% and reoperations were performed in 9.1% of cases (n = 2). Median follow-up was 37 months (range 5-66). 62% of patients (n = 13) developed tumor recurrence and 13 patients died during the follow-up period with 10 deaths being cancer related. There was no difference concerning postoperative and follow-up morbidity of survival between patients undergoing pylorus-preserving total pancreatectomy or pancreatectomy with gastrectomy. However, postoperative body weight was increased 3, 6, 9 and 12 months following preservation of the pylorus. CONCLUSION: Total pancreatectomy with preservation of the pylorus is a feasible type of resection for all types of pancreatic or ampullary tumors, which shows a similar morbidity and long-term survival but improved nutritional recovery compared with standard total pancreatectomy. Copyright 2001 S. Karger AG, Basel

13
UI - 21377739
AU - Tilleman EH; Benraadt J; Bossuyt PM; Obertop H; Gouma DJ
TI - [Diagnosis and treatment of pancreatic carcinoma in the region of Amsterdam Comprehensive Cancer Care Center in 1997]
SO - Ned Tijdschr Geneeskd 2001 Jul 14;145(28):1358-62
AD - Afd. Chirurgie, Academisch Medisch Centrum, Postbus 22660, 1100 DD Amsterdam.
OBJECTIVE: To describe the diagnostic work-up and treatment of patients with a pancreatic carcinoma in the Amsterdam area, the Netherlands, particularly in general hospitals. DESIGN: Retrospective, descriptive. METHOD: During 1997, 286 patients with a pancreatic carcinoma were diagnosed in 20 hospitals in the Amsterdam area. Diagnostic work-up and treatment data were collected from the medical records and analysed. RESULTS: Ninety percent of the patients presented in one of the 17 general hospitals (n = 252; 132 men and 154 women; mean age: 70 years). Thirty-five percent of them underwent diagnostic investigations which did not focus directly on pancreatic pathology. Ultrasound was performed in 97% of patients (4% in combination with Doppler) and CT in 60% (4% spiral CT). Endoscopic retrograde cholangiopancreatography (ERCP) was performed in 39% of these patients and endoprostheses were only inserted in half the cases. Thirty-five percent of the patients who underwent both CT and ERCP underwent ERCP first. Ninety-nine patients (39%) were referred to a reference hospital for further investigation or treatment. The period between the first investigation and the histological diagnosis was 4 weeks. CONCLUSION: In the diagnostic work-up of patients with a pancreatic carcinoma, invasive diagnostic procedures were often performed before the non-invasive tests. Spiral CT was used minimally and ERCP was frequently performed without subsequent biliary drainage. The mean duration of diagnostic work-up was relatively long.

14
UI - 21377740
AU - Gouma DJ; Tilleman EH; Benraadt J; Bossuyt PM
TI - [Diagnostics and treatment of distal bile duct or pancreatic carcinoma; guidelines of the Amsterdam and Twente Comprehensive Cancer Centers]
SO - Ned Tijdschr Geneeskd 2001 Jul 14;145(28):1362-4
AD - Afd. Chirurgie, Academisch Medisch Centrum, Postbus 22.660, 1100 DD Amsterdam. d.j.gouma@amc.uva.nl
A project on the diagnostic work-up and treatment of distal bile duct and pancreatic carcinoma was carried out in the region covered by the Comprehensive Cancer Centre in Amsterdam, the Netherlands. It consisted of (a) describing the diagnostic work-up in the area, (b) developing the guidelines, (c) spreading the recommendations. The implementation and application of the guidelines are currently being evaluated.

15
UI - 21365243
AU - Fernandez-Cruz L; Herrera M; Saenz A; Pantoja JP; Astudillo E; Sierra M
TI - Laparoscopic pancreatic surgery in patients with neuroendocrine tumours: indications and limits.
SO - Best Pract Res Clin Endocrinol Metab 2001 Jun;15(2):161-75
AD - Department of Surgery, Institute of Digestive Diseases IMD, Hospital Clinic, University of Barcelona, Spain.
Laparoscopic pancreatic procedures are still at an evaluation stage with regard to their indications and techniques. Between January 1998 and December 2000, 13 patients with endocrine pancreatic tumours - 11 insulinomas and 2 non-functioning tumours-underwent laparoscopic surgery, laparoscopic ultrasonography being used in all the patients. Enucleation was performed in five patients. The operative time was 2-3 hours. Distal pancreatectomy was performed in six patients with insulinomas, and spleen preservation with intact splenic vessels was feasible in five. Splenectomy was necessary in one patient for technical reasons. Laparoscopic distal pancreatectomy with splenic vessel preservation was performed in two patients with a large (6 and 8 cm) non-functioning tumour. The mean operative time for all the patients undergoing distal pancreatectomy was 4 hours, ranging from 3 to 5 hours. A pancreatic fistula occurred in three patients after tumour enucleation and in two patients after distal pancreatectomy; the mean hospital stay for all patients was 5 days. Enucleation guided by laparoscopic ultrasonography thus allows safe tumour dissection and excision, laparoscopic distal pancreatectomy also being feasible and safe. Splenic salvage with splenic vessel preservation is technically possible. The laparoscopic approach allows a shorter hospital stay and an earlier return to normal activities. Copyright 2001 Harcourt Publishers Ltd.

16
UI - 21291261
AU - Bathe OF; Caldera H; Hamilton KL; Franceschi D; Sleeman D; Livingstone AS; Levi JU
TI - Diminished benefit from resection of cancer of the head of the pancreas in patients of advanced age.
SO - J Surg Oncol 2001 Jun;77(2):115-22
AD - Department of Surgery, University of Miami, Miami, Florida, USA. oliverba@cancerboard.ab.ca
BACKGROUND AND OBJECTIVES: The incidence of pancreatic cancer is increasing, and an increasing proportion of these patients is older than 65 years. The benefits of resection in the geriatric population, in whom major comorbidity is more likely, are poorly defined. The authors sought to determine the relative benefits of resection of cancer of the head of the pancreas in different age groups, with particular emphasis on the geriatric population. METHODS: Between 1983 and 1995, 273 patients presented to the University of Miami for evaluation of noncystic epithelial cancer of the head of the pancreas. Resection was performed in 104 patients, and these patients are the subject of this retrospective review. Mean length of follow-up for surviving patients was 37 +/- 24 months. Outcomes were compared in patients < 65 years old (group 1, n = 38), 65-74 years old (group 2, n = 47), and > 74 years old (group 3, n = 19). RESULTS: Total pancreatectomy was performed in 12 patients and pancreaticoduodenectomy was performed in 92 patients. The overall complication rate was similar in all groups, but major morbidity was highest in group 3 (P = 0.05). Median survival for patients in group 2 was 25.1 months. Survival was significantly shorter in patients from groups 1 and 3 (median survivals 12.4 months and 11.4 months, respectively; P = 0.02). Following control for Hispanic ethnicity, which was also a significant prognostic factor on univariate analysis, only the oldest age group had a significantly shorter survival than the other two groups. Age > 74 years and Hispanic ethnicity remained significant after multivariate analysis. CONCLUSIONS: Long-term survival after resection is truncated in older patients. This finding and the observation that the major complication rate is higher in the older subgroup emphasize the need to evaluate critically whether older patients should be submitted to radical resection. Copyright 2001 Wiley-Liss, Inc.

17
UI - 97138008
AU - Order SE; Siegel JA; Principato R; Zeiger LE; Johnson E; Lang P; Lustig R; Wallner PE
TI - Selective tumor irradiation by infusional brachytherapy in nonresectable pancreatic cancer: a phase I study.
SO - Int J Radiat Oncol Biol Phys 1996 Dec 1;36(5):1117-26
AD - Institute for Systemic Radiation Therapy, Department of Radiation Oncology, Cooper Hospital/University Medical Center and Robert Wood Johnson Medical School, Camden, NJ 08103, USA.
PURPOSE: Selective high-dose radiation of solid tumors has been a goal of radiation oncology. The physiological barriers of solid tumors (high interstitial tumor pressure, reduced tumor vascularity, and poor perfusion) have been major barriers in achieving significant tumor dose of systemically infused radioconjugates. Direct tumor infusional brachytherapy overcomes these barriers and leads to selective high tumor doses. METHODS AND MATERIALS: The development of interstitial tumor infusion of macroaggregated albumin (MAA) followed by colloidal chromic phosphate 32P has overcome solid tumor obstacles in 47 patients with nonresectable pancreatic cancer in a Phase I dose escalation study. The colloidal 32P infusion was followed by external radiation and five fluorouracil. RESULTS: Of the 28 patients with cancer limited to the pancreas, 15 of 16 patients retained 86-100% (mean 96%) of the infused colloidal 32P isotope. While the other 12 patients had partial shunting to the liver, shunting to the liver was due to high interstitial resistance with tumor dose deposition of 17-88% (mean 52 %). Of the 19 patients with metastatic pancreas cancer, colloidal 32P tumor deposition ranged from 22 to 100% of the infused dose (mean 79%). The less than optimal tumor deposition led to our increasing the MAA from 600,000 to 1.5-2.5 million particles. Interstitial dexamethasone 2 mg and later 4 mg was infused first and prevented liver shunting by somehow reducing tumor resistance. The median survival in 28 Phase I patients with nonresectable pancreas cancer without metastasis, was 12 months. No significant toxicity occurred when treatment was limited to two infusions with as much as 30 mCi each. The maximum tumor dose was 17,000 Gy (1.700,000 cGy). In 19 nonresectable pancreatic cancer patients with metastasis, a 6.9 months median survival was observed. CONCLUSIONS: Infusional brachytherapy is an outpatient procedure that delivers high-dose radiation selectively to pancreatic cancer. Results of the Phase I study in nonresectable pancreas cancer has led to a national multiinstitutional Phase II trial.

18
UI - 20384668
AU - Zurlo A; Lomax A; Hoess A; Bortfeld T; Russo M; Goitein G; Valentini V; Marucci L; Capparella R; Loasses A
TI - The role of proton therapy in the treatment of large irradiation volumes: a comparative planning study of pancreatic and biliary tumors.
SO - Int J Radiat Oncol Biol Phys 2000 Aug 1;48(1):277-88
AD - Cattedra di Radioterapia, University of Rome Tor Vergata, Rome, Italy.
PURPOSE: The purpose of this study was to examine the potential benefit of proton therapy for abdominal tumors. Extensive comparative planning was conducted investigating the most up-to-date photon and proton irradiation technologies. METHODS AND MATERIALS: A number of rival plans were generated for four patients: two inoperable pancreatic tumors, one inoperable and one postoperative biliary duct tumor. The dose prescription goal for these large targets was 50 Gy, followed by a boost dose up to 20 Gy to a smaller planning target volume (PTV). Photon plans were developed using "forward" planning of coplanar and noncoplanar conformal fields and "inverse" planning of intensity-modulated (IM) fields. Proton planning was simulated as administered using the so called spot-scanning technique. Plans were evaluated on the basis of normal tissues' dose-volume constraints (Emami B, Lyman J, Brown A, et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 1990;21:109-122) and coverage of treatment volumes with prescribed doses. RESULTS: For all cases, none of the forward calculated photon plans was able to deliver 50 Gy to large PTVs at the same time respecting the dose-volume constraints on all critical organs. Nine evenly spaced IM fields achieved or nearly achieved all maximum dose constraints to critical structures for two out of three inoperable patients. IM plans also obtained good results for the postoperative patient, even though the dose to the liver was very close to the maximum allowed. In all cases, photon irradiation of large PTV1s to 50 Gy followed by a 20 Gy boost entailed a risk very close to or higher than 5% for serious complications to the kidneys, liver, or bowel. Simple arrangements of 2, 3, and 4 proton fields obtained better dose conformation to the target, allowing the delivery of planned doses including the boost to all patients, without excessive risk of morbidity. Dose homogeneity inside the targets was also superior with protons. CONCLUSION: For the irradiation of large PTVs located in the abdominal cavity, where multiple, parallel structured organs surround the target volumes, proton therapy, delivered with a sophisticated isocentric technique, has the potential to achieve superior dose distributions compared with state-of-the-art photon irradiation techniques. IM photon plans obtain better results in the postoperative case, because the reduced volume lessens the effect of the unavoidable increase of integral dose to surrounding tissues.

19
UI - 21369025
AU - Modlin IM
TI - [Efficacy and safety of intravenously administered pantoprazole in the treatment of gastrinoma]
SO - Recenti Prog Med 2001 Jul-Aug;92(7-8):456-61
AD - Department of Gastroenterology, Yale University, New Haven, USA.
The efficacy and safety of the proton pump inhibitor pantoprazole (P) in patients with Zollinger-Ellison syndrome (ZES) is well documented. We treated 21 patients with ZES with intravenous P; 13 of these patients were treated surgically in advance. The effect of P was very rapid, with reduction of the acid output within 15 min and its normalization within 60 min. The control of gastric acid secretion was maintained for a mean of 10.9 hours after the infusion of P. We conclude that the use of intravenous P allows a safe and efficient control of the acid ipersecretion in patients with ZES.

20
UI - 20564939
AU - Johnson PR; Spitz L
TI - Cysts and tumors of the pancreas.
SO - Semin Pediatr Surg 2000 Nov;9(4):209-15
AD - Institute of Child Health and Great Ormond Street Hospital for Children, NHS Trust, London, UK.
Both pancreatic cysts and pancreatic tumors rarely occur in childhood. However, when encountered they can present a diagnostic and therapeutic challenge to the pediatric surgeon. The aim of this review is to discuss the different types of pancreatic cysts and tumours that may be encountered in the pediatric population, to note the modes available for their diagnosis, and to outline treatment options. Copyright 2000 by W.B. Saunders Company

21
UI - 21333705
AU - Kasahara H; Usami M
TI - [Metabolic and nutritional management for treatment of carcinoma of the pancreas--in resectable cases]
SO - Nippon Rinsho 2001 May;59 Suppl 5():646-9
AD - Mitsubishi Kobe Hospital.

22
UI - 21333706
AU - Kasahara H; Usami M
TI - [Metabolic and nutritional management for treatment of carcinoma of the pancreas--in unresectable cases]
SO - Nippon Rinsho 2001 May;59 Suppl 5():650-3
AD - Mitsubishi Kobe Hospital.

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