UI - 12193859
AU - Hammel P
[Changes in chemotherapy for pancreatic adenocarcinoma]
SO - Gastroenterol Clin Biol 2002 Jun-Jul;26(6-7):603-4
UI - 12193860
AU - Taieb J; Lecomte T; Ezenfis J; Artru P; Mitry E; Boige V; Clavero-Fabri
MC; Vaillant JN; Rougier P; Ducreux M
[5-FU, folinic acid and cisplatin (LV5FU2-P) for unresectable pancreatic
SO - Gastroenterol Clin Biol 2002 Jun-Jul;26(6-7):605-9
AD - Departement de Medecine, Institut Gustave Roussy, Villejuif, France.
AIM: To prospectively evaluate efficacy and tolerance of the
5-fluorouracil + folinic acid + cisplatin (LV5FU2-P) combination in the
treatment of unresectable pancreatic carcinoma. PATIENTS AND METHODS:
(37-75), with advanced (n=2) or metastatic (n=33) pancreatic cancer and
initial performance status (WHO) of 0 (n=9), 1 (n=14) or 2 (n=12) were
enrolled in the study. Two consecutive groups of patients were treated
twice monthly, the first group (n=19) received the LV5FU2 regimen: a 2
hour-infusion of leucovorin 200 mg/m(2), 5-FU bolus 400 mg/m(2),
followed by 22-hour continuous infusion of 5-FU 600 mg/m(2) on 2
consecutive days and cisplatin 50 mg/m(2) on day 2. The second group
(n=16) received a simplified schedule with bolus leucovorin 40 mg/m(2),
5-FU bolus 400 mg/m(2) on day 1, followed by 5-FU 2400 mg/m(2) 48-hour
infusion and cisplatin 50 mg/m(2) on day 2. Clinical symptoms and
performance status were monitored together with weight changes. Tumor
assessment was performed every 2 months. RESULTS: Three patients (9%)
exhibited grade 4 neutropenia and grade 3 toxicity occurred in 31% of
the patients (neutropenia: n=3, thrombocytopenia: n=1, vomiting: n=3,
mucositis: n=3, diarrhea: n=1). There were no treatment-related deaths.
Objective response was observed in 10 patients (29%, 95% confidence
interval: 20-40%) including one complete response. Median
progression-free survival and overall survival were 4.5 and 9 months,
respectively. Six-months and 1-year survival rates were 70% and 25%,
respectively. Weight gain was observed in 40% of the patients and
performance status improved in 50%. CONCLUSION: LV5FU2-P regimen is
active and well tolerated. It should be compared to gemcitabine as a
first line therapy in advanced and metastatic pancreatic cancer.
UI - 12167582
AU - Hiotis SP; Klimstra DS; Conlon KC; Brennan MF
Results after pancreatic resection for metastatic lesions.
SO - Ann Surg Oncol 2002 Aug;9(7):675-9
AD - Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York
Avenue, New York, NY 10021, USA. firstname.lastname@example.org
BACKGROUND: Unlike primary pancreatic carcinoma, isolated metastatic
lesions to the pancreas are uncommon. Although the value of surgical
resection is poorly documented, resection may be deemed appropriate in
selected cases. The aim of this study was to review our experience with
the operative management of pancreatic metastases. METHODS: Sixteen
patients who underwent pancreatic resection for the treatment of
metastatic disease were identified from a prospective pancreatic
database. The clinical features of and results after resection were
examined. RESULTS: Renal cell carcinoma was the most frequent primary
histopathology (10 of 16; 62%). In the remaining patients, the primary
histopathology was non-small-cell lung cancer (n = 3), sarcoma (n = 1),
melanoma (n = 1), or transitional cell carcinoma of the bladder (n = 1).
A prolonged disease-free interval (median, 7.5 years) was characteristic
of most patients. Operative procedures performed included eight
pancreaticoduodenectomies, seven distal pancreatectomies, and one total
pancreatectomy. The operative mortality was 6%, and the morbidity was
25%. The overall 2- and 5-year actuarial survival rates were 62% and
25%, respectively. A trend toward improved survival was observed in the
renal cell carcinoma patients, but this finding was not statistically
significant. CONCLUSIONS: Long-term survival after pancreatic resection
for metastatic disease is achievable, and patients with primary renal
cell carcinoma seem to have a more favorable prognosis. Surgical
resection should thus be offered to selected patients with isolated
metastatic disease to the pancreas.
UI - 12233216
AU - Polus M; Bours V; Jerusalem G; Sautois B; Fillet G
[How I treat...advanced cancer of the pancreas with a novel approach
directed against new targets]
SO - Rev Med Liege 2002 Jul;57(7):428-32
AD - Service d'Oncologie medicale, CHU, Sart Tilman.
A better knowledge of fundamental mechanisms of carcinogenesis allows
the development of novel therapeutic tools specifically targeting the
cancer cell. Our understanding of cellular and molecular mechanisms
controlling cellular cycle and cell survival is an important step for
new anti-cancer treatments. This review will focus on new therapeutic's
strategies in advanced pancreatic cancer.
UI - 12111260
AU - Zemskov V; Prokopchuk O; Susak Y; Zemskov S; Tkachenko O; Hodysh Y;
Efficacy of ukrain in the treatment of pancreatic cancer.
SO - Langenbecks Arch Surg 2002 Jun;387(2):84-9
AD - Department of General Surgery, National Medical University, prosp.
Holosiivsky, 59B, 03039 Kyiv, Ukraine.
BACKGROUND: This monocentric study evaluated the effect of ukrain in the
treatment of pancreatic cancer. MATERIAL AND METHODS: Between January
second day x10. The control group received supportive treatment only.
RESULTS: Ukrain treatment was well tolerated. Mean values on pain
measure and Karnofsky index were significantly better in the ukrain
group than in controls ( P<0.05). One-year survival was 76% in the
ukrain group, compared to 9.5% in the control group. Median survival
after treatment with ukrain was 574 days, compared to 197 days in the
control group. CONCLUSIONS: Our data demonstrate that ukrain improves
quality of life in patients suffering from advanced pancreatic cancer
and significantly prolongs survival time in these patients.
UI - 12175991
AU - Pirocanac EC; Nassirpour R; Yang M; Wang J; Nardin SR; Gu J; Fang B;
Moossa AR; Hoffman RM; Bouvet M
Bax-induction gene therapy of pancreatic cancer.
SO - J Surg Res 2002 Aug;106(2):346-51
AD - Department of Surgery, University of California at San Diego, 92161,
BACKGROUND: Bax is a strong pro-apoptotic gene that induces programmed
cell death when expressed. Human telomerase reverse transcriptase
(hTERT) is the catalytic subunit for telomerase, an enzyme found to be
active in more than 85% of human cancers. Recently, a binary adenoviral
system (Ad/GT-Bax + Ad/hTERT-GV16) was constructed using the hTERT
promoter to induce Bax gene expression in tumor cells. METHODS: To test
whether human pancreatic tumor cells would respond to this system of
Bax-induced apoptosis, we compared the effects of Bax gene induction
with that of LacZ gene induction using the same binary system. RESULTS:
Lysates of the human pancreatic cell lines PANC-28, MIA PaCa-2, and
BxPC-3 showed significantly elevated levels of human telomerase using
the PCR-based TRAP assay. As early as 24 h after treatment with
Bax-induction gene therapy, growth inhibition was observed.
Overexpression of the Bax protein was confirmed by Western blotting.
Extensive apoptosis on FACS analysis at 48 h was seen after Bax
induction. In addition, cytosolic cytochrome c levels increased compared
to mitochondrial levels after Bax induction. Levels of caspase-3, a key
downstream enzyme involved in apoptosis, also increased significantly
compared to controls after treatment. None of these effects were seen
with LacZ. CONCLUSION: Our results suggest that the binary adenoviral
vector system, Ad/GT-Bax + Ad/hTERT-GV16, induces high levels of Bax
expression that induce apoptosis in human pancreatic cancer cells.
UI - 12181718
AU - Oda Y; Tanaka Y; Naruse T; Sasanabe R; Tsubamoto M; Funahashi H
Expression of somatostatin receptor and effects of somatostatin analog
on pancreatic endocrine tumors.
SO - Surg Today 2002;32(8):690-4
AD - Department of Breast and Endocrine Surgery, Aichi Medical University,
Nagakute-cho, Aichi-gun, Japan.
PURPOSE: Somatostatin analogs have been administered to patients with
pancreatic endocrine tumors in an attempt to inhibit hormone
hypersecretion and prevent tumor growth. It is speculated that their
efficacy is correlated with the expression of specific subtypes of
somatostatin receptors. The aim of this study was to
immunohistochemically evaluate the expression of somatostatin receptor
subtypes in human pancreatic endocrine tumors, and to determine whether
the expression of these subtypes is correlated with the effectiveness of
the somatostatin analogs.METHODS: Somatostatin receptor subtypes 1, 2,
and 3 (sst 1, 2, and 3) were immunohistochemically investigated in seven
pancreatic endocrine tumors: four insulinomas, one VIPoma, and two
nonfunctioning tumors associated with multiple endocrine neoplasia type
I, using paraffin sections. Three of the four patients with insulinoma
were given an octreotide injection.RESULTS: Cells were homogeneously
stained in the tumor region. More than 85% of the specimens expressed
sst 1, 2, and 3. There was no difference among the immunohistochemical
stainings of somatostatin receptor subtypes according to most tumor
characteristics; however, the expression of sst 2 was extremely
positive, and the expression of sst 3 was moderately positive in the
specimen from a patient in whom the octreotide injection had proven very
effective.CONCLUSION: These findings indicate that the efficacy of
octreotide may be correlated with the density of sst 2 and 3 in an
immunohistological study using paraffin sections.
UI - 12119516
AU - Heinicke JM; Buchler MW; Laffer UT
Bilio-digestive double bypass for nonresectable pancreatic cancer.
SO - Dig Surg 2002;19(3):165-7
AD - Department of Sugery, Spitalzentrum, Biel, Switzerland. email@example.com
In spite of extensive preoperative investigation, surgical exploration
is often the only way to determine whether a pancreatic cancer is
curatively resectable. If curative resection is not possible, palliation
of cholestasis and eventual duodenal obstruction is mandatory. This is
best achieved by construction of a bilio-digestive double bypass. Many
different techniques have been described but considerable rates of
delayed gastric emptying have added high morbidity to the procedure. We
propose a retrocolic construction technique combining an omega loop with
a Roux-en-Y reconstruction which to our knowledge has not been published
before. Copyright 2002 S. Karger AG, Basel
UI - 12060541
AU - Molina Villaverde R; Gonzalez Baron M
[Pancreatic neuroendocrine tumors: how far have we gone ahead?]
SO - Rev Clin Esp 2002 May;202(5):269-71
AD - Servicio de Oncologia Medica, Hospital La Paz, Madrid, Spain.
UI - 12045867
AU - Nakagohri T; Asano T; Kenmochi T; Urashima T; Ochiai T
Long-term surgical outcome of noninvasive and minimally invasive
intraductal papillary mucinous adenocarcinoma of the pancreas.
SO - World J Surg 2002 Sep;26(9):1166-9
AD - Second Department of Surgery, Chiba University School of Medicine, 1-8-1
Inohana, Chuo-ku, Chiba 260-8670, Japan. firstname.lastname@example.org
The objective of this study was to clarify the long-term outcome after
surgical resection in patients with noninvasive and minimally invasive
intraductal papillary mucinous adenocarcinoma. We performed a
retrospective review of the clinicopathological features and outcome in
patients who underwent pancreatic resection for noninvasive and
minimally invasive intraductal papillary mucinous adenocarcinoma between
invasive structures were pathologically observed in five cases. The mean
age of patients with either noninvasive (n = 16) or minimally invasive n
= 5) adenocarcinoma was 61 years. Of the patients with minimally
invasive adenocarcinoma, 4 had abdominal pain. Conversely, 7 patients
with noninvasive adenocarcinoma had no complaint. The mean size of
noninvasive and minimally invasive tumors was 2.5 cm (range 0.8 to 4.0)
and 3.3 cm (range 2.5 to 4.5), respectively. The overall 5-year and
10-year survival rates for all 21 patients were 89% and 47%,
respectively. Disease recurred in 3 patients; 2 patients with minimally
invasive adenocarcinoma and 1 with noninvasive adenocarcinoma.
Recurrence sites were peritoneum = 2) and main pancreatic duct of the
remnant pancreas (n = 1); 5 disease-free patients died of unrelated
causes. The remaining 13 patients are alive and disease free 3 to 12
years after surgery. Noninvasive and minimally invasive intraductal
papillary mucinous adenocarcinoma had a favorable prognosis after
UI - 12368670
AU - Tran K; Van Eijck C; Di Carlo V; Hop WC; Zerbi A; Balzano G; Jeekel H
Occlusion of the pancreatic duct versus pancreaticojejunostomy: a
prospective randomized trial.
SO - Ann Surg 2002 Oct;236(4):422-8; discussion 428
AD - Departments of General Surgery, Erasmus Medical Center Rotterdam,
Rotterdam, The Netherlands.
OBJECTIVE: Using a prospective randomized study to assess postoperative
morbidity and pancreatic function after pancreaticoduodenectomy with
pancreaticojejunostomy and duct occlusion without
pancreaticojejunostomy. SUMMARY BACKGROUND DATA: Postoperative
complications after pancreaticoduodenectomy are largely due to leakage
of the pancreaticoenterostomy. Pancreatic duct occlusion without
anastomosis of the pancreatic remnant may prevent these complications.
METHODS: A prospective randomized study was performed in a nonselected
series of 169 patients with suspected pancreatic and periampullary
cancer. In 86 patients the pancreatic duct was occluded without
anastomosis to pancreatic remnant, and in 83 patients a
pancreaticojejunostomy was performed after pancreaticoduodenectomy.
Postoperative complications were the endpoint of the study. All relevant
data concerning patient demographics and postoperative morbidity and
mortality as well as endocrine and exocrine function were analyzed. At 3
and 12 months after surgery, evaluation of weight loss, stools, and the
use of antidiabetics and pancreatic enzyme was repeated. RESULTS:
Patient characteristics were comparable in both groups. There were no
differences in median blood loss, duration of operation, and hospital
stay. No significant difference was noted in postoperative
complications, mortality, and exocrine insufficiency. The incidence of
diabetes mellitus was significantly higher in patients with duct
occlusion. CONCLUSIONS: Duct occlusion without pancreaticojejunostomy
does not reduce postoperative complications but significantly increases
the risk of endocrine pancreatic insufficiency after duct occlusion.
UI - 10817437
AU - Yamaguchi K; Noshiro H; Shimizu S; Morisaki T; Chijiiwa K; Tanaka M
Long-term and short-term survivors after pancreatectomy for pancreatic
SO - Int Surg 2000 Jan-Mar;85(1):71-6
AD - Department of Surgery and Oncology, Graduate School of Medical Sciences,
Kyushu University, Fukuoka, Japan.
Out of 63 Japanese patients with pancreatic carcinoma who underwent
surgical resection, 8 short-term survivors who died within 3 months
after resection and 6 long-term survivors who were alive for more than 3
years after resection were compared regarding 26 clinicopathological
parameters. The 8 short-term survivors were significantly older than the
6 long-term survivors (63.7 versus 47.8 years, P = 0.0099). The mean
peripheral lymphocyte count was significantly smaller in the short-term
survivors than in the long-term survivors (1,212 versus 2,115 /microl, P
= 0.0459). Operative blood loss was significantly larger in the
short-term survivors than in the long-term survivors (2,393 versus 1,043
g, P = 0.0157). The surgical margin was affected by malignant cells in 7
of the 8 short-term survivors, but in only 2 of the 6 long-term
survivors (P = 0.0362). Of the 8 short-term survivors, 5 were in
comprehensive stage IV and 3 in stage III, while 3 of the 6 long-term
survivors were in stage III, two in stage II, and one in stage I (P =
0.0487). All the 8 short-term survivors were of the comprehensive
curability C, while 3 of the 6 long-term survivors were of A, one B and
the other two C (P = 0.0239). Multiple regression analysis of these 6
profound factors showed that the peripheral lymphocyte count was an
independent significant parameter to differentiate the short-term and
long-term survivors. These findings suggest that, although the
aggressive nature of pancreatic cancer has been accepted, the clinical
course after pancreatectomy would also depend upon the immunological
state of the patient.
UI - 12236075
AU - Arkosy P; Sasi SL; Kerekes L; Kovacs I
[Evaluation of pancreatic anastomoses in the course of radical
SO - Magy Seb 2002 Aug;55(4):221-4
AD - Debreceni Egyetem Orvos- es Egeszsegtudomanyi Centrum II. sz. Sebeszeti
Klinika, 4004 Debrecen.
We examine the results of radical resections performed over a 10 year
period at the 2nd Department of Surgery of the University of Debrecen
Medical and Health Science Center Medical School of Medicine because of
chronic inflammation, tumors of the papilla of Vater or tumors of the
head of the pancreas. Pancreatoduodenectomy was performed in 134
patients, Whipple-type surgery in 11, and pylorus-preserving
pancreatoduodenectomy in 123 patients. Three different types of
reconstructive methods were used. In pylorus-preserving
pancreatoduodenectomy, the remnant of the pancreas was anastomosed by
performing a termino-lateral pancreatojejunostomy in 20 cases, and a
pancreatogastrostomy in 89 cases. In 14 patients, the sutures were not
satisfactory because of the soft and glandular texture of the pancreas,
so a new method was used. After removing the head of the pancreas, the
first anastomosis was a pancreatico-jejunostomy, the second was a
choledochojejunostomy, and the third was a duodeno-jejunostomy which was
fixed approximately 40 centimeters from the pancreatic anastomosis. The
most common complication was leaking pancreatogastrostomy. Four patients
with this complication were reoperated on. The 14 patients operated on
using the new method had no complications.
UI - 12377966
AU - Brett BT; Smith SC; Bouvier CV; Michaeli D; Hochhauser D; Davidson BR;
Kurzawinski TR; Watkinson AF; Van Someren N; Pounder RE; Caplin ME
Phase II study of anti-gastrin-17 antibodies, raised to G17DT, in
advanced pancreatic cancer.
SO - J Clin Oncol 2002 Oct 15;20(20):4225-31
AD - Department of Medicine, Royal Free Hospital National Health Service
Trust, London, United Kingdom.
PURPOSE: The prognosis for advanced pancreatic cancer remains poor.
Gastrin acts as a growth factor for pancreatic cancer. We describe the
first study of the antigastrin immunogen G17DT in pancreatic cancer. Our
aims were to determine the antibody response, safety, tolerability, and
preliminary evidence of efficacy of G17DT in advanced pancreatic cancer.
PATIENTS AND METHODS: Thirty patients with advanced pancreatic cancer
were immunized with three doses of either 100 micro g or 250 micro g of
G17DT. RESULTS: In the whole group, 20 (67%) of 30 patients produced an
antibody response. The 250- micro g dose resulted in a significantly
greater response rate of 82% compared with 46% for the 100- micro g
group (P =.018). The most significant side effects, seen in three
patients, were local abscess and/or fever. The median survival for the
whole group from the date of the first immunization was 187 days; median
survival was 217 days for the antibody responders and 121 days for the
antibody nonresponders. The difference in survival between the antibody
responders and nonresponders was significant (P =.0023). CONCLUSION:
Patients with advanced pancreatic cancer are able to mount an adequate
antibody response to G17DT. The 250- micro g dose is superior to the
100- micro g dose, and it appears to be generally well tolerated.
Antibody responders demonstrate significantly greater survival than
antibody nonresponders. Phase III studies are currently underway in
order to determine efficacy.
UI - 11572580
AU - Martinelli B; Pigni A; Fagnoni E; Chini C; Vallini I; Pinotti G
Personal experience in advanced pancreatic cancer: retrospective
analysis on the use of 5-fluorouracil or gemcitabine.
SO - Dig Liver Dis 2001 Aug-Sep;33(6):503
UI - 12365016
AU - Takada T; Amano H; Yasuda H; Nimura Y; Matsushiro T; Kato H; Nagakawa T;
Nakayama T; Study Group of Surgical Adjuvant Therapy for Carcinomas of
the Pancreas and Biliary Tract
Is postoperative adjuvant chemotherapy useful for gallbladder carcinoma?
A phase III multicenter prospective randomized controlled trial in
patients with resected pancreaticobiliary carcinoma.
SO - Cancer 2002 Oct 15;95(8):1685-95
AD - Department of Surgery, Teikyo University School of Medicine, Tokyo,
BACKGROUND: To the authors' knowledge, the significance of postoperative
adjuvant chemotherapy in pancreaticobiliary carcinoma has not yet been
clarified. A randomized controlled study evaluated the effect of
postoperative adjuvant therapy with mitomycin C (MMC) and 5-fluorouracil
(5-FU) (MF arm) versus surgery alone (control arm) on survival and
disease-free survival (DFS) for each specific disease comprising
resected pancreaticobiliary carcinoma (pancreatic, gallbladder, bile
duct, or ampulla of Vater carcinoma) separately. METHODS: Between April
= 173), bile duct (n = 139), gallbladder (n = 140), or ampulla of Vater
(n = 56) carcinomas were allocated randomly to either the MF group or
the control group. The MF group received MMC (6 mg/m(2) intravenously
[i.v.]) at the time of surgery and 5-FU (310 mg/m(2) i.v.) in 2 courses
of treatment for 5 consecutive days during postoperative Weeks 1 and 3,
followed by 5-FU (100 mg/m(2)orally) daily from postoperative Week 5
until disease recurrence. All patients were followed for 5 years.
RESULTS: After ineligible patients were excluded, 158 patients with
pancreatic carcinoma (81 in the MF group and 77 in the control group),
118 patients with bile duct carcinoma (58 in the MF group and 60 in the
control group), 112 patients with gallbladder carcinoma (69 in the MF
group and 43 in the control group), and 48 patients with carcinoma of
the ampulla of Vater (24 in the MF group and 24 in the control group)
were evaluated. Good compliance (> 80%) was achieved with MF treatment.
The 5-year survival rate in gallbladder carcinoma patients was
significantly better in the MF group (26.0%) compared with the control
group (14.4%) (P = 0.0367). Similarly, the 5-year DFS rate of patients
with gallbladder carcinoma was 20.3% in the MF group, which was
significantly higher than the 11.6% DFS rate reported in the control
group (P = 0.0210). Significant improvement in body weight compared with
the control was observed only in patients with gallbladder carcinoma.
There were no apparent differences in 5-year survival and 5-year DFS
rates between patients with pancreatic, bile duct, or ampulla of Vater
carcinomas. Multivariate analyses demonstrated a tendency for the MF
group to have a lower risk of mortality (risk ratio of 0.654; P =
0.0825) and recurrence (risk ratio of 0.626; P = 0.0589). The most
commonly reported adverse drug reactions were anorexia, nausea/emesis,
stomatitis, and leukopenia, none of which were noted to be serious.
CONCLUSIONS: The results of the current study indicate that gallbladder
carcinoma patients who undergo noncurative resections may derive some
benefit from systemic chemotherapy. However, alternative modalities must
be developed for patients with carcinomas of the pancreas, bile duct, or
ampulla of Vater. Copyright 2002 American Cancer Society.
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