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NCI CANCERLIT® Search: Therapy of Pancreatic Cancer - May 2002
National Cancer Institute®
Last Modified: May 1, 2002
Table of Contents
1
UI - 11894319
AU - Wilson H; Butler LJ; Repetto G; Love J
TI -
Providing care to patients with pancreatic cancer: a retrospective chart
review.
SO - Can Oncol Nurs J 2000 Fall;10(4):134-8
AD - QEII Health Sciences Centre, Halifax.
Pancreatic cancer may be considered rare, yet in Canada it is the fourth
leading cause of death by cancer in the elderly. This study was
conducted in a large tertiary centre to determine the symptoms
experienced by patients and the response by health professionals in
providing supportive care. This paper reports the results of a
retrospective review of health records from patients diagnosed with
pancreatic cancer (n = 99). Results indicate that pain, nausea,
vomiting, and anorexia were frequently reported. There was a lack of
consistency in the documentation of nursing care and little evidence of
an organized, planned approach for care delivery. The role of the
interdisciplinary health care team and its members in managing this
devastating disease and its impact on patient quality of life was
difficult to ascertain. The development of an integrated approach to the
care of patients with pancreatic cancer is presented.
2
UI - 11764659
AU - Horst E; Seidel M; Micke O; Rube C; Schafer U; Willich N
TI -
Functional evaluation of the human pancreas before and in the early
period after hyperfractionated accelerated radiochemotherapy.
SO - Front Radiat Ther Oncol 2002;37():17-25
AD - Department of Radiation Oncology, University of Munster, Germany.
horste@uni-muenster.de
3
UI - 11764671
AU - Wilkowski R; Heinemann V; Stoffregen C
TI -
Gemcitabine (Gemzar) and radiotherapy--is it feasible?
SO - Front Radiat Ther Oncol 2002;37():78-83
AD - Third Medical Department, University Hospital Grosshadern, Munich,
Germany. ralf.wilkowski@radonc.med.uni-muenchen.de
4
UI - 11867785
AU - Horst E; Micke O; Moustakis C; Schuck A; Schafer U; Willich NA
TI -
Conformal therapy for pancreatic cancer: variation of organ position due
to gastrointestinal distention--implications for treatment planning.
SO - Radiology 2002 Mar;222(3):681-6
AD - Department of Radiation Oncology, University of Munster,
Albert-Schweitzer-Strasse 33, 48129 Munster, Germany.
horste@uni-muenster.de
PURPOSE: To quantify nonrespiratory organ motion in the pancreatic
region and its effect on clinical target volume. MATERIALS AND METHODS:
Three-dimensional translations of the geometric centers of the volumes
of interest--pancreatic head, body, and tail; left and right kidney; and
the superior mesenteric artery--were measured in 20 patients by
analyzing three spiral computed tomographic (CT) protocols performed at
static exhalation and representing differential gastrointestinal
distention. Wilcoxon test for paired differences was applied to
determine statistical significance (P <.05). Spearman rank correlation
coefficients were calculated between combinations of statistically
significant translations. With the assumption that the organ positions
were represented by a three-dimensional Gaussian distribution that
occurs during treatment, clinical target volume expansions were
calculated to account for organ motion and a typical setup error.
RESULTS: Significant translations of the volume of interest were
observed. The most mobile parts of the target organs were the pancreatic
tail (P =.001) and the superior mesenteric artery (P =.01). Larger
variations from the mean in the planning CT protocol in which negative
contrast material was used usually resulted in a slightly larger
clinical target volume expansion. CONCLUSION: Our data may provide a
basis for further studies of organ motion and ways of modifying
treatment margins.
5
UI - 11910485
AU - Park SJ; Kim SW; Jang JY; Lee KU; Park YH
TI -
Intraoperative transfusion: is it a real prognostic factor of
periampullary cancer following pancreatoduodenectomy?
SO - World J Surg 2002 Apr;26(4):487-92
AD - Department of Surgery, Seoul National University College of Medicine, 28
Yongon-dong, Chongno-gu, Seoul 110-744, Korea.
The purpose of this study was to clarify the prognostic significance of
transfusion following pancreatoduodenectomy for periampullary cancers.
We analyzed 357 periampullary cancers from 1985 to 1997 (ampullary
cancer 130 cases, distal bile duct cancer 141 cases, pancreatic head
cancer 86 cases). A total of 215 (60%) of the 357 patients have received
intraoperative transfusion. The 5-year survival rate of 130 ampullary
cancer patients was 59%; altogether, 76 patients (58%) underwent
intraoperative transfusion. The 5-year survival rate of patients without
intraoperative transfusion was 79%, whereas that of patients with a
transfusion was 47% (p = 0.029). Following multivariate analysis,
intraoperative transfusion was found to be an independent poor
prognostic factor for those with ampullary cancer (relative risk 2.174).
Among those with common bile duct cancer, the overall 5-year survival
rate was 33%, and the 5-year survival rates for patients with (n = 87)
or without (n = 54) transfusion were 25% and 38%, respectively, which
did not reach statistical significance (p = 0.0717). For those with
pancreatic head cancer, the overall 5-year survival rate was 16%, and
there was no survival difference between transfused (n = 52) and
untransfused (n = 34) patients. In the present study the reason was not
clear, although intraoperative transfusion was an independent
significant prognostic factor for ampullary cancer. Careful dissection
to minimize intraoperative bleeding is mandatory during
pancreatoduodenectomy for ampullary cancer.
6
UI - 11942178
AU - Polus M; Jerusalem G; Sautois B; Silvestre RM; Collette MY; Closon MT;
TI -
Fillet G
[Clinical study of the month. Adjuvant radio-chemotherapy and
chemotherapy following curative resection of pancreatic cancer: results
of the randomized trial ESPAC-1]
SO - Rev Med Liege 2002 Feb;57(2):119-22
AD - Service d'Oncologie medicale, CHU, Sart Tilman.
The prognosis of pancreatic adenocarcinoma remains poor, with a 5-year
survival rate lower than 5%. Resection, the gold standard treatment, can
be performed in less than 15% of patients. Following surgery, the median
survival is 12 months for the most favourable cancer patients. Adjuvant
treatment have attempted to improve results. However, chemotherapy,
radiotherapy and multimodal treatments don't have demonstrated a clear
advantage in controlled trials. We will discuss results of the current
trials in this topic. The randomised trial of the European Study Group
for Pancreatic Cancer (ESPAC) recently published in the Lancet revealed
a potential benefit of adjuvant chemotherapy. A critical analysis of the
publication showed, however, that definitive conclusions of this trial
must be interpreted with caution.
7
UI - 11782707
AU - Uomo G; Germano D; Rabitti PG
TI -
[Somatostatin analogues for the treatment of gastro-entero-pancreatic
neuroendocrine tumours]
SO - Minerva Endocrinol 2001 Dec;26(4):225-9
AD - III Divisione, Medicina Interna, Azienda Ospedaliera di Rilievo
Nazionale, A. Cardarelli, Naples, Italy. uomogir@liberto.it
Somatostatin has represented a significant breakthrough in the treatment
of patients with hormone-acting, neuroendocrine
gastro-intestinal-pancreatic (NEGEP) neoplasms, even if its short
half-life made it impractical in the clinical practice. Over the last
recent years new long-acting formulations have been developed from the
native peptide. Octreotide, lanreotide and vapeotide are octapeptides
with similar biological activity, remarkable stability and longer
half-life; an extended-release formulation of octreotide
(Octreotide-LAR) and lanreotide (Lanreotide-SR) have been more recently
developed by incorporating the peptide in microspheres of a
biodegradable polymer. This formulation was conceived to provide
patients with the convenience of a once-a-month or twice-a-month
injection and to ensure a stable serum concentration between injections
and good clinical control of NEGEP tumours symptoms. Nowadays,
somatostatin long-acting analogues represent the first treatment option
in those patients who doesn't underwent radical surgery; in addition,
these substances present no important side effects, ameliorate the
prognosis and can exert some degree of tumour growth control.
8
UI - 11782708
AU - Colao A; Pulcrano M; Dorato M; Muller F; Rossi FW; De Martino MC; Biondi
TI -
B; Lombardi G
[New therapeutic strategies in gastroenteropancreatic neuroendocrine
tumours]
SO - Minerva Endocrinol 2001 Dec;26(4):231-8
AD - Dipartimento di Endocrinologia ed Oncologia Molecolare e Clinica,
Universita Federico II, Naples, Italy. colao@unina.it
Neuroendocrine tumours are frequently malignant and have often reached
an advanced stage by the time of diagnosis when they are inoperable,
accompanied by severe symptoms, sometimes of an endocrine nature.
Current therapeutic procedures include surgery, embolisation of hepatic
metastases, local radiotherapy, biotherapy and chemotherapy. Over the
years somatostatin analogs, of which octreotide is the first form, have
become increasingly important in the treatment of patients with
neuroendocrine tumours. A major step forward in analog treatment is
represented by the development of slow-release formulas which do not
require multiple daily injections and reduce the onset of resistance.
The treatment of neuroendocrine tumours in the future will be based on
the increased use of somatostatin analogs alone or in association with
interferon or chemotherapy, and will also include surgery,
radiometabolic therapy and targeted irradiation of the tumour.
9
UI - 11937010
AU - Ko AH; Tempero MA
TI -
Current and future strategies for combined-modality therapy in
pancreatic cancer.
SO - Curr Oncol Rep 2002 May;4(3):202-12
AD - Comprehensive Cancer Center, University of California at San Francisco,
1600 Divisadero Street, 4th floor, San Francisco, CA 94115, USA.
andrewko@medicine.ucsf.edu
Treatment of pancreatic cancer remains a challenging task that often
requires a multidisciplinary approach to confer optimal response and,
ideally, maximize survival. A combination of locoregional approaches
such as surgery and radiotherapy, along with systemic therapies for
eradication of micrometastases, should be considered both for patients
who are operative candidates and for those with locally advanced,
unresectable disease. How best to combine these modalities in terms of
schedule, timing, and choice of agents is a question that continues to
be actively investigated. Some of these data are equivocal or
conflicting; thus standards of care for combined-modality treatment have
not been uniformly accepted to date. This article provides an overview
of combined-modality therapy, focusing on the major studies that have
guided our current approach to the treatment of pancreatic cancer and
examining new strategies that are likely to improve outcomes and
survival for patients in the future.
10
UI - 11965607
AU - Anthony LB; Woltering EA; Espenan GD; Cronin MD; Maloney TJ; McCarthy KE
TI -
Indium-111-pentetreotide prolongs survival in gastroenteropancreatic
malignancies.
SO - Semin Nucl Med 2002 Apr;32(2):123-32
AD - Louisiana State University Medical Center, Department of Medicine, the
Louisiana State University Health Sciences Center (LSUHSC), Stanley S.
Scott Cancer Center, New Orleans, LA 70112, USA.
Somatostatin and its analogues bind to somatostatin receptors (sst) 1
through 5 that are overexpressed in neuroendocrine neoplasms such as
gastroenteropancreatic (GEP) malignancies. After ligand-receptor
binding, a fraction of the ligand-receptor complexes internalize. This
internalization process is an effective means of delivering cytotoxic
radiolabeled somatostatin analogues, especially those emitting
short-range decay particles such as Auger electrons, to the neoplastic
cell nucleus. Indium-111-pentetreotide, an sst 2 preferring somatostatin
analogue with gamma and Auger electron decay characteristics, is
commonly used for the scintigraphic evaluation and management of
neuroendocrine cancer patients. This clinical trial was performed to
determine the effectiveness and tolerability of therapeutic doses of
(111)In-pentetreotide in patients with GEP tumors. GEP tumor patients
who had failed all forms of conventional therapy, with worsening of
tumor-related signs and symptoms and/or radiographically documented
progressive disease, an expected survival less than 6 months, and sst
positivity as determined by the uptake on a 6.0 mCi
(111)In-pentetreotide scan (OctreoScan; Mallinckrodt Medical, Inc, St.
Louis, MO), were treated with at least 2 monthly 180-mCi intravenous
injections of (111)In-pentetreotide. Baseline clinical assessments,
serum chemistries, and plasma pancreastatin levels were measured and
and 3 pancreatic islet cells) patients were accrued, with 26 patients
evaluable for clinical and radiographic responses, 21 patients evaluable
for biochemical assessments, and 27 patients evaluable for survival
analysis and safety. Toxicity was evaluated by using standard National
Cancer Institute (NCI) Common Toxicity Criteria guidelines. Clinical
benefit occurred in 16 (62%) patients. Pancreastatin levels decreased by
50% or more in 81% of the patients. Objective partial radiographic
responses occurred in 2 (8%) patients, and significant tumor necrosis
(defined by 20 Hounsfield units or greater decrease from baseline)
developed in 7 (27%) patients. The following transient Grades 3/4 NCI
Common Toxicity Criteria side effects were observed, respectively:
leukocyte: 1/1; platelets: 0/2; hemoglobin: 3/0; bilirubin: 1/3;
creatinine: 1/0; neurologic: 1/0. Myeloproliferative disease and/or
myelodysplastic syndrome have not been observed in the 6 patients
followed-up for 48+ months. The median survival was 18 months (range,
3-54+ mo). Two doses (180 mCi) of (111)In-pentetreotide are safe,
well-tolerated, and improve symptoms in 62% of patients, decrease
hormonal markers in 81% of patients, decrease Hounsfield units on
computed tomography (CT) scans in 27% of patients, with 8% partial
radiographic responses and increased expected survival in GEP cancer
patients with somatostatin receptor-expressing tumors. The maximal
tolerated dose of (111)In-pentetreotide and the optimal dosing schedules
remain under investigation. Copyright 2002, Elsevier Science.
11
UI - 11314019
AU - Arlt A; Vorndamm J; Breitenbroich M; Folsch UR; Kalthoff H; Schmidt WE;
TI -
Schafer H
Inhibition of NF-kappaB sensitizes human pancreatic carcinoma cells to
apoptosis induced by etoposide (VP16) or doxorubicin.
SO - Oncogene 2001 Feb 15;20(7):859-68
AD - Laboratory of Molecular Gastroenterology, 1st Department of Medicine,
University of Kiel, Germany.
The transcription factor NF-kappaB has anti-apoptotic properties and may
confer chemoresistance to cancer cells. Here, we describe human
pancreatic carcinoma cell lines that differ in the responsiveness to the
topoisomerase-2 inhibitors VP16 (20 microM) and doxorubicin (0.3
microM): Highly sensitive T3M4 [corrected] and PT45-P1 cells, and
Capan-1 and A818-4 cells that were almost resistant to both anti cancer
drugs. VP16, but not doxorubicin, transiently induced NF-kappaB activity
in all cell lines, whereas basal NF-kappaB binding was nearly
undetectable in T3M4 [corrected] and PT45-P1 cells, but rather high in
Capan-1 and A818-4 cells, as demonstrated by gel-shift and luciferase
assays. Treatment with various NF-kappaB inhibitors (Gliotoxin, MG132
and Sulfasalazine), or transfection with the IkappaBalpha
super-repressor, strongly enhanced the apoptotic effects of VP16 or
doxorubicin on resistant Capan-1 and 818-4 cells. Our results indicate
that under certain conditions the resistance of pancreatic carcinoma
cells to chemotherapy is due to their constitutive NF-kappaB activity
rather than the transient induction of NF-kappaB by some anti-cancer
drugs. Blockade of basal NF-kappaB activity by well established drugs
efficiently reduces chemoresistance of pancreatic cancer cells and
offers the potential for improved therapeutic strategies.
12
UI - 11956906
AU - Matsuno S; Egawa S; Arai K
TI -
Trends in treatment for pancreatic cancer.
SO - J Hepatobiliary Pancreat Surg 2001;8(6):544-8
AD - First Department of Surgery, Tohoku University School of Medicine, 1-1
Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan.
Although surgical resection is considered to be the only approach that
offers a possibility of cure to patients with pancreatic cancer, the
prognosis of the disease has not been improved markedly by any surgical
procedures in the past 20 years. Large-scale randomized prospective
clinical trials are being conducted in the United States and Italy,
comparing standard lymph node dissection with extended lymph node
dissection. Although preoperative chemoradiation has various advantages
in the treatment of pancreatic cancer, it does not contribute to its
downstaging and eventual cure. The combination of leucovorin,
5-fluorouracil (5-FU), and extracorporeal irradiation, however, has been
proven to improve the patient's quality of life (QOL). Palliative
surgery still requires further research in areas such as the examination
of morbidity rates and the duration of bypass effects, now that
laparoscopic and endoscopic surgery have both been well developed.
Recent biological research has revealed the mechanisms of the
carcinogenesis and the progression of pancreatic cancer, and, against
this background, we assume that more effective trials will be conducted
soon. Immunotherapy with dendritic cells, as well as gene therapy with
mutant adenovirus, has already been employed clinically. Pancreatic
cancer therapy is now facing new prospects.
13
UI - 11956909
AU - Kouloulias VE; Nikita KS; Kouvaris JR; Uzunoglu NK; Golematis VC;
TI -
Papavasiliou CG; Vlahos LJ
Cytoreductive surgery combined with intraoperative chemo-hyperthermia
and postoperative radiotherapy in the management of advanced pancreatic
adenocarcinoma: feasibility aspects and efficacy.
SO - J Hepatobiliary Pancreat Surg 2001;8(6):564-70
AD - Department of Radiotherapy, Medical School, University of Athens,
Aretaieion Hospital, Greece.
BACKGROUND/PURPOSE: The aim of our study was to evaluate the feasibility
and the efficacy of cytoreductive surgery (CS) with intraoperative
chemo-hyperthermia in the management of advanced stage IVA (T4N0M0)
patients with unresectable adenocarcinoma of the pancreas underwent CS,
with preoperative chemotherapy (5-fluorouracil [FU] for 96 h), plus
45-Gy external beam postoperative irradiation with a 6-MeV linear
accelerator (1.8 Gy per fraction, 5 days per week). A single session of
intraoperative hyperthermia was performed with a waveguide-type
applicator operating at 433 MHz, and temperature was measured by
inserting a flexiguide needle catheter carrying a thermometry probe with
three measuring points into the tumor. The tumor region was heated to 43
degrees C-45 degrees C for up to 60 min, while 5-FU 500 mg was injected
simultaneously through the gastroduodenal artery into the splenic artery
(intraoperative regional chemotherapy). RESULTS: Postoperative recovery
was uneventful for all patients. After the combined treatment, there was
a significant decrease in the values of both serum carcinoembryonic
antigen (CEA; P = 0.017, Wilcoxon test) and carbohydrate antigen
(CA)19-9 ( P = 0.016; Wilcoxon test), from 7.6 +/- 1.5 ng/ml CEA and
869.6 +/- 126.9 U/ml CA to 3.5 +/- 0.8 ng/ml CEA and 104.7 +/- 35.4 U/ml
CA19-9. Moreover, there was a significant improvement ( P = 0.016;
Wilcoxon test) in Eastern Cooperative Oncology Group performance status,
pain score, and body mass index. The median overall survival was 18.5
(SE, 1.8) months. CONCLUSIONS: Our preliminary clinical results suggest
the tolerability and the considerable potential advantage of using
cytoreductive resection with preoperative chemotherapy, intraoperative
chemo-hyperthermia, and external beam postoperative radiotherapy for the
management of advanced adenocarcinoma of the pancreas.
14
UI - 11888712
AU - Reddy SK; Burton AW
TI -
Re: video-assisted thoracoscopic sympathectomy-splanchnicectomy.
SO - J Pain Symptom Manage 2002 Mar;23(3):177; discussion 178
15
UI - 11954403
AU - Melville A
TI -
Better quality of care for UGI cancer patients.
SO - Nurs Times 2001 Mar 22-28;97(12):36-7
16
UI - 11943127
AU - Peng S; Mou Y; Cai X; Peng C
TI -
Binding pancreaticojejunostomy is a new technique to minimize leakage.
SO - Am J Surg 2002 Mar;183(3):283-5
AD - Department of Surgery, Second Affiliated Hospital, School of Medicine,
Zhejiang University, Zhejiang Province, People's Republic of, 310009,
Hangzhou, China.
Pancreaticoduodenectomy (Whipple procedure) has been the standard
treatment for periampullary and pancreatic carcinoma. A leak or fistula
from the pancreatic anastomosis is the leading cause of morbidity and
mortality after pancreaticoduodenectomy. In order to effectively prevent
the development of pancreatic fistulae, we designed a special technique
called binding pancreaticojejunostomy, by which 3 cm of the
serosa-muscular sheath of the jejunum was bound to the pancreatic
remnant. We have performed this procedure in 105 consecutive patients;
none of the cases developed pancreatic fistula. It is a safe, simple,
and efficient technique.
17
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UI - 11955742
AU - Crane CH; Abbruzzese JL; Evans DB; Wolff RA; Ballo MT; Delclos M; Milas
TI -
L; Mason K; Charnsangavej C; Pisters PW; Lee JE; Lenzi R; Vauthey JN;
Wong AB; Phan T; Nguyen Q; Janjan NA
Is the therapeutic index better with gemcitabine-based chemoradiation
than with 5-fluorouracil-based chemoradiation in locally advanced
pancreatic cancer?
SO - Int J Radiat Oncol Biol Phys 2002 Apr 1;52(5):1293-302
AD - Pancreatic Tumor Study Group, Department of Radiation Oncology, The
University of Texas M. D. Anderson Cancer Center, Houston, TX 77030,
USA. ccrane@mdanderson.org
PURPOSE: To retrospectively compare the toxicity and efficacy of
concurrent gemcitabine-based chemoradiation with that of concurrent
5-fluorouracil (5-FU)-based chemoradiation in patients with unresectable
2000, 114 patients with localized unresectable adenocarcinoma of the
pancreas were treated with concurrent chemoradiation. Locally advanced
unresectable disease was defined as low-density tumor in contact with
the superior mesenteric artery (SMA) or celiac artery, or occlusion of
the superior mesenteric-portal venous confluence. Fifty-three patients
were selected to receive gemcitabine in 7 weekly cycles (250-500
mg/m(2)) with concurrent radiotherapy (median dose 30 Gy, range 30-33 Gy
in 10-11 fractions). The remaining 61 patients received
continuous-infusion 5-FU (200-300 mg/m(2)) with concurrent radiotherapy
(30 Gy in 10 fractions). Radiotherapy was delivered to the primary tumor
and regional lymphatics. Patients receiving gemcitabine and those
receiving 5-FU had a similar mean Karnofsky performance status (KPS, 89%
vs. 86%), distribution of tumor grade (43% vs. 33% poorly
differentiated), and percent weight loss (all p = NS). However, patients
treated with gemcitabine had a significantly larger median maximum
cross-sectional tumor area (TA, 8.8 cm(2) vs. 5.7 cm(2), p = 0.046) and
were significantly younger (median age 60 vs. 68 years, p <0.001).
Severe acute toxicity (ST) was defined as toxicity requiring a hospital
stay of more than 5 days, mucosal ulceration with bleeding, more than 3
dose deletions of gemcitabine or discontinuation of 5-FU, or toxicity
resulting in surgical intervention or death. Kaplan-Meier analysis was
used to calculate the actuarial rate of local progression on imaging
(LP), the rate of distant metastasis (DM), and the overall survival (OS)
rate. The imaging was reviewed in resected patients. RESULTS: Patients
receiving gemcitabine developed significantly more ST during treatment
(23% vs. 2%, p < 0.0001) than did those receiving 5-FU. Patients treated
with gemcitabine had a similar 10-month LP rate (62% vs. 61%), 10-month
DM rate (55% vs. 47%), 1-year OS rate (42% vs. 28%), and median OS
duration (11 months vs. 9 months) to patients treated with 5 FU (all p =
NS). Five patients who received gemcitabine and 1 patient who received
5-FU underwent margin-negative pancreaticoduodenectomy after
chemoradiation. Three patients had a short segment (
UI - 11955754
AU - Ozhasoglu C; Murphy MJ
TI -
Issues in respiratory motion compensation during external-beam
radiotherapy.
SO - Int J Radiat Oncol Biol Phys 2002 Apr 1;52(5):1389-99
AD - Department of Radiation Oncology, Stanford University School of
Medicine, Stanford, CA 94305, USA.
PURPOSE: To investigate how respiration influences the motion of lung
and pancreas tumors and to relate the observations to treatment
procedures intended to improve dose alignment by predicting the moving
tumor's position from external breathing indicators. METHODS AND
MATERIALS: Breathing characteristics for five healthy subjects were
observed by optically tracking the displacement of the chest and
abdomen, and by measuring tidal air volume with a spirometer.
Fluoroscopic imaging of five radiotherapy patients detected the motion
of lung and pancreas tumors synchronously with external breathing
indicators. RESULTS: The external and fluoroscopic data showed a wide
range of behavior in the normal breathing pattern and its effects on the
position of lung and pancreas tumors. This included transient phase
shifts between two different external measures of breathing that
diminished to zero over a period of minutes, modulated phase shifts
between tumor and chest wall motion, and other complex phenomena.
CONCLUSIONS: Respiratory compensation strategies that infer tumor
position from external breathing signals, including methods of beam
gating and dynamic beam tracking, require three-dimensional knowledge of
the tumor's motion trajectory as well as the ability to detect and adapt
to transient and continuously changing characteristics of respiratory
motion during treatment.
UI - 11906395
AU - Grodski S; Christophi C
TI -
Distal pancreatectomy with preservation of the spleen and splenic
vessels.
SO - ANZ J Surg 2001 Dec;71(12):763-4
AD - Monash University Department of Surgery, Alfred Hospital, Prahran,
Victoria, Australia. grodski@yahoo.com
This article draws attention to the concept of distal pancreatectomy
with splenic preservation including the splenic artery and vein.
UI - 11916546
AU - Wagener DJ; Wils JA; Kok TC; Planting A; Couvreur ML; Baron B
TI -
Results of a randomised phase II study of cisplatin plus 5-fluorouracil
versus cisplatin plus 5-fluorouracil with alpha-interferon in metastatic
pancreatic cancer: an EORTC gastrointestinal tract cancer group trial.
SO - Eur J Cancer 2002 Mar;38(5):648-53
AD - UMC Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
d.wagener@onco.azn.nl
A randomised phase II study of 5-fluorouracil (5-FU) plus cisplatin
(CDDP) with or without alpha-interferon 2b was performed in patients
with pancreatic cancer with measurable metastatic disease outside the
pancreas. The treatment in arm A consisted of cisplatin (100 mg/m(2)) on
day 1, followed by a continuous infusion of 5-FU 1000 mg/m(2) for 4 days
and in arm B the same treatment was given plus alpha-interferon 2b in a
dose of 3 million Units/day subcutaneously (s.c.) from day 1 for 5 days.
36 patients were entered in the trial, 18 in each arm. In arm B only 15
patients were eligible. No responses were observed in the 5-FU/CDDP arm
and only 2 partial responses were achieved in the interferon-arm,
lasting 27 and 32 weeks, respectively. Both treatment arms showed
considerable toxicity. It has to be concluded that both treatment
regimens have little activity and cannot be recommended.
UI - 11989594
AU - Osti MF; Costa AM; Bianciardi F; De Nicolo M; Donato V; Silecchia G;
TI -
Enrici RM
Concomitant radiotherapy with protracted 5-fluorouracil infusion in
locally advanced carcinoma of the pancreas: a phase II study.
SO - Tumori 2001 Nov-Dec;87(6):398-401
AD - Istituto di Radiologia, Cattedra di Radioterapia Oncologica, Rome,
Italy. mfosti@tiscali.it
AIMS AND BACKGROUND: To evaluate the efficacy of combined radiation
therapy and continuous infusion of 5-fluorouracil in patients with
locally advanced carcinoma of the pancreas. METHODS: Between January
the pancreas were treated in our Institute. In 20 patients, the tumor
(65%) was located in the head of the pancreas and in 11 (35%) in the
body or tail; 13 cases also showed involved nodes. Radiation therapy
consisted in a median dose of 63 Gy in 33-36 fractions applied to the
tumor and regional lymph nodes. Chemotherapy with 5-fluorouracil in
continuous infusion, 250 mg/m2 daily, was administered in the first and
fifth week of the radiation therapy. Thereafter, 22 patients received
3-10 cycles of adjuvant chemotherapy with same doses. Median follow-up
of the series was 20 months. The toxicity of the treatment was scored
according to WHO criteria. All patients underwent nutritional assessment
at the time of radiochemotherapy. RESULTS: The median overall survival
was 15.2 months (range, 4-42). At restaging, 17 cases (55%) showed no
change and 14 (45%) a partial remission. At the end of radiochemotherapy
in 8 (26%) of the cases there was indication for pancreatectomy, which
was executed in 4 patients. At the time of the study, 2 patients (6.4%)
were surgically proven disease free. Eleven of the 13 cases (85%)
presenting involved nodes showed that the enlarged lymph nodes had
disappeared. Nineteen patients (61%) are alive with clinical evidence of
disease anti 2 cases are alive with liver metastases; 8 patients (26%)
died for disease. In 74% of cases there was complete pain control.
Tolerance to the regimen was good. Nutritional assistance was evaluated
and was found to be correlated to survival. CONCLUSIONS: The results of
the series confirm a good tolerance with low acute toxicity. Tumor
down-staging and resectability rates were high, together with prolonged
survival and a good quality of life.
UI - 11930875
AU - Stojadinovic A; Hoos A; Brennan MF; Conlon KC
TI -
Randomized clinical trials in pancreatic cancer.
SO - Surg Oncol Clin N Am 2002 Jan;11(1):207-29, x
AD - Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York,
New York, USA. ta.stojadinovic@verizon.net
The authors reviewed 59 prospective, randomized, controlled trials for
pancreatic carcinoma that were published between 1977 and 2000. Of the
11 surgical trials, two each studied extent of resection (standard
versus pylorus-preserving pancreaticoduodenectomy) and lymphadenectomy
(standard versus extended lymph node dissection), five trials compared
different types of pancreaticenteric reconstruction, and one each
evaluated the role of prophylactic gastrojejunostomy and chemical
splanchnicectomy in the setting of advanced disease.
UI - 11914928
AU - Dralle H
TI -
The MEN 1 syndrome: the actual role of genetic testing on the timing and
extent of surgery.
SO - Langenbecks Arch Surg 2002 Mar;386(8):545-6
UI - 11914931
AU - Akerstrom G; Hessman O; Skogseid B
TI -
Timing and extent of surgery in symptomatic and asymptomatic
neuroendocrine tumors of the pancreas in MEN 1.
SO - Langenbecks Arch Surg 2002 Mar;386(8):558-69
AD - Department of Surgical Sciences, University Hospital, 75185 Uppsala,
Sweden. goran.akerstrom@kirurgi.uu.se
Pancreaticoduodenal tumors develop in a majority of patients with
multiple endocrine neoplasia type 1 (MEN 1) and have a pronounced effect
on life expectancy as the principal cause of disease related death.
Previous discussion of therapy has focused mainly on syndromes of
hormone excess and especially the management of MEN 1 associated
Zollinger-Ellison syndrome (ZES). The syndromes of hormone excess,
however, may be late features of the endocrinopathy and, when developed,
indicate presence of metastases in more than one-third of patients.
Recent possibilities for genetic diagnosis have emphasized requirements
of prophylactic operation for prevention of malignant development. We
recommend screening with biochemical markers and endoscopic ultrasound
for early detection, and strong efforts of operative tumor removal
before metastases have occurred. Surgery is generally recommended in
patients with or without hormonal syndromes in the absence of spread
hepatic metastases. Operative procedures include enucleation of tumors
in the head of the pancreas, excision of duodenal gastrinomas together
with clearance of lymph gland metastases, and as prophylaxis against
tumor recurrence combination with distal 80% subtotal pancreatic
resection. More extensive surgical tumor reduction is believed to reduce
the risks for malignant progression of the pancreaticoduodenal tumors,
but this requires further evaluation in MEN 1.
UI - 11914932
AU - Gansauge F; Ramadani M; Pressmar J; Gansauge S; Muehling B; Stecker K;
TI -
Cammerer G; Leder G; Beger HG
NSC-631570 (Ukrain) in the palliative treatment of pancreatic cancer.
Results of a phase II trial.
SO - Langenbecks Arch Surg 2002 Mar;386(8):570-4
AD - Department of General Surgery, University of Ulm, Germany.
BACKGROUND: NSC-631570 (Ukrain) is a semisynthetic compound of
thiophosphoric acid and the alkaloid chelidonine from the plant
Chelidonium majus. It has been used in complementary herbal medicine for
more than 20 years for the treatment of benign and malignant tumors.
histologically proven unresectable pancreatic cancer were randomized in
a monocentric, controlled, randomized study. Patients in arm A received
1000 mg gemcitabine/m2, those in arm B received 20 mg NSC-631570, and
those in arm C received 1000 mg gemcitabine/m2 followed by 20 mg
NSC-631570 weekly. End point of the study was overall survival. RESULTS:
In all three arms therapy was well tolerated and toxicity was moderate.
At the first re-evaluation in arm A 32%, in arm B 75%, and in arm C 82%
showed no change or partial remission according to WHO criteria (arm A
versus arm B: P<0.01, arm A versus arm C: P<0.001). Median survival
according to Kaplan-Meier analysis was in arm A 5.2 months, in arm B 7.9
months, and in arm C 10.4 months (arm A versus arm B: P<0.01, arm A
versus arm C: P<0.01). Actuarial survival rates after 6 months were 26%,
65% and 74% in arms A B and C, respectively (arm A versus arm B: P<0.05,
arm A versus arm C P<0.01). CONCLUSION: We could show that in
unresectable advanced pancreatic cancer, NSC-631570 alone and in
combination with gemcitabine nearly doubled the median survival times in
patients suffering from advanced pancreatic cancer.
UI - 11942011
AU - Alberti A; Dattola P; Littori F; Dattola A; Maccarone P; Basile M
TI -
[Intraoperative ultrasonography in the staging of pancreatic head
neoplasms]
SO - Chir Ital 2002 Jan-Feb;54(1):59-64
AD - Istituto di Chirurgia Generale, 1a Clinica Chirurgica Generale e Terapia
Chirurgica, Via Consolare Valeria, Gazzi, 98100 Messina.
Tumours of the head of the pancreas constitute the fourth most common
cause of cancer deaths. These tumours are characterised by low survival
rates (5% at 5 years) and low surgical resectability rates (20-25%).
Liver metastases, lymph-node and vascular involvement, and peritoneal
metastases are, in our opinion, exclusion criteria for curative surgical
resection. The aim of the study was to evaluate the impact of
intraoperative ultrasonography on the staging of such tumours. Over the
period from 1990 to 2000 we introduced intraoperative ultrasonography in
the staging of pancreatic cancer. We evaluated 51 patients who at
preoperative staging had been regarded as candidates for surgical
therapy consisting in a pancreaticoduodenectomy. All patients had been
staged by preoperative abdominal ultrasound, ERCP, CT and MRI.
Intraoperative ultrasound and colour-Doppler imaging (from 1997 on)
revealed involvement of (i) the liver, (ii) the splenomesenteric vessels
and (iii) the portal vein. Intraoperative ultrasonography yielded a
diagnosis of occult liver metastases in 10 cases and signs of vascular
involvement (absence of cleavage, partial and total thrombosis) in 12.
One false-negative was registered. Intraoperative ultrasonography in our
experience showed 98% sensitivity and specificity in the detection of
vascular and lymph-node involvement. Its sensitivity in the detection of
liver metastases was 100%. Intraoperative ultrasound is a procedure with
a very high sensitivity in the operative staging of cancer of the head
of the pancreas.
UI - 11952616
AU - King NK; Siriwardana HP; Siriwardena AK
TI -
Readmissions after pancreatoduodenectomy.
SO - Br J Surg 2002 Apr;89(4):497-8
UI - 11968759
AU - Tanaka M
TI -
[Current strategy to cure pancreatic cancer]
SO - Nippon Geka Gakkai Zasshi 2002 Mar;103(3):290-3
AD - Department of Surgery and Oncology, Graduate School of Medical Sciences,
Kyushu University, Fukuoka, Japan.
For more than a decade extensive retroperitoneal dissection,
chemotherapy, or radiotherapy has not prolonged the survival of patients
with pancreatic cancer. Two prospective randomized studies addressing
the clinical significance of extensive dissection or pancreatic
resection for advanced cancer are now in progress. Nonetheless, at
present, resection offers the patient the only possibility of cure.
Although the diagnosis of curable pancreatic cancer is difficult, recent
evidences have given a few hints. The first is pancreatic duct
dilatation caused by cancerous stricture. The second is diabetes as a
sign of pancreatic cancer. Our prospective pancreatographic screening of
diabetic patients selected by our criteria(Table 1) revealed 7 cancers
in 98 patients(7.1%). Within 3 years from diagnosis, the prevalence was
15%. Although the 7 cancers were advanced, this suggests that earlier
examinations in diabetic patients may possibly lead to earlier
diagnosis. The third is a small cystic lesion as a sentinel of
pancreatic cancer. Endoscopic retrograde cholangiopancreatography with
cytology of the pancreatic juice may show the presence of in situ cancer
in patients with a pancreatic cyst. At the moment, careful checks for
the presence of these hints seem to be the only strategy to offer a
chance for cure to patients with pancreatic cancer.
UI - 11928695
AU - Henne-Bruns D; Vogel I
TI -
Does the extent of lymphadenectomy have impact on the prognosis of
patients with pancreatic cancer?
SO - Onkologie 2002 Feb;25(1):69-71
AD - Abteilung fur Viszeral- und Transplantationschirurgie,
Universitatsklinik Ulm, Germany. doris.henne-bruns@medizin.uni-ulm.de
UI - 11996073
AU - Yamaguchi K; Noshiro H; Yokohata K; Nakano K; Watanabe M; Ohtani K;
TI -
Chijiiwa K; Tanaka M
Is there any benefit of preservation of the spleen in distal
pancreatectomy?
SO - Int Surg 2001 Jul-Sep;86(3):162-8
AD - Department of Surgery and Oncology, Graduate School of Medical Sciences,
Kyushu University, Fukuoka, Japan. yamaguch@mailserver.med.kyushu-ac.jp
For a pancreatic body or tail tumor, distal pancreatectomy with
splenectomy (DPS) is a standard operation. Spleen-preserving distal
pancreatectomy (SPDP) was introduced in order to preserve the organ and
thus provide the patient with a better quality of life. Clinical data
were compared between 38 Japanese patients with DPS and 9 with SPDP for
benign tumors or tumor-like lesions at the body or tail of the pancreas
at preoperative, early postoperative (< 3 months after operation), and
late postoperative periods (>6 months after operation). The preoperative
findings were not different between the two groups except for the
significantly higher serum amylase levels in the SPDP group. Operation
time, operative blood loss, and length of postoperative hospital stay
were not different between the two groups. Pancreatic fistula occurred
in 3 (8%) of the 38 patients in the DPS group and in 1 (11%) of the 9
patients in the SPDP group, abdominal abscess in 5 (13%) of the 38
patients in the DPS group and none (0%) in the 9 patients in the SPDP
group. At short-term, clinical findings were not different between the
two groups except for a significantly greater platelet count in the DPS
group than in the SPDP group (46.8 x 10(4)/microl versus 29.6 x
10(4)/microl, P = 0.0081). At long-term after the operation, clinical
findings, including the platelet count, were not different between the
two groups. Computed tomography revealed a pseudocyst in 9 (53%) of 17
patients examined in the DPS group and in 3 (75%) of 4 patients examined
in the SPDP group at short-term after operation. All patients with
pseudocysts were asymptomatic. Two asymptomatic patients (one in the DPS
group and one in the SPDP group) first developed a pseudocyst at
long-term after the operation. The alteration of glucose tolerance was
similar between the two groups. Postoperative pancreatic exocrine
function (the N-benzol-L-tyrosyl-p-aminobenzoic acid test) was not
different between the two groups. These data suggest that SPDP with
preservation of the splenic vessels can be satisfactorily performed
without elongating operative time and postoperative hospital stay or
increasing risk of postoperative complications, with the exception of
increased platelet count in the DPS group at short-term after the
operation. Thus, SPDP is worth considering as one of the options for the
treatment of benign lesions of the body or tail of the pancreas.
UI - 12019406
AU - Teramoto K; Kawamura T; Okamoto H; Hara Y; Takamatsu S; Iwai T; Arii S
TI -
Percutaneous transhepatic lymphography method to image and treat
intra-abdominal lymph node metastasis in patients with unresectable
hepatobiliary pancreatic cancer.
SO - Surgery 2002 May;131(5):529-33
AD - Division of Hepatobiliary Surgery, Department of Surgery, Tokyo Medical
and Dental University, Tokyo, Japan.
BACKGROUND: There have been no effective treatments for intra-abdominal
lymph node metastasis. One of the main reasons is that we cannot deliver
chemotherapeutic agents directly. We evaluated percutaneous transhepatic
lymphography (PTL) as a drug delivery system. METHODS: PTL was performed
16 times in 13 patients. PTL was performed by puncture of the
intrahepatic periportal area. Immediately after injection of contrast
medium, lymphatic flow through the hepatoduodenal ligament to the
intra-abdominal lymph nodes was visualized. The chemotherapeutic agent
was delivered to the metastatic intra-abdominal lymph nodes by this
route. RESULTS: In 10 of 13 patients, intrahepatic and extrahepatic
lymphatic vessels and lymph nodes were visualized by PTL. Computed
tomography after PTL showed retention of lipiodol in the lymphatic
system around the portal vein and in the enlarged metastatic lymph nodes
located in the pancreatic and celiac lymph nodes. According to the
Response Evaluation Criteria in Solid Tumors, there were 8 patients with
progressive disease and 5 with stable disease. CONCLUSIONS: The present
study showed that PTL can be used as a drug delivery system specific for
intra-abdominal lymph nodes as well as for identification of the lymph
tracts.
UI - 12007952
AU - Symon Z; Davis M; McGinn CJ; Zalupski MM; Lawrence TS
TI -
Concurrent chemoradiotherapy with gemcitabine and cisplatin for
pancreatic cancer: from the laboratory to the clinic.
SO - Int J Radiat Oncol Biol Phys 2002 May 1;53(1):140-5
AD - Department of Radiation Oncology, University of Michigan Medical Center,
1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA.
PURPOSE: We have reported that gemcitabine and concurrent radiation is a
promising therapy for patients with pancreatic cancer. We investigated
whether the addition of cisplatin, which may increase the systemic
efficacy of gemcitabine, would be synergistic with gemcitabine and/or
radiation in human pancreatic cancer cell lines.METHODS AND MATERIALS:
BxPc3 and Panc-1 human pancreatic cancer cells were treated with three
different schedules before radiation: (A) a sequential incubation of
gemcitabine for 2 h followed by cisplatin for 2 h, (B) gemcitabine for 2
h, followed by washout of drug, replenishment of media for a 24-h
incubation, followed by cisplatin for 2 h, and (C) gemcitabine for 24 h
with a concurrent incubation of cisplatin for the last 2 h. Cells were
assessed for clonogenic survival using a standard assay. Synergism was
evaluated by the median effect analysis.RESULTS: The schedule shown to
be maximally synergistic for both cell lines was the consecutive 2-h
gemcitabine, 2-h cisplatin exposure, particularly at surviving fractions
of <0.5. Cisplatin did not produce radiosensitization nor did it affect
gemcitabine-mediated radiosensitization.CONCLUSION: Cisplatin produces
synergistic cytotoxicity with gemcitabine without compromising
gemcitabine-mediated radiosensitization. On the basis of these
laboratory and previous clinical observations, we have initiated a Phase
I trial of cisplatin plus gemcitabine and radiotherapy in patients with
unresectable pancreatic cancer.
UI - 12007953
AU - Shinchi H; Takao S; Noma H; Matsuo Y; Mataki Y; Mori S; Aikou T
TI -
Length and quality of survival after external-beam radiotherapy with
concurrent continuous 5-fluorouracil infusion for locally unresectable
pancrea
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