National Cancer Institute®
Last Modified: May 1, 2002
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.
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. email@example.com
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. firstname.lastname@example.org
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. email@example.com
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.
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.
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.
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. firstname.lastname@example.org
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.
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. email@example.com
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.
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. firstname.lastname@example.org
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.
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.
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.
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.
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.
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
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.
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. email@example.com
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. firstname.lastname@example.org
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. email@example.com
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. firstname.lastname@example.org
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. email@example.com
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 - 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. firstname.lastname@example.org
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 - 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. email@example.com
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. firstname.lastname@example.org
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