Cancers, Vol. 11, Pages 991: Surgery for Recurrent Pancreatic Cancer: Is It Effective?

Cancers, Vol. 11, Pages 991: Surgery for Recurrent Pancreatic Cancer: Is It Effective? Cancers doi: 10.3390/cancers11070991 Authors: Lucia Moletta Simone Serafini Michele Valmasoni Elisa Sefora Pierobon Alberto Ponzoni Cosimo Sperti Despite improvements to surgical procedures and novel combinations of drugs for adjuvant and neoadjuvant therapies for pancreatic adenocarcinoma, the recurrence rate after radical surgery is still high. Little is known about the role of surgery in the treatment of isolated recurrences of pancreatic cancer. The aim of this study was to review the current literature dealing with surgery for recurrent pancreatic cancer in order to examine its feasibility and effectiveness. An extensive literature review was conducted according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and 14 articles dealing with re-resections for recurrent pancreatic adenocarcinoma were analyzed, focusing on the characteristics of the primary neoplasm and its recurrence, the surgical procedures used, and patient outcomes. Data were retrieved on a total of 301 patients. The interval between surgery for primary pancreatic cancer and the detection of a recurrence ranged from 2 to 120 months. The recurrence was local or regional in 230 patients, and distant in 71. The median overall survival was 68.9 months (range 3–152) after resection of the primary tumor, and 26.0 months (range 0–112) after...
Source: Cancers - Category: Cancer & Oncology Authors: Tags: Review Source Type: research

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We aimed to evaluate the efficacy and safety of 5-fluorouracil-based neoadjuvant chemoradiotherapy (NACRT) in patients with resectable/borderline resectable pancreatic ductal adenocarcinoma (PDAC).
Source: World Journal of Surgical Oncology - Category: Cancer & Oncology Authors: Tags: Research Source Type: research
AbstractBackgroundStudies have demonstrated that multimodality therapy and surgery at high volume centers are associated with a longer survival. However, it is unknown if these data have translated into national changes in care delivery.MethodsPatients with stages I –III pancreatic adenocarcinomas who underwent resections between 2004 and 2010 were identified from the National Cancer Data Base. The primary outcome was a 3-year overall survival. Temporal trends in survival outcomes and treatment variables were measured. A mediation analysis using the Lin metho d was used to discern the relative contribution of changes...
Source: Journal of Gastrointestinal Surgery - Category: Surgery Source Type: research
Objective: To compare the survival outcomes associated with clinical and pathological response in pancreatic ductal adenocarcinoma (PDAC) patients receiving neoadjuvant chemotherapy (NAC) with FOLFIRINOX (FLX) or gemcitabine/nab-paclitaxel (GNP) followed by curative-intent pancreatectomy. Background: Newer multiagent NAC regimens have resulted in improved clinical and pathological responses in PDAC; however, the effects of these responses on survival outcomes remain unknown. Methods: Clinicopathological and survival data of PDAC patients treated at 7 academic medical centers were analyzed. Primary outcomes were ove...
Source: Annals of Surgery - Category: Surgery Tags: PAPERS OF THE 139TH ASA ANNUAL MEETING Source Type: research
The American Society of Clinical Oncology guidelines recommend adjuvant chemoradiation for margin ‐positive (R1) and/or node‐positive (N+) pancreatic cancers. However, it is unclear if addition of adjuvant radiation to chemotherapy improves overall survival in this high‐risk cohort. In this propensity‐matched analysis of high‐risk pancreatic cancer patients (R1 or N+) from a large clin ical oncology database, we evaluate the benefit of adding adjuvant radiation to chemotherapy. We found evidence of superiority of adjuvant chemoradiation over adjuvant radiation alone in N+ patients but not in R1N0 patients. Abstra...
Source: Cancer Medicine - Category: Cancer & Oncology Authors: Tags: ORIGINAL RESEARCH Source Type: research
Although pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy, incremental progress has been realized over the past decade with new chemotherapeutic regimens, advanced surgical techniques, and an improved understanding of genetics. Although most patients are not candidates for surgical resection because of metastatic disease, many centers are focused on offering curative treatment for patients with borderline resectable (BR) or locally advanced (LA) tumors. These patients are treated with chemotherapy and radiation up front followed by surgical resection, and surgery often includes the resection and reconstr...
Source: JAMA Surgery - Category: Sports Medicine Source Type: research
Conclusion.Our modeling analysis suggests that nFOLFIRINOX is preferable to upfront surgery for patients with BR/LA PDAC from both an effectiveness and cost‐effectiveness standpoint. Additional clinical data that further define the long‐term effectiveness of nFOLFIRINOX are needed to confirm our results.Implications for Practice.Increasingly, neoadjuvant FOLFIRINOX has been used for borderline resectable and locally advanced pancreatic cancer with the goal of rendering them resectable and decreasing risk of recurrence. Despite many efforts to show the benefits of neoadjuvant over adjuvant therapies, clinical evidence t...
Source: The Oncologist - Category: Cancer & Oncology Authors: Tags: Health Outcomes and Economics of Cancer Care, Gastrointestinal Cancer Source Type: research
CONCLUSIONS: Current evidence suggests that neoadjuvant chemotherapy has a beneficial effect on overall survival in resectable pancreatic ductal adenocarcinoma in comparison with upfront surgery and adjuvant therapy. Further trials are needed to address the need for practice change. PMID: 31304767 [PubMed - as supplied by publisher]
Source: Annals of the Royal College of Surgeons of England - Category: Surgery Authors: Tags: Ann R Coll Surg Engl Source Type: research
Several new treatment options have become available for pancreatic ductal adenocarcinoma (PDAC), but the support for their use for resectable, borderline resectable and locally advanced PDAC is unclear.
Source: BMC Cancer - Category: Cancer & Oncology Authors: Tags: Research article Source Type: research
Abstract Background: Neoadjuvant therapy is a strategy for resectable and borderline resectable pancreatic cancer, but a consensus approach regarding optimal management is undetermined. Neoadjuvant options include chemotherapy with/without radiotherapy. Stereotactic body radiation therapy (SBRT) is a novel radiation technique that may provide benefit over conventionally fractionated radiation therapy (CFRT) in the neoadjuvant setting. The purpose of the present study is to determine neoadjuvant treatment with SBRT to other neoadjuvant treatment options for patients with resectable pancreatic cancer. Material and m...
Source: Acta Oncologica - Category: Cancer & Oncology Authors: Tags: Acta Oncol Source Type: research
The objective of this study was to evaluate the role of lymph node (LN) dissection and staging in outcomes of patients with pancreatic adenocarcinoma (PDAC) who underwent neoadjuvant chemotherapy (NAC). Methods National Cancer Database was queried for patients with stages I to III PDAC diagnosed between 2004 and 2014. Overall survival (OS) was derived from Kaplan-Meier methods, and Cox-regression model was used to evaluate associations between the number of LN examined, number of positive nodes, and LN ratio with OS. Results A total 35,599 patients were included, 3395 (9%) underwent NAC, 19,865 (56%) received adjuvan...
Source: Pancreas - Category: Gastroenterology Tags: Original Articles Source Type: research
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