Neoadjuvant Therapy and Surgery for Locally Invasive Pancreatic Cancer

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 reconstruction of major blood vessels. In a prospective observational study, Maggino et al report the utility of primary chemotherapy for BR and LA PDAC along with the rates of receipt and completion of therapy, conversion to operation, and survival.
Source: JAMA Surgery - Category: Sports Medicine Source Type: research

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Pancreatic ductal adenocarcinoma (PDAC) has still a dismal prognosis, mainly because only 15–20% of all patients present with resectable tumor stages at the time of diagnosis. Due to locally extended tumor growth or distant metastases upfront resection is not reasonable in the majority of patients. Considerably, PDAC will be the 2nd most frequent cause of cancer-related deaths within the next 10 years for both men and women. While there is currently no convincing evidence for the use of neoadjuvant therapy in resectable PDAC, there are controversial results from studies investigating neoadjuvant treatment concepts in...
Source: Frontiers in Oncology - Category: Cancer & Oncology Source Type: research
CONCLUSION: The 'triangle operation' for borderline resectable pancreatic head cancer can be achieved safely by laparoscopy in carefully selected patients.1-11 Proven experience in both open and laparoscopic pancreatic surgery is mandatory. PMID: 31802299 [PubMed - as supplied by publisher]
Source: Ann Oncol - Category: Cancer & Oncology Authors: Tags: Ann Surg Oncol Source Type: research
Abstract BACKGROUND: Neoadjuvant therapy has shown value in various cancer types. The role of neoadjuvant therapy in pancreatic ductal adenocarcinoma (PDAC), however, remains unknown. The aim of the present work is to evaluate the effect of neoadjuvant therapy on the survival of patients with borderline-resectable PDAC. PATIENTS AND METHODS: Between 2004 and 2015, 7730 patients with resectable PDAC and 1980 patients with borderline-resectable PDAC were identified from the National Cancer Database (NCDB). Survival was compared between resectable and borderline-resectable patients. Survival and pathologic chara...
Source: Ann Oncol - Category: Cancer & Oncology Authors: Tags: Ann Surg Oncol Source Type: research
ConclusionThe ‘triangle operation’ forborderline resectable pancreatic head cancer can be achieved safely by laparoscopy in carefully selected patients.1–11 Proven experience in both open and laparoscopic pancreatic surgery is mandatory.
Source: Annals of Surgical Oncology - Category: Cancer & Oncology Source Type: research
AbstractBackgroundNeoadjuvant therapy has shown value in various cancer types. The role of neoadjuvant therapy in pancreatic ductal adenocarcinoma (PDAC), however, remains unknown. The aim of the present work is to evaluate the effect of neoadjuvant therapy on the survival of patients with borderline-resectable PDAC.Patients and MethodsBetween 2004 and 2015, 7730 patients with resectable PDAC and 1980 patients with borderline-resectable PDAC were identified from the National Cancer Database (NCDB). Survival was compared between resectable and borderline-resectable patients. Survival and pathologic characteristics were also...
Source: Annals of Surgical Oncology - Category: Cancer & Oncology Source Type: research
CONCLUSIONS: NeoTx is not only cytotoxic, but has pleiotropic, beneficial effects on all cellular and non-cellular components of PCa. Combinational approaches including immunotherapy may unleash long-term and more effective anti-tumor responses and improve prognosis of PCa. PMID: 31585935 [PubMed - as supplied by publisher]
Source: Clinical Cancer Research - Category: Cancer & Oncology Authors: Tags: Clin Cancer Res Source Type: research
Publication date: Available online 30 August 2019Source: Seminars in Ultrasound, CT and MRIAuthor(s): Axel Dallongeville, Lucie Corno, Stéphane Silvera, Isabelle Boulay-Coletta, Marc ZinsAbstractComputed Tomography remains the optimal imaging modality for both diagnosis and staging of pancreatic adenocarcinoma. Especially, CT is highly accurate in assessing the relationship of the tumor to critical arterial and venous structures, since their involvement can preclude surgical resection or indicate a neoadjuvant strategy in borderline resectable or locally advanced lesions. MRI provides additional staging information ...
Source: Seminars in Ultrasound, CT and MRI - Category: Radiology Source Type: research
CONCLUSIONSUp-front TP associated to SVR was predictive of worse survival in borderline resectable PDAC. Perioperative treatments in high-risk surgical groups may improve such poor outcomes.
Source: Hepatobiliary and Pancreatic Diseases International - Category: Gastroenterology Source Type: research
Publication date: Available online 23 May 2019Source: Hepatobiliary &Pancreatic Diseases InternationalAuthor(s): June S Peng, Jane Wey, Sricharan Chalikonda, Daniela S Allende, R Matthew Walsh, Gareth Morris-StiffAbstractBackgroundPrevious studies have demonstrated the prognostic significance of pathologic tumor response in pancreatic adenocarcinoma following neoadjuvant therapy (NAT). The aim of this study was to determine the incidence of significant pathologic response to NAT in borderline resectable pancreatic cancer (BRPC), and association of NAT regimen and other clinico-pathologic characteristics with pathologic...
Source: Hepatobiliary and Pancreatic Diseases International - Category: Gastroenterology Source Type: research
SummaryAlthough some improvements have been made in recent years, the prognosis of pancreatic ductal adenocarcinoma remains poor. Surgical resection followed by adjuvant systemic therapy is the only curative treatment option in early stage disease. The role of radiotherapy in the treatment of pancreatic cancer is not well defined and still controversially discussed. Following the results of the ESPAC-1 trial, adjuvant radiochemotherapy (RCT) was no longer employed in most European countries. Nevertheless, in high-risk situations for local recurrence, the addition of adjuvant radiochemotherapy to adjuvant systemic therapy s...
Source: European Surgery - Category: Surgery Source Type: research
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