A Systematic Review of Resectability and Survival After Concurrent Chemoradiation in Primarily Unresectable Pancreatic Cancer

Morganti, Alessio Giuseppe; Massaccesi, Mariangela; Torre, Giuseppe La; Caravatta, L.; Piscopo, Adele; Tambaro, Rosa; Sofo, Luigi; Sallustio, Giuseppina; Ingrosso, M.; Macchia, G.; Deodato, Francesco; Picardi, V.; Ippolito, Edy; Cellini, Numa; Valentini, Vincenzo

doi:10.1245/s10434-009-0762-4

Cited by 135 publications

(108 citation statements)

References 56 publications

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“…In fact, in our previous pilot study, a dose of 30 Gy in 10 fractions (3 Gy/fraction; EQD 2 : 32.5 Gy) produced a complete response of pain in 50% of patients with a partial response in a further 25% of patients. 27 Finally, the administration of a higher dose (37.5 Gy, 7.5 Gy/fraction, EQD 2 : 54.7 Gy with ˛/ˇ ratio of 10) to part of the tumor could increase the palliative effect.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, this dose is definitely higher compared to standard preoperative treatment of locally advanced pancreatic tumors (median: 50.2 Gy, range: 45-55.8 Gy). 27 Based on these results, prospective trials based on a clinical application of this strategy seem to be justified, at least in selected patients without overlapping between PTVd and PTVv, to evaluate the clinical efficacy of this technique in the setting of locally advanced pancreatic carcinoma.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies on the use of preoperative radiotherapy and chemoradiation showed the possibility to achieve a radical resection even in patients with initially unresectable disease. However, the success rate is still low (about 25-30%) 27 because of the limits in the radiation dose that can be safely administered in this anatomical region.…”

Section: Introductionmentioning

confidence: 99%

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Individually optimized stereotactic radiotherapy for pancreatic head tumors: A planning feasibility study

Buwenge

Cilla

Guido

et al. 2016

Reports of Practical Oncology & Radiotherapy

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Individually optimized stereotactic radiotherapy for pancreatic head tumors: A planning feasibility study

Buwenge

Cilla

Guido

et al. 2016

Reports of Practical Oncology & Radiotherapy

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“…An estimated 48,960 new cases of pancreatic cancer and 40,560 mortalities from pancreatic cancer occurred in the United States of America in 2015, making this cancer type the fourth leading cause of cancer-associated mortality (2). Surgery is the only reported cure for pancreatic cancer; however, the resectability rate is only 18% due to its high rate of vascular invasion and metastasis (3). Radiotherapy and chemotherapy may extend survival time to some extent, but their overall effectiveness remains limited (4).…”

Section: Introductionmentioning

confidence: 99%

IFN-γ induces the upregulation of RFXAP via inhibition of miR-212-3p in pancreatic cancer cells: A novel mechanism for IFN-γ response

et al. 2018

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Abstract. Previous studies have demonstrated that pancreatic cancer-derived microRNA (miR)-212-3p can inhibit the expression of regulatory factor X-associated protein (RFXAP), an important transcription factor for major histocompatibility complex (MHC) class II, and thereby lead to downregulation of MHC class II in dendritic cells. It has also been established that interferon (IFN)-γ can increase the expression of MHC class II in immune cells. It was therefore hypothesized that IFN-γ can inhibit miR-212-3p expression in pancreatic cancer, leading to the upregulation of RFXAP and MHC class II expression. This may represent a novel molecular mechanism underlying the use of IFN-γ in immunotherapy. Data from the present study revealed that miR-212-3p was inhibited by IFN-γ in a dose and time-dependent manner in the pancreatic ductal adenocarcinoma cell line PANC-1. RFXAP and MHC class II expression were increased following IFN-γ stimulation. A luciferase assay was performed to validate RFXAP as a target gene of miR-212-3p. The expression levels of RFXAP and MHC class II were decreased by miR-212-3p mimics and increased by miR-212-3p inhibitors. In PANC-1 cells transfected with miR-212-3p mimics, IFN-γ stimulation could not increase the RFXAP and MHC class II. The results from the present study suggest that IFN-γ increases RFXAP and MHC class II expression by inhibiting miR-212-3p. To the best of our knowledge, this is the first report of this novel molecular mechanism underlying the effects of IFN-γ on pancreatic cancer, which may aid with the development of immunotherapies for patients with pancreatic cancer.

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“…Neoadjuvant treatment in the form of chemotherapy and/or radiation therapy is being used more frequently to downstage locally advanced unresectable lesions (28)(29)(30). Studies evaluating the impact of neoadjuvant chemo radiation have demonstrated that secondary resection becomes possible in about 30-40% of patients with locally SMA and SMV 2 [4] Celiac or portal lymphadenopathy 5 [10] Other/unknown 5 [10] Initial operation type, n [%]…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant therapy prior to surgical resection for previously explored pancreatic cancer patients is associated with improved survival

Lü

Soares

et al. 2017

Hepatobiliary Surg. Nutr.

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Background: Patients with pancreatic ductal adenocarcinoma (PDAC) are frequently referred to tertiary centers after unsuccessful attempted resections at other institutions. The outcome of these patients who are ultimately resected is not well understood. Methods:We performed a retrospective review of patients with PDAC who underwent re-exploration between 1995 and 2013 at a single high volume tertiary care institution. We aimed to evaluate the association of neoadjuvant therapy prior to re-exploration on pathologic findings and clinical outcome in previously explored patients with PDAC.Results: Between 1995 and 2013, 50 of the 2,062 patients who were surgically explored underwent pancreatic resection following a previous exploration where they were deemed unresectable. The most common reason for unresectability at initial operation was vascular invasion (80%) and a presumed R2 resection. Thirty-seven (74%) patients received neoadjuvant therapy. Neoadjuvant therapy was associated with improved TNM stage (P=0.002), fewer positive lymph nodes (0 vs. 2, P=0.025), and improved median survival (24 vs. 13 months, P=0.044). Compared to R2 resected patients with PDAC who had not previously been explored, re-explored patients had significantly lower pathologic T and N stages (P<0.001) and a longer median survival (19 vs. 10 months, P<0.001). Conclusions:Patients with PDAC deemed unresectable may warrant re-exploration. Treatment with neoadjuvant therapy between operations is associated with improved pathological stage and survival. In this highly selected group of patients, successful resection is associated with improved survival compared to R2 resections.

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A Systematic Review of Resectability and Survival After Concurrent Chemoradiation in Primarily Unresectable Pancreatic Cancer

Cited by 135 publications

References 56 publications

Individually optimized stereotactic radiotherapy for pancreatic head tumors: A planning feasibility study

Individually optimized stereotactic radiotherapy for pancreatic head tumors: A planning feasibility study

IFN-γ induces the upregulation of RFXAP via inhibition of miR-212-3p in pancreatic cancer cells: A novel mechanism for IFN-γ response

Neoadjuvant therapy prior to surgical resection for previously explored pancreatic cancer patients is associated with improved survival

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