Adjuvant Radiotherapy and 5-Fluorouracil After Curative Resection of Cancer of the Pancreas and Periampullary Region

Klinkenbijl, Jean H. G.; Jeekel, J.; Sahmoud, Tarek; Pel, Renée van; Couvreur, M.L.; Veenhof, C. H. N.; Arnaud, J P; González, D. González; Wit, L. T. de; Hennipman, A.; Wils, J.

doi:10.1097/00000658-199912000-00006

Cited by 1,204 publications

(744 citation statements)

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“…Unfortunately, the data accumulated since then have not been uniformly supportive of these findings (11,12,20,21). Almost 20 years later, the role of adjuvant therapies in pancreatic cancer is controversial, with most patients receiving adjuvant therapy only as part of one of many ongoing clinical trials.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, the benefit of adjuvant therapies in the treatment of pancreatic cancer has yet to be definitively demonstrated. Nonetheless, accumulating experience with the well-known agent 5-fluorouracil suggests that a role may exist for adjuvant chemotherapy, either alone or in combination with radiation (11,12). Additional studies exploring the postoperative use of other cytotoxic agents, including the promising deoxycytidine analogue gemcitabine, are currently in progress (3).…”

Section: Introductionmentioning

confidence: 99%

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Survival Efficacy of Adjuvant Cytosine-Analogue CS-682 in a Fluorescent Orthotopic Model of Human Pancreatic Cancer

et al. 2004

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Adjuvant treatment with the cytosine analogue 1-(2-C-cyano-2-deoxy-␤-D-arabino-pentofuranosyl)-N 4 -palmitoylcytosine (CS-682) results in a highly significant increase in survival in the aggressive orthotopic MIAPaCa-2 human pancreatic cancer mouse model. Seven days after implantation, mice were randomized into eight groups, depending on whether they were to be treated by tumor resection, 5 weeks of CS-682 chemotherapy at 40 -60 mg/kg once daily, or both. Throughout the course of treatment, noninvasive optical whole-body imaging based on brilliant red fluorescent protein expression of the tumor permitted visualization and quantification of primary, metastatic, and recurrent disease. Total tumor burden negatively correlated with survival. Untreated mice died of disseminated disease with a median survival of 26 days. Surgical resection alone conferred a small but significant survival advantage (median survival, 28 days, P ‫؍‬ 0.03). Primary CS-682 treatment at all doses also significantly prolonged survival compared with untreated animals (P < 0.05) and was more effective than surgery alone at doses of 50 and 60 mg/kg (median survival, 34 days, P ‫؍‬ 0.045, and 38.5 days, P ‫؍‬ 0.03, respectively). Maximal survival (median, 48 days, with 30% of animals surviving longer than 60 days) was achieved by adjuvant CS-682 (50 mg/kg), given after surgical resection of the primary pancreatic tumor (P ‫؍‬ 0.004 compared with surgery alone). The results demonstrate that adjuvant oral administration of CS-682 for pancreatic cancer is highly effective with acceptable toxicity, suggesting its potential for cure of this disease in appropriate combinations.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Survival Efficacy of Adjuvant Cytosine-Analogue CS-682 in a Fluorescent Orthotopic Model of Human Pancreatic Cancer

et al. 2004

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“…Those receiving 5-FU combined with a platinum-based agent showed a better response rate and median progression-free survival [33]. Radiotherapy has been combined with chemotherapy in duodenal adenocarcinoma [34]. Another study found no difference in 5-year survival between those did and did not receive concurrent 5-FU and radiotherapy.…”

Section: Adjuvant Therapymentioning

confidence: 99%

Small Bowel Adenocarcinoma – Report of Two Cases and Review of Literature

2012

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Although accounting for 90 % of the intestinal surface area, small bowel adenocarcinomas are not common. The majority of these lesions are incidentally detected during laparotomy for intestinal obstruction or perforation. The symptoms associated with these lesions are not very specific and preoperative diagnosis is rare. We report two cases of jejunal adenocarcinomas detected in patients undergoing laparotomy for acute abdomen and review the literature for small bowel adenocarcinomas.

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“…Adjuvant EBRT and IORT have been used alone and in combination in the adjuvant setting (Table 2) [21,32,[53][54][55][56][57][58][59][60] . The majority of studies indicate that EBRT alone or in combination with IORT has a significant survival advantage over the use of IORT alone.…”

Section: Adjuvant Radiotherapy (Chemoradiotherapy)mentioning

confidence: 99%

“…The trial will recruit 110 patients into each arm and will be completed by 2007 aiming to provide a definitive answer to the role of adjuvant regional therapy for pancreatic cancer. [53] 1993 26 45-55 20 18 Zerbi et al [21] 1994 43 12.5-20 1 9 71 7 4 7 1 2 49 10 Di Carlo et al [54] 1997 27 14 2 7 12.5-201 7 Dobelbower et al [55] 1997 [57] 1998 34 24 EBRT 13 EBRT + IOR 1 3 59 19 Klinkenbijl et al* [58] 1999 54pdc 12.6 10 60pdc 4 0 17.1 20 Mehta et al [59] 2000 52 45-54 8 IORT 32 75 38 Lee et al [60] 2000 22 47 1 3 4 9 81 EBRT = external beam radiotherapy; IORT = intraoperative radiotherapy; nm = nega tive resection margin; pm = positive resection margin; pdc = pancreatic ductal adenocarcinoma.…”

Section: Adjuvant Regional Therapymentioning

confidence: 99%

Adjuvant therapy for pancreatic cancer

Aung

Smith

Neoptolemos

2007

Expert Opinion on Pharmacotherapy

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The outlook for patients with pancreatic cancer has been grim. There have been major advances in the surgical treatment of pancreatic cancer, leading to a dramatic reduction in post-operative mortality from the development of high volume specialized centres. This stimulated the study of adjuvant and neoadjuvant t r e a t m e n t s i n p a n c r e a t i c c a n c e r i n c l u d i n g chemoradiotherapy and chemotherapy. Initial protocols have been based on the original but rather small GITSG study first reported in 1985. There have been two large European trials totalling over 600 patients (EORTC and ESPAC-1) that do not support the use of chemoradiation as adjuvant therapy. A second major finding from the ESPAC-1 trial (541 patients randomized) was some but not conclusive evidence for a survival benefit associated with chemotherapy. A third major finding from the ESPAC-1 trial was that the quality of life was not affected by the use of adjuvant treatments compared to surgery alone. The ESPAC-3 trial aims to assess the definitive use of adjuvant chemotherapy in a randomized controlled trial of 990 patients. Subject headingspancreatic neoplasms/drug therapy; pancreatic neoplasms/radiotherapy; human; review Ghaneh P, Slavin J, Sutton R, Hartley M, Neoptolemos JP.

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Adjuvant Radiotherapy and 5-Fluorouracil After Curative Resection of Cancer of the Pancreas and Periampullary Region

Abstract: Adjuvant radiotherapy in combination with 5-fluorouracil is safe and well tolerated. However, the benefit in this study was small; routine use of adjuvant chemoradiotherapy is not warranted as standard treatment in cancer of the head of the pancreas or periampullary region.

Cited by 1,204 publications

References 34 publications

Survival Efficacy of Adjuvant Cytosine-Analogue CS-682 in a Fluorescent Orthotopic Model of Human Pancreatic Cancer

Survival Efficacy of Adjuvant Cytosine-Analogue CS-682 in a Fluorescent Orthotopic Model of Human Pancreatic Cancer

Small Bowel Adenocarcinoma – Report of Two Cases and Review of Literature

Adjuvant therapy for pancreatic cancer

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