Diagnosis and Management of Borderline Resectable Pancreatic Adenocarcinoma

Schwarz, L.; Katz, Matthew H.

doi:10.1016/j.hoc.2015.04.004

Cited by 19 publications

(3 citation statements)

References 66 publications

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“… 5 However, biomarkers actually utilized in clinical practice are currently limited to clinicopathological characteristics such as the histological stage, pathological type, resection margins, or tumor–node–metastasis (TNM) stage, which can be evaluated only through postoperative histological studies and findings during surgery. 6 – 8 Therefore, new biomarkers that are inexpensive and technically feasible are required.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of preoperative lymphocyte-to-monocyte ratio in pancreatic adenocarcinoma

Li¹,

Xu²,

Ji³

et al. 2016

OTT

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BackgroundInflammation and immunity have an important role in the development of cancer. The lymphocyte-to-monocyte ratio (LMR) has been shown to be of prognostic value in several malignant forms. The purpose of this study was to analyze the prognostic significance of preoperative LMR in post-curative resection of pancreatic adenocarcinoma.MethodsA total of 144 patients with primary pancreatic adenocarcinoma who underwent curative operation were enrolled in this retrospective study. The correlation between preoperative LMR and survival was analyzed using Kaplan–Meier curves and multivariate Cox regression analyses.ResultsIn the univariate analysis, an elevated preoperative LMR was significantly associated with an increased overall survival (OS) (19 months vs 12 months, P=0.000), and this result remained significant in the multivariate analysis (hazard ratio [HR]: 0.148; 95% confidence interval [CI]: 0.085–0.252; P=0.000). Furthermore, patients with high LMR also had higher median recurrence-free survival (RFS) than patients with low LMR in univariate (18 months vs 10 months, P=0.000) and multivariate analyses (HR: 0.148; 95% CI: 0.085–0.252; P=0.000). Subgroup analyses showed that both patients with stage III cancer and patients with stage I+II cancer can obtain OS and RFS benefits from high LMR.ConclusionLMR can be considered as an independent prognostic biomarker for operable pancreatic adenocarcinoma.

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Section: Introductionmentioning

confidence: 99%

Prognostic value of preoperative lymphocyte-to-monocyte ratio in pancreatic adenocarcinoma

Li¹,

Xu²,

Ji³

et al. 2016

OTT

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“…Similarly, a group of French investigators showed that neoadjuvant therapy reduced the accuracy of the ability of CT scan to delineate operability, which was due in particular to an overestimation of vascular invasion in these patients . Based on these and additional similar findings, experts in the field have stated that it is ‘critical to understand that RECIST should not be used as a primary determinant of resectability after neoadjuvant therapy.’ We found that patients receiving neoadjuvant treatment exhibited a favorable pathological response to treatment and demonstrated reduced margin positivity despite an apparent larger radiological tumor size following neoadjuvant therapy. This suggests that such imaging is inadequate for assessing patients’ response before surgery.…”

Section: Discussionmentioning

confidence: 78%

Neoadjuvant chemoradiation for non‐metastatic pancreatic cancer increases margin‐negative and node‐negative rates at resection

Berriochoa

Abdel‐Wahab

Leyrer

et al. 2017

J of Digest Diseases

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“…Patients with pancreatic cancer often present with disease that is not amenable to upfront resection, termed either borderline resectable (BRPC) if the tumor abuts the blood vessel or locally advanced (LAPC) if the tumor is encasing the vessel (Schwarz and Katz 2015).…”

Section: Neoadjuvant Radiotherapymentioning

confidence: 99%

Principles of Radiation Therapy in Older Adults

2017

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The specialty of radiation oncology has significantly evolved over the past few decades. Historically, large volumes of normal tissue were irradiated along with the tumor due to the prevailing techniques and equipment in the era of two-dimensional delivery. This led to an increased incidence of side effects, causing difficulty for elderly patients to tolerate treatment. Not only were toxicities higher but also the radiation dose could not be escalated due to uncertainty about tumor location and dose to the intended target. With the advent of computer integration into the radiation oncology clinic, the therapeutic window improved dramatically. For the first time, tumors could be visualized in three dimensions so that a new technique called 3D conformal radiation therapy (3D-CRT) evolved. The tumors could now be delineated such that the dose could be spatially encompassed with more precision than ever before. This led to significant improvements in local control for a variety of tumor types with fewer side effects, which is of particular concern in elderly patients, who usually present with a higher number of comorbidities that can limit treatment toleration. This chapter will discuss advances in radiotherapy and their significance for elderly patients. It will also discuss considerations for neoadjuvant, definitive, adjuvant, and palliative radiation in a geriatric population across tumor sites, with a focus on toxicity and tolerability.

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Diagnosis and Management of Borderline Resectable Pancreatic Adenocarcinoma

Cited by 19 publications

References 66 publications

Prognostic value of preoperative lymphocyte-to-monocyte ratio in pancreatic adenocarcinoma

Prognostic value of preoperative lymphocyte-to-monocyte ratio in pancreatic adenocarcinoma

Neoadjuvant chemoradiation for non‐metastatic pancreatic cancer increases margin‐negative and node‐negative rates at resection

Principles of Radiation Therapy in Older Adults

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