Multimodality Approaches for Pancreatic Cancer

Yang, Gary; Wagner, Timothy D.; Fuß, Martin; Thomas, Charles R.

doi:10.3322/canjclin.55.6.352

Cited by 24 publications

(14 citation statements)

References 102 publications

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“…However, some kinds of cancers, including those of the lung and pancreas, still show an extremely low survival rate, less than 10% (Yang et al, 2005;Jemal et al, 2006). Thus, early diagnostic methods or a rational treatment against these cancers should be developed for increasing their survival rate.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

p53, secreted by K-Ras–Snail pathway, is endocytosed by K-Ras-mutated cells; implication of target-specific drug delivery and early diagnostic marker

Lee

Chung

et al. 2009

Oncogene

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Section: Introductionmentioning

confidence: 99%

“…It is interesting that these types of cancers show frequent alternation in Kisten-Ras (K-Ras: Jones et al, 2008;Ding et al, 2008). In particular, oncogenic mutation of K-Ras is a predominant event in pancreatic cancer (Jones et al, 2008), the survival rate of which is less than 5% (Yang et al, 2005;Jones et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

p53, secreted by K-Ras–Snail pathway, is endocytosed by K-Ras-mutated cells; implication of target-specific drug delivery and early diagnostic marker

Lee

Chung

et al. 2009

Oncogene

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“…Image-guided radiation therapy (IGRT) takes into account the interfraction and intrafraction dose variation, as a consequence of organ motion. Better technology and the use of conformal treatment have led to higher tolerable radiation doses (Yang et al, 2005). With improvements in staging and radiation techniques future studies may re-evaluate the application of upfront chemoradiation or the use of early systemic therapy for the treatment of micro metastases followed by consolidation therapy within adequately powered studies.…”

Section: à2mentioning

confidence: 99%

Systematic review, including meta-analyses, on the management of locally advanced pancreatic cancer using radiation/combined modality therapy

et al. 2007

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There is no consensus on the management of locally advanced pancreatic cancer, with either chemotherapy or combined modality approaches being employed (Maheshwari and Moser, 2005). No published meta-analysis (Fung et al, 2003;Banu et al, 2005;Liang, 2005;Bria et al, 2006;Milella et al, 2006) has included randomised controlled trials employing radiation therapy. The aim of this systematic review was to compare the following: (i) chemoradiation followed by chemotherapy (combined modality therapy) vs best supportive care (ii) radiotherapy vs chemoradiation (iii) radiotherapy vs combined modality therapy (iv) chemotherapy vs combined modality therapy (v) 5FU-based combined modality treatment vs another-agent-based combined modality therapy. Relevant randomised controlled trials were identified by searching databases, trial registers and conference proceedings. The primary end point was overall survival and secondary end points were progression-free survival/time-to-progression, response rate and adverse events. Survival data were summarised using hazard ratio (HR) and response-rate/adverse-event data with relative risk. Eleven trials involving 794 patients met the inclusion criteria. Length of survival with chemoradiation was increased compared with radiotherapy alone (two trials, 168 patients, HR 0.69; 95% confidence interval (CI) 0.51 -0.94), but chemoradiation followed by chemotherapy did not lead to a survival advantage over chemotherapy alone (two trials, 134 patients, HR 0.79; CI 0.32 -1.95). Meta-analyses could not be performed for the other comparisons. A survival benefit was demonstrated for chemoradiation over radiotherapy alone. Chemoradiation followed by chemotherapy did not demonstrate any survival advantage over chemotherapy alone, but important clinical differences cannot be ruled out due to the wide CI.

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“…With only about 1% of patients is still alive 5 years from the time of diagnosis, these patients have a very poor prognosis. Current therapeutic approaches for patients with LAPC include these of chemoradiotherapy (CRT) or chemotherapy (1,2). Tumor-associated antigens, including carcinoembyronic antigen (CEA), pancreatic anti-oncofetal antigen, tissue polypeptide, cancer antigen (CA) 125, and carbohydrate antigen (CA) 19-9 have been linked to pancreatic adenocarcinoma.…”

Section: Introductionmentioning

confidence: 99%

Change in CA 19-9 Levels after Chemoradiotherapy Predicts Survival in Patients with Locally Advanced Unresectable Pancreatic Cancer

Yang

Malik

Chandrasekhar

et al. 2010

International Journal of Radiation Oncology*Biology*Physics

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.Purpose: RTOG 9704 demonstrated a prognostic role for postoperative CA 19-9 in patients with resectable pancreatic carcinoma following surgery. Our study aimed to investigate whether CA 19-9 provided similar prognostic information in patients with locally advanced unresectable pancreatic cancer (LAPC) treated with chemoradiotherapy (CRT) and to determine whether such endpoints should therefore be reported in future randomized trials. Only patients with a bilirubin of less than 2 mg/dL at the time the CA 19-9 was evaluated were included in the analysis to avoid the confounding effect of hyperbilirubinemia. Of the eligible patients, 54 had pre and post CRT CA 19-9 values available. The median age was 68 years and 52% were female. Categorized versions of the first post-CRT CA 19-9 were tested in 50 point increments beginning at <50 to >1,000 and percent change in pre to post-CRT CA 19-9 using cut points of 10% increments from <0% (increased) to >90%. Survival was measured from the date of first post CRT CA 19-9 level until death or last follow-up.Univariate and multivariate statistical methodologies were used to determine significant prognostic factors for overall survival.Results: Median CA 19-9 prior to CRT was 363 U/mL and post CRT median was 85.5 U/mL. Following CRT, patients with a decrease of >90% from their baseline CA 19-9 level had a significantly improved median survival than those that did not (16.2 vs. 7.5 months, P=0.01). The median survival of patients with a CA 19-9 level lower than the median post CRT value was 10.3 months, compared with 7.1 months for those with a CA 19-9 level greater than the median (P=0.03). Post CRT CA 19-9 less than 50 U/mL and histologic grade I-II also showed prognostic significance (both P=0.03). In multivariate analysis, post CRT CA 19-9 less than the median level of 85.5 U/mL was an independent prognostic factor for overall survival (HR 0.34; 95% CI, 0.13-0.85, P=0.02). Conclusions:Our results indicate that post treatment CA 19-9 is predictive for overall survival in patient with LAPC following CRT. We recommend that pre and post treatment CA 19-9 levels be obtained in patients receiving CRT and that these values be considered for prognostic nomograms and future clinical trials.

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Multimodality Approaches for Pancreatic Cancer

Cited by 24 publications

References 102 publications

p53, secreted by K-Ras–Snail pathway, is endocytosed by K-Ras-mutated cells; implication of target-specific drug delivery and early diagnostic marker

p53, secreted by K-Ras–Snail pathway, is endocytosed by K-Ras-mutated cells; implication of target-specific drug delivery and early diagnostic marker

Systematic review, including meta-analyses, on the management of locally advanced pancreatic cancer using radiation/combined modality therapy

Change in CA 19-9 Levels after Chemoradiotherapy Predicts Survival in Patients with Locally Advanced Unresectable Pancreatic Cancer

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