Pancreatic Adenocarcinoma, Version 2.2012

Tempero, Margaret A.; Arnoletti, J. Pablo; Behrman, Stephen W.; Ben‐Josef, Edgar; Benson, Al B.; Casper, Ephraim S.; Cohen, Steven J.; Czito, Brian G.; Ellenhorn, Joshua D. I.; Hawkins, William G.; Herman, Joseph M.; Hoffman, John P.; Ko, Andrew H.; Komanduri, Srinadh; Koong, Albert C.; Wee, Wen; Malafa, Mokenge P.; Merchant, Nipun B.; Mulvihill, Sean J.; Muscarella, Peter; Nakakura, Eric K.; Obando, Jorge; Pitman, Martha B.; Sasson, Aaron R.; Tally, Anitra; Thayer, Sarah P.; Whiting, Samuel H.; Wolff, Robert A.; Wolpin, Brian M.; Freedman-Cass, Deborah A.; Shead, Dorothy A.

doi:10.6004/jnccn.2012.0073

Cited by 301 publications

(179 citation statements)

References 41 publications

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“…Endoscopic ultrasound (EUS) can complement other imaging modalities with valuable staging information and is good in detecting especially smaller lesions. At present, the routine use of endoscopic retrograde cholangiopancreatography or fluorine-18 fluorodeoxyglucose positron emission tomography cannot be recommended [8,13]. …”

Section: Diagnosticsmentioning

confidence: 99%

“…In most cases, tumor diagnosis and resectability is adequately evaluable using one cross-sectional imaging study and the current state-of-the-art imaging modality is contrast-enhanced multidetector computed tomography (CT) with advanced volumetric processing techniques [8,13]. Patients are typically scanned in an arterial and venous phase.…”

Section: Diagnosticsmentioning

confidence: 99%

“…EUS-guided fine needle aspiration (EUS-FNA) is regarded to be the best modality for obtaining a tissue diagnosis in locoregional disease when needed (e.g. prior to neoadjuvant therapy) [8,13]. …”

Section: Diagnosticsmentioning

confidence: 99%

“…Current guidelines differentiate between resectable, borderline resectable, locally advanced unresectable and metastatic pancreatic cancer [8]. Surgery embedded in a multimodal setting is the cornerstone in the therapy of resectable and borderline resectable disease.…”

Section: Introductionmentioning

confidence: 99%

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Pancreatic Cancer: Current Options for Diagnosis, Staging and Therapeutic Management

Hartwig

Büchler²

2013

Gastrointest Tumors

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Background: Pancreatic cancer is characterized by frequently delayed diagnosis and aggressive tumor growth which hampers most of the current treatment modalities. This review aims to summarize the available evidence about the diagnostic and therapeutic aspects of resectable and non-resectable pancreatic cancer therapy. Summary: Embedded in the concept of multimodal therapy, surgery plays the central role in the treatment of pancreatic cancer. With advantageous tumor characteristics and complete tumor resection as the most relevant positive prognostic factors, the detection of premalignant or early invasive lesions combined with safe and oncologic adequate surgery is the major therapeutic aim. Most pancreatic adenocarcinomas are locally advanced or metastatic when diagnosed and need to be treated by the combination of surgery and (radio)chemotherapy or by palliative chemotherapy. Key Message An interdisciplinary, multimodal approach to therapy is critical for improving the outcomes of patients with pancreatic cancer. Practical Implications Cross-sectional imaging techniques (such as contrast-enhanced multidetector computed tomography) are useful for assessing tumor resectability. For localized, non-metastatic, resectable tumors, the necessity of preoperative biopsies remains controversial. Important prognostic parameters are tumor size, invasion of surrounding tissue, lymph node metastasis and distant metastasis. Various classification systems based on the TNM system have been used for tumor staging and prognosis. The presence of distant metastases is regarded as non-resectable disease, requiring chemotherapy as first treatment. The definition of borderline resectable tumors is still under debate, although a recent definition has been provided by an expert consensus statement. Standard lymphadenectomy is the recommended procedure in pancreatoduodenectomy, based upon the guidelines of the International Study Group of Pancreatic Surgery (ISGPS). Adjuvant chemotherapy is applied in generally all cases of pancreatic ductal adenocarcinoma following macroscopic complete tumor resection. The benefits of adjuvant chemoradiotherapy or immunochemoradiotherapy, or neoadjuvant therapy, however, remain a matter of controversy. For palliative treatment gemcitabine monotherapy is widely used; the FOLFIRINOX protocol provides an alternative for a minority of patients.

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Section: Diagnosticsmentioning

confidence: 99%

Section: Diagnosticsmentioning

confidence: 99%

Section: Diagnosticsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Pancreatic Cancer: Current Options for Diagnosis, Staging and Therapeutic Management

Hartwig

Büchler²

2013

Gastrointest Tumors

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“…About 80% of pancreatic carcinomas are located in pancreas head, and adenocarcinomas comprise 75% of them [1]. Strong evidence from previous studies showed that complete resection is the only chance for cure, which is possible only in 10% -20% of patients [2]. Thus, palliative managements are the sole treatment options for about 80% of pancreatic cancer patients.…”

Section: Introductionmentioning

confidence: 99%

Surgical Bypass versus Endoscopic Stenting for Unresectable Head Pancreatic Cancer, Which Palliative Treatment Is Better in Developing Countries, Morocco as an Example

Mazine¹,

Mohammed²,

Karima³

et al. 2017

OJGas

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Background: Metal stents for unresectable pancreatic cancer are associated with longer patency and superior cost-effectiveness. However, they are too expensive to be recommended routinely in developing countries. Moreover, a debate on outcome results in these patients who receive plastic biliary endoprothesis versus surgical bypass as palliation of obstructive jaundice. We aimed to compare retrospectively the outcomes in patients treated with plastic stent or surgical bypass as a palliative option for these patients. Patients and Methods: We have examined data for patients (n = 86) who received endoscopic stenting (n = 64) or surgical bypass (n = 22), from January 2013 to November 2016, as a palliative treatment for obstructive jaundice from inoperable cancer head pancreas. Results: Serum bilirubin and CA19.9 levels were comparable in age and gender matched patient groups. Moreover, post-operative major complications and 30-days mortality showed no significant differences among patient groups. However, surgical bypass treated patients showed longer initial hospital stay (9 vs. 6 days, p = 0.014), higher cost ($1600 vs. $1088) and longer survival (192 vs. 101 days, p = 0.003) compared to endoscopy-stenting treated patients. Re-hospitalization was required for 5 stented patients (averaged $448). Conclusion: Biliary bypass surgery for unresectable pancreatic cancer may improve patient survival, although prolongs hospital stay. It may be recommended for relatively fit patients with a life expectancy of 6 months and more.

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Pathological Complete Response in Patients With Resected Pancreatic Adenocarcinoma After Preoperative Chemotherapy

Stoop,

Oba,

et al. 2024

JAMA Netw Open

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ImportancePreoperative chemo(radio)therapy is increasingly used in patients with localized pancreatic adenocarcinoma, leading to pathological complete response (pCR) in a small subset of patients. However, multicenter studies with in-depth data about pCR are lacking.ObjectiveTo investigate the incidence, outcome, and risk factors of pCR after preoperative chemo(radio)therapy.Design, Setting, and ParticipantsThis observational, international, multicenter cohort study assessed all consecutive patients with pathology-proven localized pancreatic adenocarcinoma who underwent resection after 2 or more cycles of chemotherapy (with or without radiotherapy) in 19 centers from 8 countries (January 1, 2010, to December 31, 2018). Data collection was performed from February 1, 2020, to April 30, 2022, and analyses from January 1, 2022, to December 31, 2023. Median follow-up was 19 months.ExposuresPreoperative chemotherapy (with or without radiotherapy) followed by resection.Main Outcomes and MeasuresThe incidence of pCR (defined as absence of vital tumor cells in the sampled pancreas specimen after resection), its association with OS from surgery, and factors associated with pCR. Factors associated with overall survival (OS) and pCR were investigated with Cox proportional hazards and logistic regression models, respectively.ResultsOverall, 1758 patients (mean [SD] age, 64 [9] years; 879 [50.0%] male) were studied. The rate of pCR was 4.8% (n = 85), and pCR was associated with OS (hazard ratio, 0.46; 95% CI, 0.26-0.83). The 1-, 3-, and 5-year OS rates were 95%, 82%, and 63% in patients with pCR vs 80%, 46%, and 30% in patients without pCR, respectively (P &lt; .001). Factors associated with pCR included preoperative multiagent chemotherapy other than (m)FOLFIRINOX ([modified] leucovorin calcium [folinic acid], fluorouracil, irinotecan hydrochloride, and oxaliplatin) (odds ratio [OR], 0.48; 95% CI, 0.26-0.87), preoperative conventional radiotherapy (OR, 2.03; 95% CI, 1.00-4.10), preoperative stereotactic body radiotherapy (OR, 8.91; 95% CI, 4.17-19.05), radiologic response (OR, 13.00; 95% CI, 7.02-24.08), and normal(ized) serum carbohydrate antigen 19-9 after preoperative therapy (OR, 3.76; 95% CI, 1.79-7.89).Conclusions and RelevanceThis international, retrospective cohort study found that pCR occurred in 4.8% of patients with resected localized pancreatic adenocarcinoma after preoperative chemo(radio)therapy. Although pCR does not reflect cure, it is associated with improved OS, with a doubled 5-year OS of 63% compared with 30% in patients without pCR. Factors associated with pCR related to preoperative chemo(radio)therapy regimens and anatomical and biological disease response features may have implications for treatment strategies that require validation in prospective studies because they may not universally apply to all patients with pancreatic adenocarcinoma.

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Pancreatic Adenocarcinoma, Version 2.2012

Cited by 301 publications

References 41 publications

Pancreatic Cancer: Current Options for Diagnosis, Staging and Therapeutic Management

Pancreatic Cancer: Current Options for Diagnosis, Staging and Therapeutic Management

Surgical Bypass versus Endoscopic Stenting for Unresectable Head Pancreatic Cancer, Which Palliative Treatment Is Better in Developing Countries, Morocco as an Example

Pathological Complete Response in Patients With Resected Pancreatic Adenocarcinoma After Preoperative Chemotherapy

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