Role of EUS in the management of pancreatic and ampullary carcinoma: a prospective study assessing resectability and prognosis

Buscail, Louis; Pagès, P; Berthélemy, Philippe; Fourtanier, G; Frexinos, Jacques; Escourrou, J.

doi:10.1016/s0016-5107(99)70341-x

Cited by 130 publications

(69 citation statements)

References 23 publications

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“…18 Ampullary tumors are considered unresectable when the tumor invades the portal vein or mesenteric artery or vein; the tumor invades the adjacent organs, such as the spleen, stomach, or mesocolon; or when hepatic or peritoneal metastasis is observed. 19 Because ampullary tumors easily occlude the CBD before invading the adjacent tissues or metastasizing to distant organs, EUS had a limited role in predicting tumor resectability in our study. Larger series of cases with vascular involvements are needed to evaluate the accuracy of EUS in predicting tumor resectability.…”

Section: Discussionmentioning

confidence: 84%

Reappraisal of endosonography of ampullary tumors: Correlation with transabdominal sonography, CT, and MRI

Chen

Yang

Yeh

et al. 2008

J of Clinical Ultrasound

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Purpose. To reappraise the accuracy of transabdominal sonography (US), CT, MRI, and endosonography (EUS) in the diagnosis and staging of ampullary tumors.Method. We reviewed the medical records and the images of 41 consecutive patients with ampullary tumors. Tumor detection rate and accuracy of TNM (tumor-node-metastasis) staging of malignant tumors were determined. Imaging findings were correlated with histopathologic findings.Results. The detection rates for ampullary tumors were 97.6% for EUS, 81.3% for MRI, 28.6% for CT, and 12.2% for US (p < 0.001 for EUS versus CT; p < 0.001 for EUS versus US; p > 0.05 for EUS versus MRI). The accuracy in T staging for ampullary carcinomas was 72.7% for EUS, 53.8% for MRI, and 26.1% for CT (p < 0.01 for EUS versus CT; p > 0.05 for EUS versus MRI). The accuracy in N staging for ampullary carcinomas was 66.7% for EUS, 76.9% for MRI, and 43.5% for CT with no statistically significant difference between the 3 modalities. The sensitivity in detecting malignant lymph nodes was 46.7% for EUS, 25.0% for MRI, and 0% for CT (p < 0.01 for EUS versus CT; p > 0.05 for EUS versus MRI; p > 0.05 for MRI versus CT). Transpapillary stenting, advanced tumor extension (>T2), large tumor size (>2 cm), tumor differentiation, and endoscopic appearance of tumor growth did not significantly influence EUS accuracy in T or N staging (p > 0.05). A mpullary carcinomas often manifest with jaundice, abdominal pain, and anemia. They tend to have a higher resectability rate and better subsequent prognosis than other periampullary carcinomas. 1,2 It has been reported that if ampullary carcinoma invades the pancreas, the incidence of lymph node metastasis increases, and prognosis is poor. 3,4 However, there is substantial support in the literature for local resection of T1 ampullary tumors because of the very low incidence of lymph node metastasis. 5,6 Accurate staging of ampullary tumors is therefore critical for surgical planning and predicting the patient's prognosis. Conclusion. EUS was superior to CT and was equiv-Radial endosonography (EUS) provides highresolution sonograms by placing a high-frequency (7.5-12 MHz) ultrasound probe in close proximity to the periampullary region, avoiding interference from soft tissues and bowel gas. EUS can clearly delineate the pancreatic

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Section: Discussionmentioning

confidence: 84%

Reappraisal of endosonography of ampullary tumors: Correlation with transabdominal sonography, CT, and MRI

Chen

Yang

Yeh

et al. 2008

J of Clinical Ultrasound

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“…Bypass procedures can be reserved for patients in whom stenting fails [32][33][34][35][36]. A single-institution study of 155 laparoscopically staged patients, 40 with locally advanced disease and 115 with metastatic disease, assessed the need for a surgical bypass procedure.…”

Section: Obstructive Jaundicementioning

confidence: 99%

“…The Oncologist 2003;8: [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] The expected number of new cases of pancreatic cancer in 2002 within the article should read 30,300 rather than 33,000. The authors would like to thank Dr. Tom Cole for bringing this to their attention.…”

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confidence: 99%

Metastatic Pancreatic Cancer: Emerging Strategies in Chemotherapy and Palliative Care

2003

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For these reasons, efforts at identifying and treating disease-related symptomatology are priorities. This update overviews symptom management, supportive care strategies, and both standard and emerging palliative chemotherapy options. The incorporation of molecularly targeted therapies into treatment of metastatic pancreatic cancer is reviewed as well. These strategies are of relevance to internists, gastroenterologists, oncologists, and other specialists who care for patients with pancreatic cancer.

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“…Indeed, other important alterations in pancreatic cancer include mutations in the K-ras oncogene (90%), the p53 (85%) and Smad4 (50%) tumor-suppressor genes and the p16 (85% mutated and 15% silenced epigenetically) cell cycle inhibitor gene. [68][69][70][71] Together, these alterations promote cellular proliferation, suppress inhibitory pathways, and facilitate tumor spread and metastasis.…”

Section: Discussionmentioning

confidence: 99%

Replication-deficient rSV40 mediate pancreatic gene transfer and long-term inhibition of tumor growth

et al. 2006

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Pancreatic cancer is one of the most aggressive and devastating human malignancies. There is an urgent need for more effective therapy for patients with advanced disease. In this context, genetic therapy potentially represents a rational new approach to treating pancreatic cancer, which could provide an adjunct to conventional options. Because of the promise of recombinant SV40 vectors, we tested their ability to deliver a transgene, and to target a transcript, so as to inhibit pancreatic tumors growth in vivo. BxPC3 and Capan-1 cells were efficiently transduced using SV40 vectors without selection, as compared to synthetic vectors PEI. SV40 vectors were as efficient as adenoviral vectors, and provided long-term transgene expression. Next, we devised a SV40-derived, targeted gene therapy approach of pancreatic cancer, by combining hTR tumor-specific promoter with sst2 somatostatin receptor tumor-suppressor gene. In vitro cell proliferation was strongly impaired following administration of SV(hTR-sst2). SV40-derived sst2-mediated antiproliferative effect was dependent on the local production of somatostatin. In vivo, intratumoral gene transfer of sst2 using rSV40 vectors resulted in a marked inhibition of Capan-1 tumor progression, and proliferation. These results represent the initial steps toward a novel approach to the gene therapy of pancreatic cancer using SV40 as a vector.

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Role of EUS in the management of pancreatic and ampullary carcinoma: a prospective study assessing resectability and prognosis

Cited by 130 publications

References 23 publications

Reappraisal of endosonography of ampullary tumors: Correlation with transabdominal sonography, CT, and MRI

Reappraisal of endosonography of ampullary tumors: Correlation with transabdominal sonography, CT, and MRI

Metastatic Pancreatic Cancer: Emerging Strategies in Chemotherapy and Palliative Care

Replication-deficient rSV40 mediate pancreatic gene transfer and long-term inhibition of tumor growth

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