Thin-section contrast-enhanced computed tomography accurately predicts the resectability of malignant pancreatic neoplasms

Fuhrman, George M.; Charnsangavej, Chusilp; Abbruzzese, James L.; Cleary, Karen R.; Martin, Randi C.; Fenoglio, Claudia J.; Evans, Douglas B.

doi:10.1016/0002-9610(94)90060-4

Cited by 225 publications

(74 citation statements)

References 22 publications

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“…We applied rigorous radiological criteria to clearly define our study population. In agreement with other centers, 24,25 we consider a highquality CT scan as an objective, reproducible, and reliable technique for pretreatment staging, identification of subsets of patients on the basis of vascular involvement, and definition of resectability status. In our opinion, a portal thrombosis or a major artery (SMA or CA) encasement should be regarded as unresectability criteria.…”

Section: Discussionsupporting

confidence: 73%

Pancreatic Resections after Chemoradiotherapy for Locally Advanced Ductal Adenocarcinoma: Analysis of Perioperative Outcome and Survival

et al. 2006

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Background: The most accepted treatment for locally advanced pancreatic cancer is chemoradiotherapy. However, indications to and results of pancreatic resections after chemoradiation are not yet defined.Methods: From June 1999 to December 2003, 28 patients with locally advanced pancreatic cancer (group 1) were enrolled for institutional trials of gemcitabine-based chemoradiotherapy. Tumors were stratified as unresectable or borderline resectable according to the pattern of vascular involvement at pretreatment computed tomographic scan. Patients with partial response or stable disease and in-range Ca19-9 were surgically explored. Perioperative outcome and survival of group 1 were compared with 44 patients primary resected for localized cancer with or without adjuvant treatment in the same time period (group 2).Results: Only one unresectable tumor was successfully resected compared to 7 out of 18 (39%) that were borderline resectable. Operations after chemoradiation were 1 hour longer and postoperative stays 5 days longer, but transfusion rate, morbidity, and mortality were not significantly different. Median survival was 15.4 months for group 1 (>21 for resected vs. 10 for not resected, P < 0.01) and 14 months for group 2. In both groups, a disease-free survival beyond 24 months was recorded only among patients resected with negative margins.Conclusions: The conversion of an unresectable cancer to a resectable one is a rare event. On the contrary, the resection of a borderline resectable tumor was successfully accomplished in one-third of cases. Chemoradiotherapy did not increase the operative risk, but the interventions were more technically demanding and required a longer postoperative stay. Patients resected after chemoradiation for a locally advanced tumor had at least the same survival as those primary resected for a localized one. Only R0 resections in both groups gave the chance of disease-free survival longer than 24 months.

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Section: Discussionsupporting

confidence: 73%

Pancreatic Resections after Chemoradiotherapy for Locally Advanced Ductal Adenocarcinoma: Analysis of Perioperative Outcome and Survival

et al. 2006

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“…However, this advanced CT technique remains the diagnostic and staging modality of choice for these patients. '6'17 Fuhrman et al 18 in 1994 reported on 42 patients with pancreatic malignancies in whom thin-section contrast-enhanced CT scans were used as the preoperative staging modality predicting resectability. A pancreatic resection was performed in 37 patients for a resectability rate of 88%.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Ultrasound Enhances Standard Laparoscopy in the Staging of Pancreatic Cancer

Minnard¹,

Conlon²,

Hoos³

et al. 1998

Annals of Surgery

145

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ObjectiveTo define the role of laparoscopic ultrasound (LUS) in the staging of pancreatic tumors. Summary Background DataLaparoscopy has recently been established as a valuable tool in the staging of pancreatic cancer. It has been suggested that the addition of LUS to standard laparoscopy could improve the accuracy of this procedure. MethodsA prospective evaluation of 90 patients with pancreatic tumors undergoing laparoscopy and LUS was performed over a 27-month period. LUS equipped with an articulated curved and linear array transducer (6 to 10 MHz) was used. All patients underwent rigorous laparoscopic examination. Clinical, surgical, and pathologic data were collected. ResultsThe median age was 65 years (range 43 to 85 years). Sixty

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“…The prognosis of pancreatic cancer continues to be one of the most dismal among all the solid neoplasms [1]. To date, the only potentially curative therapy is surgical resection.…”

Section: Introductionmentioning

confidence: 99%

Phase II Trial of Primary Radiation Therapy and Concurrent Chemotherapy for Patients with Locally Advanced Pancreatic Cancer

Magnino¹,

Gatti

Massucco³

et al. 2005

Oncology

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Objectives: Primary chemoradiotherapy for locally advanced pancreatic cancer (LAPC) may improve local control, curative resection rate and long-term survival. We performed a phase II study to evaluate toxicity and activity of primary radiation therapy and concurrent chemotherapy with gemcitabine (GEM) twice weekly in patients (pts) with LAPC. Methods: From 6/1999 to 6/2003, 23 LAPC pts received GEM 100 mg/m² twice weekly in the first 15 pts and 50 mg/m² in the last 8 pts, concurrently with radiotherapy (1.8 Gy/day for a total dose of 45 Gy). Results: The treatment was completed in 19/23 pts. Toxicities: G3–4 hematological toxicity occurred in 35 and 4% respectively; G3 nausea and vomiting and gastrointestinal toxicity in 30%. Clinical benefit was found in 10/18 pts (55%). Overall response: partial response rate 4/18 (22%); stable disease 13/18 (72%); progressive disease 1/18 (6%). Six pts underwent pancreaticoduodenectomy with extended lymphadenectomy (5/6 pts pT3, 1/6 pts microscopic cancer foci, 1/6 N+, 5/6 negative retroperitoneal margin). Median survival: 14 months for the entire group, 12 months for unresected pts, 20 months for resected pts. Conclusions: The treatment with GEM twice weekly at 50 mg/m² associated with radiotherapy (45 Gy) is feasible and permits to obtain clinical benefit in a good percentage of pts. Objective response, median survival, and local and systemic control are similar to other studies and need further improvement.

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Thin-section contrast-enhanced computed tomography accurately predicts the resectability of malignant pancreatic neoplasms

Cited by 225 publications

References 22 publications

Pancreatic Resections after Chemoradiotherapy for Locally Advanced Ductal Adenocarcinoma: Analysis of Perioperative Outcome and Survival

Pancreatic Resections after Chemoradiotherapy for Locally Advanced Ductal Adenocarcinoma: Analysis of Perioperative Outcome and Survival

Laparoscopic Ultrasound Enhances Standard Laparoscopy in the Staging of Pancreatic Cancer

Phase II Trial of Primary Radiation Therapy and Concurrent Chemotherapy for Patients with Locally Advanced Pancreatic Cancer

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