NCCN Clinical Practice Guidelines in Oncology. Pancreatic Adenocarcinoma
Available from: Shilpen Patel
- "Patients diagnosed and staged according to the AJCC 6 th edition criteria were re-staged accordingly. Borderline disease was defined based on the NCCN guidelines[7,16]. Required criteria for classification of borderline resectable disease based on CT imaging included no distant metastases and at least one of the following: 1) Venous involvement of the SMV and/or PV showing tumor abutment with or without narrowing or short-segment occlusion of the lumen with proximal and distal sparing allowing for safe resection, 2) GDA encasement up to the HA with either short segment encasement or direct abutment of the HA, without extension to the celiac axis, 3) tumor abutment of the SMA ≤180° of the circumference of the vessel wall. "
Available from: Daniel Habermehl
- "According to Gillen and colleagues, resectability criteria varied substantially within the included studies : A minority of studies focussed on the NCCN guidelines for resectability . The majority of studies did not report any detailed information on their resectability criteria. "
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ABSTRACT: To evaluate efficacy and secondary resectability in patients with locally advanced pancreatic cancer (LAPC) treated with neoadjuvant chemoradiotherapy (CRT).
A total of 215 patients with locally advanced pancreatic cancer were treated with chemoradiation at a single institution. Radiotherapy was delivered with a median dose of 52.2 Gy in single fractions of 1.8 Gy. Chemotherapy was applied concomitantly as gemcitabine (GEM) at a dose of 300 mg/m2 weekly, followed by adjuvant cycles of full-dose GEM (1000 mg/m2). After neoadjuvant CRT restaging was done to evaluate secondary resectability. Overall and disease-free survival were calculated and prognostic factors were estimated.
After CRT a total of 26% of all patients with primary unresectable LAPC were chosen to undergo secondary resection. Tumour free resection margins could be achieved in 39.2% (R0-resection), R1-resections were seen in 41.2%, residual macroscopic tumour in 11.8% (R2) and in 7.8% resection were classified as Rx. Patients with complete resection after CRT showed a significantly increased median overall survival (OS) with 22.1 compared to 11.9 months in non-resected patients. Median OS and disease-free survival (DFS) of all patients were 12.3 and 8.1 months respectively. In most cases the first site of disease progression was systemic with hepatic (52%) and peritoneal (36%) metastases.
A high percentage of patients with locally advanced pancreatic cancer can undergo secondary resection after gemcitabine-based chemoradiation and has a relative long-term prognosis after complete resection.
Available from: Sonja Gillen
- "Currently, there is a lack of controlled randomized studies, data on low response rates combined with relevant toxicity of pretreatment, and controversial reports on both resectability and survival after preoperative radiation and/or chemotherapy. In addition, assessment of the resectability criteria and evaluation of the response to pretreatment are highly dependent on the expertise of the involved surgeons, gastroenterologists, and radiologists . "
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ABSTRACT: Palliative treatment concepts are considered in patients with non-curatively resectable and/or metastasized pancreatic cancer. However, patients without metastases, but presented with marginally resectable or locally non-resectable tumors should not be treated by a palliative therapeutic approach. These patients should be enrolled in neoadjuvant radiochemotherapy trials because a potentially curative resection can be achieved in approximately one-third of them after finishing treatment and restaging. Within the scope of best possible palliative care, resection of the primary cancer together with excision of metastases represents a therapeutic option to be contemplated in selected cases. Comprehensive palliative therapy is based on treatment of bile duct or duodenal obstruction for certain locally unresectable or metastasized advanced pancreatic cancer. However, endoscopic or percutaneous stenting procedures and surgical bypass provide safe and highly effective therapeutic alternatives. In case of operative drainage of the biliary tract (biliodigestive anastomosis), the prophylactic creation of a gastro-intestinal bypass (double bypass) is recommended. The decision to perform a surgical versus an endoscopic procedure for palliation depends to a great extent on the tumor stage and the estimated prognosis, and should be determined by an interdisciplinary team for each patient individually.
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