Journal ArticleDOI
Preoperative Gemcitabine-Based Chemoradiation for Patients With Resectable Adenocarcinoma of the Pancreatic Head
Douglas B. Evans,Gauri R. Varadhachary,Christopher H. Crane,Charlotte C. Sun,Jeffrey E. Lee,Peter W.T. Pisters,Jean Nicolas Vauthey,Huamin Wang,Karen R. Cleary,Gregg A Staerkel,Chusilp Charnsangavej,Elizabeth A. Lano,Linus Ho,Renato Lenzi,James L. Abbruzzese,Robert A. Wolff +15 more
Reads0
Chats0
TLDR
The encouraging overall survival observed in this large trial supports the continued investigation of gemcitabine-based preoperative therapy in resectable pancreatic cancer.Abstract:
Purpose We conducted a phase II trial to assess the outcomes of patients who received preoperative gemcitabine-based chemoradiation and pancreaticoduodenectomy (PD) for stage I/II pancreatic adenocarcinoma. Patients and Methods Eligible patients with pancreatic head/uncinate process adenocarcinoma and radiographically defined potentially resectable disease received chemoradiation with 7 weekly intravenous (IV) infusions of gemcitabine (400 mg/m 2 IV over 30 minutes) plus radiation therapy (30 Gy in 10 fractions over 2 weeks). Patients underwent restaging 4 to 6 weeks after completion of chemoradiation and, in the absence of disease progression, were taken to surgery. Results The study enrolled 86 patients. At the time of restaging, disease progression or a decline in performance status precluded 13 patients from surgery. Seventy-three (85%) of 86 patients were taken to surgery, extrapancreatic disease was found in nine, and 64 (74%) of 86 underwent a successful PD. Median overall survival (86 patients) was 22.7 months with a 27% 5-year survival. Median survival was 34 months for the 64 patients who underwent PD and 7 months for the 22 unresected patients (P .001). The 5-year survival for those who did and did not undergo PD was 36% and 0%, respectively. Conclusion Preoperative gemcitabine-based chemoradiation followed by restaging and evaluation for surgery separated the study population into two different subsets: patients likely to benefit from PD (n 64) and those in whom surgery would be unlikely to provide clinical benefit (n 22). Furthermore, the encouraging overall survival observed in this large trial supports the continued investigation of gemcitabine-based preoperative therapy in resectable pancreatic cancer. J Clin Oncol 26:3496-3502. © 2008 by American Society of Clinical Oncologyread more
Citations
More filters
Journal ArticleDOI
Clinical practice guidelines in oncology
William J. Gradishar,Benjamin O. Anderson,Ron Balassanian,Sarah L. Blair,Harold J. Burstein,Amy E. Cyr,Anthony D. Elias,William B. Farrar,Andres Forero,Sharon H. Giordano,Matthew P. Goetz,Lori J. Goldstein,Steven J. Isakoff,Janice A. Lyons,P. Kelly Marcom,Ingrid A. Mayer,Beryl McCormick,Meena S. Moran,Ruth O'Regan,Sameer A. Patel,Lori J. Pierce,Elizabeth C. Reed,Kilian E. Salerno,Lee S. Schwartzberg,Amy Sitapati,Karen L. Smith,Mary Lou Smith,Hatem Soliman,George Somlo,Melinda L. Telli,John H. Ward,Rashmi Kumar,Dorothy A. Shead +32 more
TL;DR: This manuscript focuses on the NCCN Guidelines Panel recommendations for the workup, primary treatment, risk reduction strategies, and surveillance specific to DCIS.
Journal ArticleDOI
Only women with symptoms need to have their breast implants removed, says government
Journal ArticleDOI
Preoperative Biliary Drainage for Cancer of the Head of the Pancreas
Niels A. van der Gaag,Erik A.J. Rauws,Casper H.J. van Eijck,Marco J. Bruno,Erwin van der Harst,Frank J G M Kubben,Josephus J. G. M. Gerritsen,Jan Greve,Michael F. Gerhards,Ignace H J T de Hingh,Jean H. G. Klinkenbijl,Chung Y. Nio,Steve M. M. de Castro,Olivier R. Busch,Thomas M. van Gulik,Patrick M.M. Bossuyt,Dirk J. Gouma +16 more
TL;DR: Routine preoperative biliary drainage in patients undergoing surgery for cancer of the pancreatic head increases the rate of complications.
Journal ArticleDOI
Recent Progress in Pancreatic Cancer
Christopher L. Wolfgang,Joseph M. Herman,Daniel A. Laheru,Alison P. Klein,Michael A. Erdek,Elliot K. Fishman,Ralph H. Hruban +6 more
TL;DR: In this paper, it is shown that multidisciplinary care that provides comprehensive and coordinated evaluation and treatment is the most effective way to manage patients with pancreatic cancer, and it is clear that multi-disciplinary care is the best way to care for patients.
Journal ArticleDOI
Pancreatic adenocarcinoma, version 2.2017: Clinical practice guidelines in Oncology
Margaret A. Tempero,Mokenge P. Malafa,Mahmoud M. Al-Hawary,Horacio J. Asbun,Andrew Bain,Stephen W. Behrman,Al B. Benson,Ellen F. Binder,Dana Backlund Cardin,Charles Cha,E. Gabriela Chiorean,Vincent Chung,Brian G. Czito,Mary Dillhoff,Efrat Dotan,Cristina R. Ferrone,Jeffrey M. Hardacre,William G. Hawkins,Joseph M. Herman,Andrew H. Ko,Srinadh Komanduri,Albert C. Koong,Noelle K. LoConte,Andrew M. Lowy,Cassadie Moravek,Eric K. Nakakura,Eileen M. O'Reilly,Jorge Obando,Sushanth Reddy,Courtney L. Scaife,Sarah P. Thayer,Colin D. Weekes,Robert A. Wolff,Brian M. Wolpin,Jennifer L. Burns,Susan Darlow +35 more
TL;DR: The NCCN Guidelines for Pancreatic Adenocarcinoma focus on diagnosis and treatment with systemic therapy, radiation therapy, and surgical resection, as well as on management of locally advanced unresectable and metastatic disease.
References
More filters
Journal ArticleDOI
Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial.
H. A. Burris,Malcolm J. Moore,J. S. Andersen,M R Green,Mace L. Rothenberg,M R Modiano,M. C. Cripps,Russell K. Portenoy,A M Storniolo,P Tarassoff,R Nelson,F A Dorr,C. D. Stephens,D. D. Von Hoff +13 more
TL;DR: It is demonstrated that gemcitabine is more effective than 5-FU in alleviation of some disease-related symptoms in patients with advanced, symptomatic pancreas cancer and confers a modest survival advantage over treatment with5-FU.
Journal ArticleDOI
A Randomized Trial of Chemoradiotherapy and Chemotherapy after Resection of Pancreatic Cancer
John P. Neoptolemos,Deborah D. Stocken,Helmut Friess,Claudio Bassi,Janet A. Dunn,Helen Hickey,Hans G. Beger,Laureano Fernández-Cruz,Christos Dervenis,François Lacaine,Massimo Falconi,Paolo Pederzoli,Akos F. Pap,David Spooner,David J. Kerr,Markus W. Büchler +15 more
TL;DR: Adjuvant chemotherapy has a significant survival benefit in patients with resected pancreatic cancer, whereas adjuvant chemoradiotherapy has a deleterious effect on survival.
Journal ArticleDOI
Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial.
Helmut Oettle,Stefan Post,Peter Neuhaus,Klaus Gellert,Jan M. Langrehr,Karsten Ridwelski,Harald Schramm,J. Fahlke,Carl Zuelke,Christof Burkart,Klaus Gutberlet,E. Kettner,Harald Schmalenberg,Karin Weigang-Koehler,Wolf O. Bechstein,Marco Niedergethmann,Ingo G.H. Schmidt-Wolf,Lars Roll,Bernd Doerken,Hanno Riess +19 more
TL;DR: The results support the use of gemcitabine as adjuvant chemotherapy in resectable carcinoma of the pancreas by significantly delayed the development of recurrent disease after complete resection of pancreatic cancer compared with observation alone.
Journal ArticleDOI
Preoperative chemoradiation and pancreaticoduodenectomy for adenocarcinoma of the pancreas.
Douglas B. Evans,Tyvin A. Rich,David R. Byrd,Karen R. Cleary,John H. Connelly,Bernard Levin,Chusilp Charnsangavej,Claudia J. Fenoglio,Frederick C. Ames +8 more
TL;DR: The results suggest that pancreaticoduodenectomy can be performed with a low incidence of complications after chemoradiation for localized adenocarcinoma of the pancreas.
Journal ArticleDOI
Impact of resection status on pattern of failure and survival after pancreaticoduodenectomy for pancreatic adenocarcinoma
Chandrajit P. Raut,Jennifer F. Tseng,Jennifer F. Tseng,Charlotte C. Sun,Huamin Wang,Robert A. Wolff,Christopher H. Crane,Rosa F. Hwang,Jean Nicolas Vauthey,Eddie K. Abdalla,Jeffrey E. Lee,Peter W.T. Pisters,Douglas B. Evans +12 more
TL;DR: There was no statistically significant difference in patient survival or recurrence based on R status, and this series is unique in the incorporation of a standardized surgical technique for the SMA dissection, the prospective use of a reproducible system for pathologic evaluation of resection margins, the absence of R2 resections, and the frequent use of multimodality therapy.
Related Papers (5)
Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial.
Helmut Oettle,Stefan Post,Peter Neuhaus,Klaus Gellert,Jan M. Langrehr,Karsten Ridwelski,Harald Schramm,J. Fahlke,Carl Zuelke,Christof Burkart,Klaus Gutberlet,E. Kettner,Harald Schmalenberg,Karin Weigang-Koehler,Wolf O. Bechstein,Marco Niedergethmann,Ingo G.H. Schmidt-Wolf,Lars Roll,Bernd Doerken,Hanno Riess +19 more
A Randomized Trial of Chemoradiotherapy and Chemotherapy after Resection of Pancreatic Cancer
FOLFIRINOX versus Gemcitabine for Metastatic Pancreatic Cancer
Thierry Conroy,Françoise Desseigne,Marc Ychou,Olivier Bouché,Rosine Guimbaud,Yves Becouarn,Antoine Adenis,Jean-Luc Raoul,Sophie Gourgou-Bourgade,Jaafar Bennouna,Jean-Baptiste Bachet,Faiza Khemissa-Akouz,Denis Péré-Vergé,Catherine Delbaldo,Eric Assenat,Bruno Chauffert,C. Montoto-Grillot,Michel Ducreux +17 more