scholarly journals Endoscopic Management of Pancreatic Cancer: From Diagnosis to Palliative Therapy

10.5772/27430 ◽  
2012 ◽  
Author(s):  
Erika Madrigal ◽  
Jennifer Chennat
Keyword(s):  
Pancreatic Cancer ◽  
Palliative Therapy ◽  
Endoscopic Management

OC.07.9 ENDOSCOPIC MANAGEMENT OF ANASTOMOTIC LEAK AFTER RESECTIVE SURGERY FOR COLONIC-INFILTRATING PANCREATIC CANCER

2021 ◽  
Vol 53 ◽  
pp. S122-S123
Author(s):  
R. Di Mitri ◽  
A. Bonaccorso ◽  
F. Mocciaro ◽  
E. Conte ◽  
M. Amata ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Anastomotic Leak ◽  
Endoscopic Management ◽  
Resective Surgery

Prospective observational study of prevalence, assessment and treatment of pancreatic exocrine insufficiency (PEI) in patients with advanced pancreatic cancer (aPC): PanDA.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 196-196
Author(s):  
Angela Lamarca ◽  
Lindsay Carnie ◽  
Dinakshi Shah ◽  
Kate Vaughan ◽  
Zainul Abedin Kapacee ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
High Risk ◽  
Observational Study ◽  
Breath Test ◽  
Cox Regression ◽  
Pancreatic Enzyme ◽  
Palliative Therapy ◽  
Advanced Pancreatic Cancer ◽  
P Value ◽  
Screening Methods

196 Background: PEI in patients with advanced pancreatic cancer is well documented, but there is a lack of consensus regarding optimal screening. Methods: Eligible patients for this observational study (NCT03616431) were those diagnosed with aPC referred for consideration of palliative therapy who consented to evaluation by a research dietitian. In addition to symptom and full dietetic assessment (including Mid-Upper Arm Circumference (MUAC), handgrip and stair climb test), full nutritional blood panel, faecal elastase (FE) and 13C mixed triglyceride breath test (for diagnostic cohort (DiC)) were performed. Primary objectives: prospective assessment of PEI prevalence (dietitian-assessed; demographic cohort (DeC)), and to design (using breath test as gold standard; DiC) and validate (follow-up cohort (FuC)) the most suitable screening tool for PEI in patients with aPC. Logistic and Cox regression were used for statistical analysis (Stat v.12). Results: Between 1st July 2018 and 30th October 2020, 112 eligible patients [50 (DeC), 25 (DiC), 37 (FuC)]. Prevalence of PEI in the DeC was 64.0% (PEI-related symptoms were flatus (84.0%), weight loss (84.0%), abdominal discomfort (50.0%) and steatorrhea (48.0%)); 70.0% of patients required pancreatic enzyme replacement therapy and 74.0% had anorexia (low appetite); 44.0% and 18.0% had low vitamin D and vitamin A levels, respectively. Designed PEI screening panel (DiC; 19 patients with breath test completed) included FE [normal/missing (0 points); low (1 point)] and MUAC [normal/missing ( > percentile 25 for age/gender) (0 points); low (2 points)] and identified patients at high-risk (2-3 total points) of PEI [vs. low-medium risk (0-1 total points)]. When patients from DeC and DiC) were analysed together, those classified as “high-risk of PEI” according to the screening panel had shorter overall survival (multivariable Hazard Ratio (mHR) 1.86 (95% CI 1.03-3.36); p-value 0.040) when adjusted for other prognostic factors, including presence of PEI symptoms (mHR 2.28 (95% CI 1.19-4.35); p-value 0.013). The screening panel was tested in the FuC; 78.38% were classified as patients at “high-risk of PEI”; of these, 89.6% were confirmed to have PEI by the dietitian. The panel was feasible for use in clinical practice, (64.8% of patients completed fully the assessments required) and acceptability was high (87.5% of patients would do it again). The majority of patients (91.3%) recommended that all future patients with aPC should have dietitian input. Conclusions: PEI is present in the majority of patients with aPC, and early dietetic input is important to provide a holistic nutritional overview, including, but not limited to, PEI. This proposed screening panel could be used to prioritise patients at higher risk of PEI requiring urgent dietitian input. Its prognostic role needs further validation. Clinical trial information: NCT03616431.

scholarly journals Conversion Surgery for Advanced Pancreatic Cancer

2019 ◽  
Vol 8 (11) ◽  
pp. 1945
Author(s):  
Thomas Hank ◽  
Oliver Strobel
Keyword(s):  
Pancreatic Cancer ◽  
Locally Advanced ◽  
Palliative Therapy ◽  
Advanced Pancreatic Cancer ◽  
Treatment Strategies ◽  
Ductal Adenocarcinoma ◽  
Conversion Surgery ◽  
Radiological Criteria ◽  
Intention To Treat ◽  
Conversion Rates

While primarily unresectable locally advanced pancreatic cancer (LAPC) used to be an indication for palliative therapy, a strategy of neoadjuvant therapy (NAT) and conversion surgery is being increasingly used after more effective chemotherapy regimens have become available for pancreatic ductal adenocarcinoma. While high-level evidence from prospective studies is still sparse, several large retrospective studies have recently reported their experience with NAT and conversion surgery for LAPC. This review aims to provide a current overview about different NAT regimens, conversion rates, survival outcomes and determinants of post-resection outcomes, as well as surgical strategies in the context of conversion surgery after NAT. FOLFIRINOX is the predominant regimen used and associated with the highest reported conversion rates. Conversion rates considerably vary between less than 5% and more than half of the study population with heterogeneous long-term outcomes, owing to a lack of intention-to-treat analyses in most studies and a high heterogeneity in resectability criteria, treatment strategies, and reporting among studies. Since radiological criteria of local resectability are no longer applicable after NAT, patients without progressive disease should undergo surgical exploration. Surgery after NAT has to be aimed at local radicality around the peripancreatic vessels and should be performed in expert centers. Future studies in this rapidly evolving field need to be prospective, analyze intention-to-treat populations, report stringent and objective inclusion criteria and criteria for resection. Innovative regimens for NAT in combination with a radical surgical approach hold high promise for patients with LAPC in the future.

Accelerated fraction radiotherapy with concomitant capecitabine as neoadjuvant therapy of borderline resectable pancreatic cancer.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 329-329 ◽  
Author(s):  
Samhita Chakraborty ◽  
Todd W. Bauer ◽  
Monica M Morris ◽  
Erin Yarde ◽  
J Thomas Parsons ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Molecular Mechanisms ◽  
Palliative Therapy ◽  
External Beam Radiation ◽  
Resectable Pancreatic Cancer ◽  
Borderline Resectable ◽  
Beam Radiation ◽  
Early Stage Disease ◽  
Borderline Resectable Pancreatic Cancer ◽  
Grade 3

329 Background: Surgical therapy remains the only curative modality for pancreatic cancer, though survival remains quite poor even for patients with resected early stage disease. Better (neo) adjuvant therapies are needed to improve resectability rates for patients with borderline resectable pancreatic cancer and to prevent recurrence following resection. We undertook this pilot study to determine the safety of accelerated fraction radiotherapy (AFRT) with capecitabine in such patients. Methods: Eligible patients have histologically confirmed borderline resectable adenocarcinoma of the pancreas as defined by the MD Anderson categories of vascular involvement, indeterminate metastatic disease, borderline performance status; normal organ function; and no prior therapy for pancreatic cancer. Radiation is given as external beam radiation therapy to a dose of 50 Gy delivered in 20, 2.5 Gy fractions Mon-Fri using IMRT. If insurance denied IMRT, 3D conformal techniques with daily image guidance is permitted. Capecitabine is delivered as 825mg/m2 BID on radiation days. The primary outcome is to determine the frequency of treatment-related adverse events (AE). Planned enrollment is 40 pts. Results: 10 pts have enrolled to date. 8/10 received IMRT. This regimen has been exceedingly tolerable. Lymphopenia is the most common AE (n=10), grade 3-4 n=6. Other common toxicities were hyponatremia (n=6), fatigue (n=5). Grade 3 AE occurred in 8 pts, grade 4 in 3 patients. One pt had hemorrhage from a radiation induced gastric ulcer complicated by an MI. 5/10 pts had stable disease and were resected and 4/5 had an R0 resection. In the remaining 5/10 patients, disease progressed outside the pancreas and they are receiving palliative therapy. Conclusions: The combination of AFRT and capecitabine was well tolerated. Xenograft models derived from these patients’ tumors are being used to study molecular mechanisms of treatment resistance that could be targeted in a follow up phase II study building on this platform.

Predictive value of heparanase expression in the palliative therapy of pancreatic cancer

Pancreatology ◽  
2005 ◽  
Vol 5 (6) ◽  
pp. 570-575 ◽  
Author(s):  
K. Schoppmeyer ◽  
J. Kronberg ◽  
A. Tannapfel ◽  
J. Mössner ◽  
C. Wittekind ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Predictive Value ◽  
Palliative Therapy

Pancreatic cancer — Palliative therapy: chemotherapy

2007 ◽  
Vol 6 (2) ◽  
pp. 142-148
Author(s):  
Anne Katrin Berger ◽  
Drik Jäger
Keyword(s):  
Pancreatic Cancer ◽  
Palliative Therapy

scholarly journals Palliative therapy in pancreatic cancer—interventional treatment with stents

2019 ◽  
Vol 4 ◽  
pp. 7-7
Author(s):  
Alexander Waldthaler ◽  
Wiktor Rutkowski ◽  
Roberto Valente ◽  
Urban Arnelo ◽  
J.‐Matthias Löhr
Keyword(s):  
Pancreatic Cancer ◽  
Palliative Therapy ◽  
Interventional Treatment
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