Pancreatic adenocarcinoma: Outstanding problems

Abstract

Pancreatic adenocarcinoma remains the fourth leading cause of cancer-related death and is one of the most aggressive malignant tumors with an overall 5-year survival rate of less than 4%. Surgical resection remains the only potentially curative treatment but is only possible for 15%-20% of patients with pancreatic adenocarcinoma. About 40% of patients have locally advanced nonresectable disease. In the past, determination of pancreatic cancer resectability was made at surgical exploration. The development of modern imaging techniques has allowed preoperative staging of patients. Institutions disagree about the criteria used to classify patients. Vascular invasion in pancreatic cancers plays a very important role in determining treatment and prognosis. There is no evidence-based consensus on the optimal preoperative imaging assessment of patients with suspected pancreatic cancer and a unified definition of borderline resectable pancreatic cancer is also lacking. Thus, there is much room for improvement in all aspects of treatment for pancreatic cancer. Multi-detector computed tomography has been widely accepted as the imaging technique of choice for diagnosing and staging pancreatic cancer. With improved surgical techniques and advanced perioperative management, vascular resection and reconstruction are performed more frequently; patients thought once to be unresectable are undergoing radical surgery. However, when attempting heroic surgery, a realistic approach concerning the patient's age and health status, probability of recovery after surgery, perioperative morbidity and mortality and life quality after tumor resection is necessary.

Feasibility of automated pancreas segmentation based on dynamic MRI

“…Although radiotherapy alone is unlikely to cure pancreatic cancer, with sufficiently high doses, it is possible to achieve local control or resectability conversion [3][4][5][6][7][8] that is correlated to significantly prolonged patient survival. 9 However, radiation doses to the pancreas are limited by the surrounding radiosensitive serial organs. The goals to deliver sufficient tumour dose are further complicated by significant organ motion in this region.…”

Diagnostic Value of Three-Dimensional Reconstructions of Ct Images in Patients With Ductal Pancreas Adenocarcinoma

“…Компьютерная томография (КТ) является методом выбора в диагностике и предопераци-онном стадировании рака поджелудочной же-лезы [4][5][6][7]. По мере совершенствования компь-ютерных томографов (мультиспиральная ком-пьютерная томография) и получения изотроп-ных вокселей, стала доступна более совершен-ная постпроцессорная обработка, с помощью которой возможно получить исчерпывающие данные о локализации опухоли, инвазии сосу-дов и соседних органов, что имеет огромное значение для хирурга на предоперационном этапе [2].…”

Feasibility of automated 3-dimensional magnetic resonance imaging pancreas segmentation

“…Many patients present with unresectable locally advanced lesions at the time of diagnosis. Although it is unlikely to cure pancreatic cancer with radiotherapy alone, with sufficiently high doses, it is possible to achieve local control or resectability conversion 3–8 that is correlated to significantly prolonged patient survival 9 . However, radiation doses to pancreas are limited by surrounding radiosensitive serial organs.…”