Pancreatic Adenocarcinoma, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology

Tempero, Margaret A.; Malafa, Mokenge P.; Al-Hawary, Mahmoud M.; Asbun, Horacio J.; Bain, Andrew; Behrman, Stephen W.; Benson, Beverly; Binder, Ellen F.; Cardin, Dana Backlund; Cha, Charles; Chiorean, E. Gabriela; Chung, Vincent; Czito, Brian G.; Dillhoff, Mary; Dotan, Efrat; Ferrone, Cristina R.; Hardacre, Jeffrey M.; Hawkins, William G.; Herman, Joseph M.; Ko, Andrew H.; Komanduri, Srinadh; Koong, Albert C.; LoConte, Noelle K.; Lowy, Andrew M.; Moravek, Cassadie; Nakakura, Eric K.; O’Reilly, Eileen M.; Obando, Jorge; Reddy, Sushanth; Scaife, Courtney L.; Thayer, Sarah P.; Weekes, Colin D.; Wolff, Robert A.; Wolpin, Brian M.; Burns, Jennifer L.; Darlow, Susan

doi:10.6004/jnccn.2017.0131

Cited by 887 publications

(926 citation statements)

References 148 publications

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“…Patients with pathologically confirmed, measurable or non-measurable assessable MPC or LAPC (including unresectable and borderline resectable) were eligible for inclusion in this study. Patients were determined to have locally advanced unresectable or borderline resectable disease by the investigators (RRs, CHC) using the imaging criteria established by the National Comprehensive Cancer Network (NCCN) (Callery et al, 2009;Tempero et al, 2010). No prior therapy of any type for advanced disease was allowed.…”

Section: Methodsmentioning

confidence: 99%

Final analysis of a phase II study of modified FOLFIRINOX in locally advanced and metastatic pancreatic cancer.

Stein

James

Cong³

et al. 2016

JCO

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Section: Methodsmentioning

confidence: 99%

Final analysis of a phase II study of modified FOLFIRINOX in locally advanced and metastatic pancreatic cancer.

Stein

James

Cong³

et al. 2016

JCO

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“…Hastaların yaklaşık yarısı metastatik dönemde tanı alır ve 5 yıllık sağkalım oranları %2.7'dir (1 (2,3). Yaş, performans durumu ve diğer klinik faktörler göz önüne alındığında kombine kemoterapi (KT) almaya uygun olmayan hastalarda ise gemsitabin (G) tercih edilir (3).…”

Section: Introductionunclassified

The efficacy of gemcitabine alone versus gemcitabine plus cisplatin in the treatment of metastatic pancreatic cancer

Erdem¹,

Doğan²,

Güven³

et al. 2018

Acta Oncol Tur.

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ÖZET GİRİŞ ve AMAÇ:Bu çalışmanın amacı metastatik pankreas kanserinin tedavisinde gemsitabin-sisplatin (GP) kombine kemoterapisine (KT) karşı gemsitabin (G) kemoterapisinin etkinliğini değerlendirmektir. YÖNTEM ve GEREÇLER: Nisan 2005 ile Kasım 2015 tarihleri arasında merkezimizde histopatolojik olarak adenokarsinom tanısı almış metastatik pankreas kanserli hastalarda progresyonsuz sağkalıma (PS) ve genel sağkalıma (GS) etki eden faktörler (klinikopatolojik özellikler, tedaviler, bazal tümör markırları, serum albümin, kreatinin ve bilirubin düzeyleri) retrospektif olarak değerlendirildi. BULGULAR: Üç kür ve üzerinde KT alan toplam 99 hastanın (74 hasta GP, 25 hasta G) yanıt değerlendirmesi yapıldı. Gruplar demografik özellikleri açısından karşılaştırıldığında kombine KT alan hastalar daha genç, daha iyi ECOG performans skoruna ve daha az komorbid hastalığa sahipti. Hastaların %41.4'ü progresyondan sonra ikinci basamak KT almış olup, bu G grubunda %28.0, GP grubunda ise %45.9'du. GP ve G grupları arasında GS farkı saptanmadı (sırasıyla; 8.3 aya karşı 6.0 ay, P=0.13). Ortanca PS GP alan hastalarda G alan hastalara kıyasla daha uzundu (sırasıyla; 5.1 ay ve 3.9 ay, P=0.01) ve bu fark çok değişkenli analizle de doğrulandı. ECOG performans skoru daha iyi (8.3 aya karşı 6.3 ay) ve ikinci basmak KT alan hastalar (12.1 aya karşı 5.9 ay) daha uzun GS ile ilişkili saptandı. TARTIŞMA ve SONUÇ: Gemsitabin-sisplatin tedavisi ile daha iyi PS elde edilirken GS farkı istatiksel olarak anlamlı değildi. Tanı anında ECOG performans durumunu daha iyi ve ikinci basamak KT alabilen hastalar daha iyi genel sağ kalıma sahiptir. Anahtar Kelimeler: Pankreas kanseri, Gemsitabin, Sisplatin ABSTRACT INTRODUCTION: The purpose of this trial was to evaluate the efficacy of gemcitabine (G) alone versus gemcitabine plus cisplatin (GP) in the treatment of metastatic pancreatic cancer. METHODS: In ninety-nine patients with a histopathologically confirmed diagnosis of metastatic pancreatic cancer from April 2005 to December 2015, factors affecting progression-free (PFS) and overall survival (OS) (clinicopathological features, treatments, basal tumor markers, serum albumin, creatinine and bilirubin levels) were retrospectively evaluated. RESULTS: Response evaluations were performed in 99 patients (74 patients for GP group, 25 patients for G group) who received three cycles and more chemotherapy (CT). When the groups were compared in terms of their demographic characteristics, the patients in the group receiving GP were younger with a better performance status and had less comorbid disease. About 41.4% of the patients received second line CT after progression (28.0% in the G group, 45.9% in the GP group). The median OS was 8.3 months in the GP group and 6.0 months in the G group (P=0.13). The median PFS was 5.1 months in the GP group and 3.9 months in the G group (P=0.01). In multivariate analysis, combination CT was associated with longer PFS (5.1 vs. 3.9 months). Patients with a good performance status (8.3 vs. 6.3 months), and those who received se...

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“…While endoscopic biliary metal stent is described as a preferred method for BO alone due to unresectable pancreatic cancer in the National Comprehensive Cancer Network guidelines, open or laparoscopic gastrojejunostomy is recommended for GOO alone of patients with good performance status. 5 Although there is no description of recommended treatment for concurrent BO and GOO in the guidelines, it is empirically realized that surgical bypass plays an important role in the clinical practice. This review describes procedures, outcomes and minimally invasive approach of biliary and gastrointestinal double bypass for concurrent BO and GOO.…”

Section: Introductionmentioning

confidence: 99%

Surgical management of the cases with both biliary and duodenal obstruction

Miyasaka

Ohtsuka

Velasquez

et al. 2018

Int J Gastrointest Interv

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Endoscopic management is presently the recommended first-line of treatment for biliary strictures. However, surgery still has an important role especially for biliary obstruction (BO) with duodenal obstruction. Even though endoscopic treatment for concurrent BO and gastric-outlet obstruction has been proposed, it is still not widespread. Duodenal obstruction is often associated with malignant BO which makes endoscopic treatment more challenging. Biliary and gastrointestinal double bypass with Roux-en-Y hepaticojejunostomy and gastrojejunostomy is the most common surgical intervention for malignant biliary and gastric-outlet obstruction. A variety of procedures of biliary bypass and gastrointestinal bypass have been reported. According to several studies, mortality rates range from 0% to 7%, while morbidity rates range from 3% to 50%. Higher morbidity was observed in symptomatic patients caused by the disease. Most common morbidity after double bypass was delayed gastric emptying. Recurrence of BO and gastric-outlet obstruction was less frequently seen after surgical bypass compared to after endoscopic treatment. Minimally invasive approach has been applied to double bypass. Studies showed that laparoscopic double bypass has a shorter hospital stay and reduced postoperative pain; however, due to its technical demand, it is still presently an uncommon procedure. Robotic bypass surgery may resolve this issue in the future. Further analyses of outcomes of both surgical and endoscopic treatments are necessary to establish better and suitable palliation options for concurrent biliary and duodenal obstruction caused by unresectable malignant tumors.

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Pancreatic Adenocarcinoma, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology

Cited by 887 publications

References 148 publications

Final analysis of a phase II study of modified FOLFIRINOX in locally advanced and metastatic pancreatic cancer.

Final analysis of a phase II study of modified FOLFIRINOX in locally advanced and metastatic pancreatic cancer.

The efficacy of gemcitabine alone versus gemcitabine plus cisplatin in the treatment of metastatic pancreatic cancer

Surgical management of the cases with both biliary and duodenal obstruction

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