Resection of locally advanced pancreatic cancer after downstaging with continuous-infusion 5-fluorouracil, mitomycin-C, leucovorin, and dipyridamole

Todd, Karen E.; Gloor, Beat; Lane, John S.; Isacoff, William H.; Reber, Howard A.

doi:10.1016/s1091-255x(98)80008-5

Cited by 78 publications

(40 citation statements)

References 14 publications

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“…Many patients are considered unresectable because of portal vein or superior mesenteric vein involvement. Several centers, including ours (unpublished data), have been able to induce tumor regression with neoadjuvant chemotherapy and to resect with negative margins [17,18]. Our study indicates that these patients require staging with diagnostic laparoscopy to rule out metastatic disease before initiation of neoadjuvant therapy.…”

Section: Discussionmentioning

confidence: 64%

Diagnostic laparoscopy improves staging of pancreatic cancer deemed locally unresectable by Computed Tomography

2005

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Section: Discussionmentioning

confidence: 64%

Diagnostic laparoscopy improves staging of pancreatic cancer deemed locally unresectable by Computed Tomography

2005

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“…Response rates varied between 39% and 47%, with a median survival time of 14-15.5 months [4,[30][31][32]. The resectability rate was 10.5%, using combined radiochemotherapy with 5-FU, leucovorin, and mitomycin [30], and 14.2% after 5-FU, streptozotocin, and cisplatin, with simultaneous split-course radiotherapy [4]. Gemcitabine has also been studied in combination with other chemotherapy agents in the treatment of advanced pancreatic cancer.…”

Section: Discussionmentioning

confidence: 99%

Phase II study of gemcitabine combined with radiation therapy in patients with localized, unresectable pancreatic cancer

Epelbaum

Rosenblatt

Nasrallah

et al. 2002

Journal of Surgical Oncology

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“…83,84 As has been suggested for BRCA1-and BRCA2-deficient tumors, 85,86 this hypersensitivity to cross-linking drugs could provide an expanded therapeutic window, potentially allowing the use of low-dose, low toxicity, and long-term rational chemotherapeutic options for the treatment of the BRCA2-related subset of pancreatic cancer patients. Occasional complete remissions of pancreatic cancer have been reported with therapies that included mitomycin, [87][88][89][90][91] although the BRCA2 status of such occasional patients has not been reported. Although speculative, it now seems reasonable to suggest that the BRCA2 gene status might become a standard laboratory determination in the care of pancreatic cancer patients.…”

Section: Potentially What Forms Of Rational Therapy Could Be Considementioning

confidence: 99%

An Introduction to Pancreatic Adenocarcinoma Genetics, Pathology and Therapy

Kern

Hruban²,

Hidalgo³

et al. 2002

Cancer Biology & Therapy

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Cancer is bad, but pancreatic cancer is especially so. Underlying the aggressive behavior of pancreatic cancer is a highly patterned set of biologic rules for its development. The accumulating discoveries regarding the genetic basis of pancreatic cancer and developments in the clinical management of the disease provide hope for meaningful improvements in the understanding and control of this disease. WHAT IS A TYPICAL PRESENTATION FOR THIS DISEASE?Pancreatic cancer is usually diagnosed at a biologically late stage. A patient, usually in their 60s or 70s, may notice unexplained weight loss, back pain, altered bowel habits, or the sudden onset of jaundice. During the clinical evaluation, a mass is found in the pancreas, usually in the head, the right-sided region of pancreas adjacent to the duodenum. Unfortunately, in 80% of these patients it is clinically evident that the cancer has already spread to other organs, most commonly in the liver. The only options for these patients include palliation (procedures such as placement of a stent within an occluded biliary duct) or noncurative courses of chemotherapy. A subset of patients, about 20%, will, however, have no detectable metastatic disease. These patients are candidates for a surgical resection.Pancreatic adenocarcinoma affects close to 30,000 persons a year in the United States and is the fourth most common form of cancer death in both sexes. WHAT ARE THE SURGICAL OPTIONS?For patients with tumors in the head of the gland, options for resection include a pancreaticoduodenectomy (or Whipple operation). A minority of patients will have tumors originating in the left side, or tail, of the gland, and are candidates for distal pancreatectomy, usually with splenectomy. The five-year survival for the groups of patients who do not undergo resectional procedures is clearly less than five percent. In the group of patients who undergo surgical resection, five-year survival rates are largely between 15 and 20%. 1 Within this latter group, patients with small cancers, cancer-free margins of resection, and without metastases to local lymph nodes will be expected to have an even better prognosis approaching 40% five-year survival overall. Nearly all patients who undergo surgical resection, unfortunately, eventually succumb to metastatic disease, including even the cases resected when the primary lesion is extremely small. 2,3 The implication is that pancreatic cancer must metastasize distantly, prior to clinical presentation, in virtually all cases. WHERE SHOULD PANCREATIC CANCER SURGERY BE DONE?Considerable data would support the centralization of pancreatic cancer surgery to specific "centers of excellence". The first such analyses came from the state of Maryland and compared cost and outcome between one high-volume regional provider and 38 other Maryland hospitals during a five-year period. 4 Hospital mortality was six times higher for patients treated at low-volume providers; mortality rates specifically increased with decreasing volume, from 2.2% at the regional ...

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Resection of locally advanced pancreatic cancer after downstaging with continuous-infusion 5-fluorouracil, mitomycin-C, leucovorin, and dipyridamole

Cited by 78 publications

References 14 publications

Diagnostic laparoscopy improves staging of pancreatic cancer deemed locally unresectable by Computed Tomography

Diagnostic laparoscopy improves staging of pancreatic cancer deemed locally unresectable by Computed Tomography

Phase II study of gemcitabine combined with radiation therapy in patients with localized, unresectable pancreatic cancer

An Introduction to Pancreatic Adenocarcinoma Genetics, Pathology and Therapy

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