S3-Leitlinie zum exokrinen Pankreaskarzinom

Seufferlein, Thomas; Porzner, Marc; Becker, Therese; Budach, Volker; Ceyhan, Güralp O.; Espósito, Irene; Fietkau, Rainer; Follmann, Markus; Frieß, Helmut; Galle, PR; Geißler, Michael; Glanemann, Matthias; Gress, Thomas M.; Heinemann, Volker; Hohenberger, Werner; Hopt, Ulrich T.; Izbicki, Jakob R.; Klar, E.; Kleeff, Jörg; Kopp, I.; Kullmann, Frank; Langer, Thomas; Langrehr, Jan M.; Lerch, Markus M.; Löhr, Matthias; Lüttges, Jutta; Lutz, Manfred P.; Mayerle, Julia; Michl, Patrick; Möller, Peter; Molls, M.; Münter, Marc W.; Nothacker, Monika; Oettle, Helmut; Post, S; Reinacher‐Schick, Anke; Röcken, Christoph; Roeb, Elke; Saeger, H. D.; Schmid, Roland M.; Schmiegel, Wolff; Schoenberg, M. H.; Siveke, Jens T.; Stuschke, Martin; Tannapfel, Andrea; Uhl, Waldemar; Unverzagt, Susanne; Oorschot, B. van; Vashist, Y.; Werner, Jens; Yekebas, EF

doi:10.1055/s-0033-1356220

Cited by 161 publications

(76 citation statements)

References 29 publications

(31 reference statements)

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“…Accordingly, no statements with respect to this entity have been released from most international guidelines including ESMO, National Comprehensive Cancer Network and American Society for Clinical Oncology [14, 15, 30]. German guidelines state that in case of ILM all local therapy options should be considered [16]. However, in most cases surgery does not represent an option due to the localization of the recurrent tumor.…”

Section: Discussionmentioning

confidence: 99%

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Combined Systemic Chemotherapy and CT-Guided High-Dose-Rate Brachytherapy for Isolated Local Manifestation of Pancreatic Cancer after Surgical Resection

et al. 2018

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Background: Prospective data on the optimal management of patients with pancreatic ductal adenocarcinoma (PDA) and isolated local manifestation (ILM) after surgery are lacking. Hence, no statements with respect to this entity have been released from most international guidelines including European Society for Medical Oncology, National Comprehensive Cancer Network, and American Society for Clinical Oncology. Methods: We report for the first time a case-series of 3 patients with PDA and ILM receiving combined systemic chemotherapy and CT-guided high-dose-rate interstitial brachytherapy (CT-HDRBT). Results: CT-HDRBT allowed in all patients with pronounced chemotherapy-induced side effects either a pause of cytostatic treatment or de-escalation to a “maintenance” therapy (dose reduction, interval prolongation, scheme modification with withdrawal of most toxic drugs). Conclusion: Combining CT-HDRBT to systemic chemotherapy in patients with PDA and ILM is feasible and safe. As for patients with PDA and ILM no standard of care exists, designing an appropriate randomized prospective trial for this highly selected group of patients is challenging.

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Section: Discussionmentioning

confidence: 99%

“…The optimal treatment strategy for ILM remains unclear [14-16]. In small studies, case series, and case reports surgical re-resection, stereotactic body radiation therapy, and chemoradiation alone or in combination with intraarterial chemotherapy have been described [17-23].…”

Section: Introductionmentioning

confidence: 99%

Combined Systemic Chemotherapy and CT-Guided High-Dose-Rate Brachytherapy for Isolated Local Manifestation of Pancreatic Cancer after Surgical Resection

et al. 2018

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“…Normally such a situation is considered unresectable [34] . However, a radical distal pancreatectomy with splenectomy and en-bloc resection of the celiac trunk without reconstruction of the celiac axis is a potential curative approach for these cases [35] .…”

Section: Infiltration Of the Celiac Trunkmentioning

confidence: 99%

“…, but more relevant toxicities were observed in the 5-FU group [40] . In conclusion, both chemotherapeutic regimens are considered standard care in the adjuvant [41] , but the better toxicity profile of gemcitabine should be taken into consideration [34] . More recently, the Japanese JASPAC-01 trial compared gemcitabine to the 5-FU prodrug S1 (80/100/120 mg/d based on body surface area, p.o., d1-28, q6w, for 4 courses).…”

Section: Current Standardsmentioning

confidence: 99%

Perioperative treatment options in resectable pancreatic cancer - how to improve long-term survival

Sinn

Bahra

Denecke

et al. 2016

WJGO

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“…The dismal prognosis of pancreatic cancer is caused by a variety of factors: (a) due to its location in the retroperitoneum, pancreatic cancer causes symptoms only when it has already grown to an advanced stage and is no longer locally resectable [2]. (b) Pancreatic cancer has a tendency to disseminate not only into the bloodstream and into the lymphatic tissue but also along nerve fibers, leading to an unusually high recurrence rate even after successful R0 resection [3]. For both these issues, a current consensus predicts that methods allowing earlier detection of pancreatic cancer would be of benefit and improve survival [4].…”

Section: Introductionmentioning

confidence: 99%

Development of Pancreatic Cancer: Targets for Early Detection and Treatment

Lerch

Mayerle²,

Mahajan³

et al. 2016

Dig Dis

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Background: Pancreatic ductal adenocarcinoma (PDAC) is the 4th leading cause of cancer death worldwide and compared to other malignancies its share in cancer mortality is expected to rise further. This is due to a lack of sensitive diagnostic tools that would permit earlier detection in a potentially curable stage and the very slow progress in finding effective drug treatments for pancreatic cancer. Key Messages: Aside from genetic predispositions and environmental agents, chronic pancreatitis is by far the greatest risk factor for PDAC. It also shares several etiological factors with pancreatic cancer and represents its most challenging differential diagnosis. Biomarkers that can distinguish between chronic pancreatitis and PDAC may therefore be suitable for the latter's early detection. Moreover, targeting the natural history of chronic pancreatitis would be one approach to prevent PDAC. Targeting tumor-cell signaling directly by interfering with receptor tyrosine kinases has shown some efficacy, although the results in clinical trials were less encouraging than for other cancers. Other compounds developed have targeted the formation of extracellular matrix around the tumor, the proteolytic activity in the tumor environment, histone deacetylases, hedgehog signaling and heat shock proteins, but none has yet found its way into routine patient care. Attempts to individualize treatment according to the tumor's somatic mutation profile are novel but so far impractical. Conclusions: Progress in the treatment of pancreatic cancer has been exceedingly slow and mostly dependent on improved pharmaceutical preparations or combinations of established chemotherapeutic agents. The promise of major breakthroughs implied in targeting tumor signal transduction events has so far not materialized.

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S3-Leitlinie zum exokrinen Pankreaskarzinom

Cited by 161 publications

References 29 publications

Combined Systemic Chemotherapy and CT-Guided High-Dose-Rate Brachytherapy for Isolated Local Manifestation of Pancreatic Cancer after Surgical Resection

Combined Systemic Chemotherapy and CT-Guided High-Dose-Rate Brachytherapy for Isolated Local Manifestation of Pancreatic Cancer after Surgical Resection

Perioperative treatment options in resectable pancreatic cancer - how to improve long-term survival

Development of Pancreatic Cancer: Targets for Early Detection and Treatment

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