Helpt u ons aan 500 donateurs?

13 januari 2024: zie ook dit artikel: https://kanker-actueel.nl/protonenbestraling-tijdens-chemokuren-voor-operabele-alvleesklierkanker-pdac-geeft-bemoedigende-resultaten-met-betere-2-jaars-overleving-van-57-procent.html

Zie ook artikelen over de Nanoknife / Ireversible electroporation en literatuurlijst specifiek bij alvleesklierkanker.

26 maart 2018: Bron: Radiation Oncology

Aanvullend op onderstaand artikel zou u dit studierapport eens kunnen lezen. Management of Borderline Resectable Pancreatic Cancer  beschrijft de ontwikkelingen van de laatste jaren hoe borderline alvleesklierkanker (wel of niet operabel) te behandelen. De keuze is of er eerst chemo en/of radiotherapie gegeven moet worden en daarna operatie of eerst een operatie gevolgd door chemo of gerichte behandelingen en/of immuuntherapie.

De conclusie uit deze studie is daarover niet eensluidend(maar het studierapport is heel gedetailleerd beschreven met veel verwijzingen naar studies, dus lees ook dat studierapport mocht u geinteresseerd zijn) :

Conclusie: Ondanks de verschillende meningen over wat nu precies de optimale methode is om een borderline stadium van alvleesklierkanker te definiëren als geschikt voor operatie, groeit de consensus dat deze subgroep van alvleesklierkankerpatiënten (pancreatic ductal adenocarcinoma) (PDAC) een aparte groep vertegenwoordigt binnen de stadia van alvleesklierkanker. Een groep met een eigen prognose, die aanzienlijk kan worden verbeterd als er een gunstige respons wordt bereikt na een preoperatieve behandeling en/of operatie / resectie. Verbeterde chirurgietechnieken kunnen ook het aantal patiënten dat mogelijk in aanmerking komt voor een operatie, verhogen. Zie bv: de Nanoknife / Ireversible electroporation.

Opens large image

Fig. 1

Magnified section of a computed tomography axial slice of a borderline resectable pancreatic adenocarcinoma (red contour) highlighting the tumor contact region with the superior mesenteric artery (SMA; yellow contour) <180°. Abbreviation: SMV = superior mesenteric vein. (A color version of this figure is available at www.redjournal.org)

Het abstract plus referentielijst van Management of Borderline Resectable Pancreatic Cancer staat onderaan dit artikel.

11 november 2010: Bron: American Society for Radiation Oncology (ASTRO) 52nd Annual Meeting: Abstract 216 Presented November 3, 2010.

Bestraling vooraf aan operatie bij alvleesklierkanker leek de afgelopen jaren een behandeling die beter niet kon worden uitgevoerd, zie ook studieresultaten in gerelateerde artikelen daarover,  omdat de resultaten op overlevingstijd en genezing slechter bleken dan zonder bestraling. Nu echter is op een groot congres een studie gepubliceerd die aan zou tonen dat vooraf bestralen aan operatie toch voor een significante levernsverlenging en zelfs overall overleving kan zorgen. Echter de onderzoekers zeggen er zelf al bij dat zij twijfels hebben over deze aanpak omdat er geen vergelijkingsgroep met chemo is geweest en er ook niet gekeken is naar de uitzaaiingen in de lymfklieren bij de deelnemende patiënten. Zij stellen dan ook dat bestralen vooraf aan operatie bij operabele alvleesklierkanker controversieel blijft. Hier enkele citaten uit  een artikel van Medscape:

November 8, 2010 (San Diego, California) — Adjuvant radiation therapy is beneficial after surgery for pancreatic cancer, according to the results of a large population-based study. The results of the study, presented here at the American Society for Radiation Oncology 52nd Annual Meeting, show that radiation therapy after surgical resection is strongly associated with improvements in both cause-specific survival and overall survival.

For the entire cohort, the median overall survival was 17 months. Patients who underwent surgery alone had a median overall survival of 15 months; for those who received adjuvant radiation therapy, it was 20 months.

In the surgery-only cohort, 1-year survival was 55.8% and 2-year survival was 31.6%. In the radiation therapy cohort, 1-year survival was 72.2% and 2-year survival was 40.4%.

"We did find radiation therapy to be significant for overall survival," said lead author Krisha Opfermann, MD, from the Medical University of South Carolina in Charleston.

On multivariate analyses, for those who underwent surgery, improved overall survival was associated with "a higher number of lymph nodes resected, a lower absolute number of positive resected lymph nodes, a lack of regional extent of the disease, a lower lymph node ratio, and more recent diagnosis," she explained.

For those who received radiation therapy, "the year of diagnosis and the regional extent of the disease" no longer affected overall survival, Dr. Opfermann said.

Commenting on the paper, Salma K Jabbour, MD, from the Cancer Institute of New Jersey in New Brunswick, noted that "this was a very unique trial."

Among lymph-node-positive patients, radiation therapy improved survival in most groups of patients, she said. Lees het volledige artikel op Medscape verder: klik hier

The present report aimed to provide a critical review of the different approaches for the management of BR pancreatic ductal adenocarcinoma (PDAC), specifically addressing the different definitions of BR disease and exploring the current treatment modalities in depth.

Source: Radiation Radiology: 

DOI: https://doi.org/10.1016/j.ijrobp.2017.12.287

Management of Borderline Resectable Pancreatic Cancer

Diego A.S. Toesca, MD

Amanda J. Koong,

George A. Poultsides, MD

Brendan C. Visser, MD

Sigurdis Haraldsdottir, MD, PhD

Albert C. Koong, MD, PhD

Daniel T. Chang, MD'Correspondence information about the author MD Daniel T. Chang

With the rapid development of imaging modalities and surgical techniques, the clinical entity representing tumors that are intermediate between resectable and unresectable pancreatic adenocarcinoma has been identified has been termed “borderline resectable” (BR). These tumors are generally amenable for resection but portend an increased risk for positive margins after surgery and commonly necessitate vascular resection and reconstruction. Although there is a lack of consensus regarding the appropriate definition of what constitutes a BR pancreatic tumor, it has been demonstrated that this intermediate category carries a particular prognosis that is in between resectable and unresectable disease. In order to downstage the tumor and increase the probability of clear surgical margins, neoadjuvant therapy is being increasingly utilized and studied. There is a lack of high-level evidence to establish the optimal treatment regimen for BR tumors. When resection with negative margins is achieved after neoadjuvant therapy, the prognosis for BR tumors approaches and even exceeds that for resectable disease. This review presents the current definitions, different treatment approaches, and the clinical outcomes of BR pancreatic cancer.

Conclusions

Despite the controversies regarding the optimal method to define BR disease, a consensus is growing that this subset of PDAC represents a unique class within the spectrum of PDAC, with its own prognosis, which can be significantly improved if a favorable response is achieved after preoperative therapy and resection. Evolving techniques of surgery could also increase the number of patients who might be considered to have BR disease. Prospective randomized trials comparing different neoadjuvant regimens are needed to properly define the best neoadjuvant treatment regimen before surgery.

References

  1. Siegel, R.L., Miller, K.D., and Jemal, A. Cancer statistics, 2017. CA Cancer J Clin. 2017; 67: 7–30
  2. Rahib, L., Smith, B.D., Aizenberg, R. et al. Projecting cancer incidence and deaths to 2030: The unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res. 2014; 74: 2913–2921
  3. Kuhlmann, K.F., de Castro, S.M., Wesseling, J.G. et al. Surgical treatment of pancreatic adenocarcinoma; actual survival and prognostic factors in 343 patients. Eur J Cancer. 2004; 40: 549–558
  4. Sohn, T.A., Yeo, C.J., Cameron, J.L. et al. Resected adenocarcinoma of the pancreas-616 patients: Results, outcomes, and prognostic indicators. J Gastrointest Surg. 2000; 4: 567–579
  5. Neoptolemos, J.P., Stocken, D.D., Dunn, J.A. et al. Influence of resection margins on survival for patients with pancreatic cancer treated by adjuvant chemoradiation and/or chemotherapy in the ESPAC-1 randomized controlled trial. Ann Surg. 2001; 234: 758–768
  6. Winter, J.M., Cameron, J.L., Campbell, K.A. et al. 1423 Pancreaticoduodenectomies for pancreatic cancer: A single-institution experience. J Gastrointest Surg. 2006; 10: 1199–1211
  7. Tamm, E., Charnsangavej, C., and Szklaruk, J. Advanced 3-D imaging for the evaluation of pancreatic cancer with multidetector CT. Int J Gastrointest Cancer. 2001; 30: 65–71
  8. Faria, S.C., Tamm, E.P., Loyer, E.M. et al. Diagnosis and staging of pancreatic tumors. Semin Roentgenol. 2004; 39: 397–411
  9. Kulig, J., Popiela, T., Zajac, A. et al. The value of imaging techniques in the staging of pancreatic cancer. Surg Endosc. 2005; 19: 361–365
  10. Varadhachary, G.R. Preoperative therapies for resectable and borderline resectable pancreatic cancer. J Gastrointest Oncol. 2011; 2: 136–142
  11. Lopez, N.E., Prendergast, C., and Lowy, A.M. Borderline resectable pancreatic cancer: Definitions and management. World J Gastroenterol. 2014; 20: 10740–10751
  12. Katz, M.H., Crane, C.H., and Varadhachary, G. Management of borderline resectable pancreatic cancer. Semin Radiat Oncol. 2014; 24: 105–112
  13. Mehta, V.K., Fisher, G., Ford, J.A. et al. Preoperative chemoradiation for marginally resectable adenocarcinoma of the pancreas. J Gastrointest Surg. 2001; 5: 27–35
  14. Varadhachary, G.R., Tamm, E.P., Abbruzzese, J.L. et al. Borderline resectable pancreatic cancer: Definitions, management, and role of preoperative therapy. Ann Surg Oncol. 2006; 13: 1035–1046
  15. Callery, M.P., Chang, K.J., Fishman, E.K. et al. Pretreatment assessment of resectable and borderline resectable pancreatic cancer: Expert consensus statement. Ann Surg Oncol. 2009; 16: 1727–1733
  16. Abrams, R.A., Lowy, A.M., O'Reilly, E.M. et al. Combined modality treatment of resectable and borderline resectable pancreas cancer: Expert consensus statement. Ann Surg Oncol. 2009; 16: 1751–1756
  17. National Comprehensive Cancer Network. Pancreatic Adenocarcinoma (version 1.2017; February 24, 2017). (Available at:)
    https://www.nccn.org/professionals/physician_gls/PDF/pancreatic.pdf
    March 30, 2017
  18. Appel, B.L., Tolat, P., Evans, D.B. et al. Current staging systems for pancreatic cancer. Cancer J. 2012; 18: 539–549
  19. Katz, M.H., Marsh, R., Herman, J.M. et al. Borderline resectable pancreatic cancer: Need for standardization and methods for optimal clinical trial design. Ann Surg Oncol. 2013; 20: 2787–2795
  20. Bockhorn, M., Uzunoglu, F.G., Adham, M. et al. Borderline resectable pancreatic cancer: A consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2014; 155: 977–988
  21. Tran Cao, H.S., Balachandran, A., Wang, H. et al. Radiographic tumor–vein interface as a predictor of intraoperative, pathologic, and oncologic outcomes in resectable and borderline resectable pancreatic cancer. J Gastrointest Surg. 2014; 18: 269–278
  22. Marinelli, T., Filippone, A., Tavano, F. et al. A tumour score with multidetector spiral CT for venous infiltration in pancreatic cancer: Influence on borderline resectable. Radiol Med. 2014; 119: 334–342
  23. Al-Hawary, M.M., Francis, I.R., Chari, S.T. et al. Pancreatic ductal adenocarcinoma radiology reporting template: Consensus statement of the Society of Abdominal Radiology and the American Pancreatic Association. Radiology. 2014; 270: 248–260
  24. Evans, D.B., George, B., and Tsai, S. Non-metastatic pancreatic cancer: Resectable, borderline resectable, and locally advanced—Definitions of increasing importance for the optimal delivery of multimodality therapy. Ann Surg Oncol. 2015; 22: 3409–3413
  25. Chang, S.T., Jeffrey, R.B., Patel, B.N. et al. Preoperative multidetector CT diagnosis of extrapancreatic perineural or duodenal invasion is associated with reduced postoperative survival after pancreaticoduodenectomy for pancreatic adenocarcinoma: Preliminary experience and implications for patient care. Radiology. 2016; 281: 816–825
  26. Hoffe, S., Rao, N., and Shridhar, R. Neoadjuvant vs adjuvant therapy for resectable pancreatic cancer: The evolving role of radiation. Semin Radiat Oncol. 2014; 24: 113–125
  27. Eshuis, W.J., Tol, J.A., Nio, C.Y. et al. Leakage of the gastroenteric anastomosis after pancreatoduodenectomy. Surgery. 2014; 156: 75–82
  28. Neoptolemos, J.P., Palmer, D.H., Ghaneh, P. et al. Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): A multicentre, open-label, randomised, phase 3 trial. Lancet. 2017; 389: 1011–1024
  29. Seufferlein, T., Bachet, J.B., Van Cutsem, E. et al. Pancreatic adenocarcinoma: ESMO-ESDO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012; 23: vii33–vii40
  30. Khorana, A.A., Mangu, P.B., Berlin, J. et al. Potentially curable pancreatic cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol. 2016; 34: 2541–2556
  31. Massucco, P., Capussotti, L., Magnino, A. et al. Pancreatic resections after chemoradiotherapy for locally advanced ductal adenocarcinoma: Analysis of perioperative outcome and survival. Ann Surg Oncol. 2006; 13: 1201–1208
  32. Stokes, J.B., Nolan, N.J., Stelow, E.B. et al. Preoperative capecitabine and concurrent radiation for borderline resectable pancreatic cancer. Ann Surg Oncol. 2011; 18: 619–627
  33. Takai, S., Satoi, S., Yanagimoto, H. et al. Neoadjuvant chemoradiation in patients with potentially resectable pancreatic cancer. Pancreas. 2008; 36: e26–e32
  34. Cho, I.R., Chung, M.J., Bang, S. et al. Gemcitabine based neoadjuvant chemoradiotherapy therapy in patients with borderline resectable pancreatic cancer. Pancreatology. 2013; 13: 539–543
  35. Habermehl, D., Kessel, K., Welzel, T. et al. Neoadjuvant chemoradiation with gemcitabine for locally advanced pancreatic cancer. Radiat Oncol. 2012; 7: 28
  36. Brown, K.M., Siripurapu, V., Davidson, M. et al. Chemoradiation followed by chemotherapy before resection for borderline pancreatic adenocarcinoma. Am J Surg. 2008; 195: 318–321
  37. Chun, Y.S., Milestone, B.N., Watson, J.C. et al. Defining venous involvement in borderline resectable pancreatic cancer. Ann Surg Oncol. 2010; 17: 2832–2838
  38. Barugola, G., Partelli, S., Crippa, S. et al. Outcomes after resection of locally advanced or borderline resectable pancreatic cancer after neoadjuvant therapy. Am J Surg. 2012; 203: 132–139
  39. Kang, C.M., Chung, Y.E., Park, J.Y. et al. Potential contribution of preoperative neoadjuvant concurrent chemoradiation therapy on margin-negative resection in borderline resectable pancreatic cancer. J Gastrointest Surg. 2012; 16: 509–517
  40. Kim, E.J., Ben-Josef, E., Herman, J.M. et al. A multi-institutional phase 2 study of neoadjuvant gemcitabine and oxaliplatin with radiation therapy in patients with pancreatic cancer. Cancer. 2013; 119: 2692–2700
  41. Takahashi, H., Ohigashi, H., Gotoh, K. et al. Preoperative gemcitabine-based chemoradiation therapy for resectable and borderline resectable pancreatic cancer. Ann Surg. 2013; 258: 1040–1050
  42. Hirono, S., Kawai, M., Okada, K.I. et al. Treatment strategy for borderline resectable pancreatic cancer with radiographic artery involvement. Pancreas. 2016; 45: 1438–1446
  43. McClaine, R.J., Lowy, A.M., Sussman, J.J. et al. Neoadjuvant therapy may lead to successful surgical resection and improved survival in patients with borderline resectable pancreatic cancer. HPB (Oxford). 2010; 12: 73–79
  44. Sahora, K., Kuehrer, I., Schindl, M. et al. NeoGemTax: Gemcitabine and docetaxel as neoadjuvant treatment for locally advanced nonmetastasized pancreatic cancer. World J Surg. 2011; 35: 1580–1589
  45. Sahora, K., Kuehrer, I., Eisenhut, A. et al. NeoGemOx: Gemcitabine and oxaliplatin as neoadjuvant treatment for locally advanced, nonmetastasized pancreatic cancer. Surgery. 2011; 149: 311–320
  46. Lee, J.L., Kim, S.C., Kim, J.H. et al. Prospective efficacy and safety study of neoadjuvant gemcitabine with capecitabine combination chemotherapy for borderline-resectable or unresectable locally advanced pancreatic adenocarcinoma. Surgery. 2012; 152: 851–862
  47. Boone, B.A., Steve, J., Krasinskas, A.M. et al. Outcomes with FOLFIRINOX for borderline resectable and locally unresectable pancreatic cancer. J Surg Oncol. 2013; 108: 236–241
  48. Motoi, F., Ishida, K., Fujishima, F. et al. Neoadjuvant chemotherapy with gemcitabine and S-1 for resectable and borderline pancreatic ductal adenocarcinoma: Results from a prospective multi-institutional phase 2 trial. Ann Surg Oncol. 2013; 20: 3794–3801
  49. Paniccia, A., Edil, B.H., Schulick, R.D. et al. Neoadjuvant FOLFIRINOX application in borderline resectable pancreatic adenocarcinoma: A retrospective cohort study. Medicine (Baltimore). 2014; 93: e198
  50. Rose, J.B., Rocha, F.G., Alseidi, A. et al. Extended neoadjuvant chemotherapy for borderline resectable pancreatic cancer demonstrates promising postoperative outcomes and survival. Ann Surg Oncol. 2014; 21: 1530–1537
  51. Ielpo, B., Duran, H., Diaz, E. et al. Preoperative treatment with gemcitabine plus nab-paclitaxel is a safe and effective chemotherapy for pancreatic adenocarcinoma. Eur J Surg Oncol. 2016; 42: 1394–1400
  52. Kim, S.S., Nakakura, E.K., Wang, Z.J. et al. Preoperative FOLFIRINOX for borderline resectable pancreatic cancer: Is radiation necessary in the modern era of chemotherapy?. J Surg Oncol. 2016; 114: 587–596
  53. Murakami, Y., Uemura, K., Sudo, T. et al. Survival impact of neoadjuvant gemcitabine plus S-1 chemotherapy for patients with borderline resectable pancreatic carcinoma with arterial contact. Cancer Chemother Pharmacol. 2017; 79: 37–47
  54. Okada, K.I., Hirono, S., Kawai, M. et al. Phase I study of nab-paclitaxel plus gemcitabine as neoadjuvant therapy for borderline resectable pancreatic cancer. Anticancer Res. 2017; 37: 853–858
  55. Conroy, T., Desseigne, F., Ychou, M. et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011; 364: 1817–1825
  56. Von Hoff, D.D., Ervin, T., Arena, F.P. et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med. 2013; 369: 1691–1703
  57. Katz, M.H., Pisters, P.W., Evans, D.B. et al. Borderline resectable pancreatic cancer: The importance of this emerging stage of disease. J Am Coll Surg. 2008; 206: 833–848
  58. Landry, J., Catalano, P.J., Staley, C. et al. Randomized phase II study of gemcitabine plus radiotherapy versus gemcitabine, 5-fluorouracil, and cisplatin followed by radiotherapy and 5-fluorouracil for patients with locally advanced, potentially resectable pancreatic adenocarcinoma. J Surg Oncol. 2010; 101: 587–592
  59. Chuong, M.D., Hayman, T.J., Patel, M.R. et al. Comparison of 1-, 2-, and 3-dimensional tumor response assessment after neoadjuvant GTX-RT in borderline-resectable pancreatic cancer. Gastrointest Cancer Res. 2011; 4: 128–134
  60. Patel, M., Hoffe, S., Malafa, M. et al. Neoadjuvant GTX chemotherapy and IMRT-based chemoradiation for borderline resectable pancreatic cancer. J Surg Oncol. 2011; 104: 155–161
  61. Kharofa, J., Kelly, T.R., Ritch, P.S. et al. 5-FU/leucovorin, irinotecan, oxaliplatin (FOLFIRINOX) induction followed by chemoXRT in borderline resectable pancreatic cancer. ()J Clin Oncol. 2012; 30: e14613
  62. Leone, F., Gatti, M., Massucco, P. et al. Induction gemcitabine and oxaliplatin therapy followed by a twice-weekly infusion of gemcitabine and concurrent external-beam radiation for neoadjuvant treatment of locally advanced pancreatic cancer: A single institutional experience. Cancer. 2013; 119: 277–284
  63. Dholakia, A.S., Hacker-Prietz, A., Wild, A.T. et al. Resection of borderline resectable pancreatic cancer after neoadjuvant chemoradiation does not depend on improved radiographic appearance of tumor–vessel relationships. J Radiat Oncol. 2013; 2: 413–425
  64. Christians, K.K., Tsai, S., Mahmoud, A. et al. Neoadjuvant FOLFIRINOX for borderline resectable pancreas cancer: A new treatment paradigm?. Oncologist. 2014; 19: 266–274
  65. Kharofa, J., Tsai, S., Kelly, T. et al. Neoadjuvant chemoradiation with IMRT in resectable and borderline resectable pancreatic cancer. Radiother Oncol. 2014; 113: 41–46
  66. Badiyan, S.N., Olsen, J.R., Lee, A.Y. et al. Induction chemotherapy followed by concurrent full-dose gemcitabine and intensity-modulated radiation therapy for borderline resectable and locally advanced pancreatic adenocarcinoma. Am J Clin Oncol. 2016; 39: 1–7
  67. Katz, M.H., Shi, Q., Ahmad, S.A. et al. Preoperative modified FOLFIRINOX treatment followed by capecitabine-based chemoradiation for borderline resectable pancreatic cancer: Alliance for Clinical Trials in Oncology trial A021101. JAMA Surg. 2016; 151: e161137
  68. Hammel, P., Huguet, F., van Laethem, J.L. et al. Effect of chemoradiotherapy vs chemotherapy on survival in patients with locally advanced pancreatic cancer controlled after 4 months of gemcitabine with or without erlotinib: The LAP07 randomized clinical trial. JAMA. 2016; 315: 1844–1853
  69. Chakraborty, S., Morris, M.M., Bauer, T.W. et al. Accelerated fraction radiotherapy with capecitabine as neoadjuvant therapy for borderline resectable pancreatic cancer. Gastrointest Cancer Res. 2014; 7: 15–22
  70. Takeda, Y., Nakamori, S., Eguchi, H. et al. Neoadjuvant gemcitabine-based accelerated hyperfractionation chemoradiotherapy for patients with borderline resectable pancreatic adenocarcinoma. Jpn J Clin Oncol. 2014; 44: 1172–1180
  71. Prasad, S., Cambridge, L., Huguet, F. et al. Intensity modulated radiation therapy reduces gastrointestinal toxicity in locally advanced pancreas cancer. Pract Radiat Oncol. 2016; 6: 78–85
  72. Wang, L.S., Shaikh, T., Handorf, E.A. et al. Dose escalation with a vessel boost in pancreatic adenocarcinoma treated with neoadjuvant chemoradiation. Pract Radiat Oncol. 2015; 5: e457–e463
  73. Passoni, P., Reni, M., Cattaneo, G.M. et al. Hypofractionated image-guided IMRT in advanced pancreatic cancer with simultaneous integrated boost to infiltrated vessels concomitant with capecitabine: A phase I study. Int J Radiat Oncol Biol Phys. 2013; 87: 1000–1006
  74. Krishnan, S., Chadha, A.S., Suh, Y. et al. Focal radiation therapy dose escalation improves overall survival in locally advanced pancreatic cancer patients receiving induction chemotherapy and consolidative chemoradiation. Int J Radiat Oncol Biol Phys. 2016; 94: 755–765
  75. Koong, A.C., Le, Q.T., Ho, A. et al. Phase I study of stereotactic radiosurgery in patients with locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys. 2004; 58: 1017–1021
  76. Koong, A.C., Christofferson, E., Le, Q.T. et al. Phase II study to assess the efficacy of conventionally fractionated radiotherapy followed by a stereotactic radiosurgery boost in patients with locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys. 2005; 63: 320–323
  77. Schellenberg, D., Goodman, K.A., Lee, F. et al. Gemcitabine chemotherapy and single-fraction stereotactic body radiotherapy for locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys. 2008; 72: 678–686
  78. Mahadevan, A., Jain, S., Goldstein, M. et al. Stereotactic body radiotherapy and gemcitabine for locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys. 2010; 78: 735–742
  79. Schellenberg, D., Kim, J., Christman-Skieller, C. et al. Single-fraction stereotactic body radiation therapy and sequential gemcitabine for the treatment of locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys. 2011; 81: 181–188
  80. Herman, J.M., Chang, D.T., Goodman, K.A. et al. Phase 2 multi-institutional trial evaluating gemcitabine and stereotactic body radiotherapy for patients with locally advanced unresectable pancreatic adenocarcinoma. Cancer. 2015; 121: 1128–1137
  81. Chuong, M.D., Springett, G.M., Freilich, J.M. et al. Stereotactic body radiation therapy for locally advanced and borderline resectable pancreatic cancer is effective and well tolerated. Int J Radiat Oncol Biol Phys. 2013; 86: 516–522
  82. Rajagopalan, M.S., Heron, D.E., Wegner, R.E. et al. Pathologic response with neoadjuvant chemotherapy and stereotactic body radiotherapy for borderline resectable and locally-advanced pancreatic cancer. Radiat Oncol. 2013; 8: 254
  83. Mellon, E.A., Hoffe, S.E., Springett, G.M. et al. Long-term outcomes of induction chemotherapy and neoadjuvant stereotactic body radiotherapy for borderline resectable and locally advanced pancreatic adenocarcinoma. Acta Oncol. 2015; 54: 979–985
  84. Moningi, S., Dholakia, A.S., Raman, S.P. et al. The role of stereotactic body radiation therapy for pancreatic cancer: A single-institution experience. Ann Surg Oncol. 2015; 22: 2352–2358
  85. Rashid, O.M., Pimiento, J.M., Gamenthaler, A.W. et al. Outcomes of a clinical pathway for borderline resectable pancreatic cancer. Ann Surg Oncol. 2016; 23: 1371–1379
  86. Shaib, W.L., Hawk, N., Cassidy, R.J. et al. A phase 1 study of stereotactic body radiation therapy dose escalation for borderline resectable pancreatic cancer after modified FOLFIRINOX (NCT01446458). Int J Radiat Oncol Biol Phys. 2016; 96: 296–303
  87. Chuong, M.D., Frakes, J.M., Figura, N. et al. Histopathologic tumor response after induction chemotherapy and stereotactic body radiation therapy for borderline resectable pancreatic cancer. J Gastrointest Oncol. 2016; 7: 221–227
  88. Hong, T.S., Ryan, D.P., Borger, D.R. et al. A phase 1/2 and biomarker study of preoperative short course chemoradiation with proton beam therapy and capecitabine followed by early surgery for resectable pancreatic ductal adenocarcinoma. Int J Radiat Oncol Biol Phys. 2014; 89: 830–838
  89. Nichols, R.C., George, T.J., Zaiden, R.A. et al. Proton therapy with concomitant capecitabine for pancreatic and ampullary cancers is associated with a low incidence of gastrointestinal toxicity. Acta Oncol. 2013; 52: 498–505
  90. Sachsman, S., Nichols, R.C., Morris, C.G. et al. Proton therapy and concomitant capecitabine for non-metastatic unresectable pancreatic adenocarcinoma. Int J Particle Ther. 2014; 1: 692–701
  91. Shinoto, M., Yamada, S., Yasuda, S. et al. Phase 1 trial of preoperative, short-course carbon-ion radiotherapy for patients with resectable pancreatic cancer. Cancer. 2013; 119: 45–51
  92. Shinoto, M., Yamada, S., Terashima, K. et al. Carbon ion radiation therapy with concurrent gemcitabine for patients with locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys. 2016; 95: 498–504
  93. Jones, S., Zhang, X., Parsons, D.W. et al. Core signaling pathways in human pancreatic cancers revealed by global genomic analyses. Science. 2008; 321: 1801–1806
  94. Crane, C.H., Varadhachary, G.R., Yordy, J.S. et al. Phase II trial of cetuximab, gemcitabine, and oxaliplatin followed by chemoradiation with cetuximab for locally advanced (T4) pancreatic adenocarcinoma: Correlation of Smad4(Dpc4) immunostaining with pattern of disease progression. J Clin Oncol. 2011; 29: 3037–3043
  95. Esnaola, N.F., Chaudhary, U.B., O'Brien, P. et al. Phase 2 trial of induction gemcitabine, oxaliplatin, and cetuximab followed by selective capecitabine-based chemoradiation in patients with borderline resectable or unresectable locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys. 2014; 88: 837–844
  96. Moore, M.J., Goldstein, D., Hamm, J. et al. Erlotinib plus gemcitabine compared with gemcitabine alone in patients with advanced pancreatic cancer: A phase III trial of the National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol. 2007; 25: 1960–1966
  97. Sinn, M., Bahra, M., Liersch, T. et al. CONKO-005: Adjuvant chemotherapy with gemcitabine plus erlotinib versus gemcitabine alone in patients after R0 resection of pancreatic cancer: A multicenter randomized phase III trial. J Clin Oncol. 2017; 35: 3330–3337
  98. Van Buren, G., Ramanathan, R.K., Krasinskas, A.M. et al. Phase II study of induction fixed-dose rate gemcitabine and bevacizumab followed by 30 Gy radiotherapy as preoperative treatment for potentially resectable pancreatic adenocarcinoma. Ann Surg Oncol. 2013; 20: 3787–3793
  99. Sahora, K., Schindl, M., Kuehrer, I. et al. A phase II trial of two durations of bevacizumab added to neoadjuvant gemcitabine for borderline and locally advanced pancreatic cancer. Anticancer Res. 2014; 34: 2377–2384
  100. Nywening, T.M., Wang-Gillam, A., Sanford, D.E. et al. Targeting tumour-associated macrophages with CCR2 inhibition in combination with FOLFIRINOX in patients with borderline resectable and locally advanced pancreatic cancer: A single-centre, open-label, dose-finding, non-randomised, phase 1B trial. Lancet Oncol. 2016; 17: 651–662
  101. Chiaravalli, M., Reni, M., and O'Reilly, E.M. Pancreatic ductal adenocarcinoma: State-of-the-art 2017 and new therapeutic strategies. Cancer Treat Rev. 2017; 60: 32–43
  102. Granier, C., De Guillebon, E., Blanc, C. et al. Mechanisms of action and rationale for the use of checkpoint inhibitors in cancer. ESMO Open. 2017; 2: e000213
  103. Le, D.T., Uram, J.N., Wang, H. et al. PD-1 blockade in tumors with mismatch-repair deficiency. N Engl J Med. 2015; 372: 2509–2520
  104. Le, D.T., Durham, J.N., Smith, K.N. et al. Mismatch repair deficiency predicts response of solid tumors to PD-1 blockade. Science. 2017; 357: 409–413
  105. Jensen, E.H., Armstrong, L., Lee, C. et al. Neoadjuvant interferon-based chemoradiation for borderline resectable and locally advanced pancreas cancer: A phase II pilot study. HPB (Oxford). 2014; 16: 131–139
  106. Royal, R.E., Levy, C., Turner, K. et al. Phase 2 trial of single agent ipilimumab (anti-CTLA-4) for locally advanced or metastatic pancreatic adenocarcinoma. J Immunother. 2010; 33: 828–833
  107. Dudeja, V., Greeno, E.W., Walker, S.P. et al. Neoadjuvant chemoradiotherapy for locally advanced pancreas cancer rarely leads to radiological evidence of tumour regression. HPB (Oxford). 2013; 15: 661–667
  108. Apte, M.V., Xu, Z., Pothula, S. et al. Pancreatic cancer: The microenvironment needs attention too!. Pancreatology. 2015; 15: S32–S38
  109. Ferrone, C.R., Marchegiani, G., Hong, T.S. et al. Radiological and surgical implications of neoadjuvant treatment with FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer. Ann Surg. 2015; 261: 12–17
  110. Katz, M.H., Fleming, J.B., Bhosale, P. et al. Response of borderline resectable pancreatic cancer to neoadjuvant therapy is not reflected by radiographic indicators. Cancer. 2012; 118: 5749–5756
  111. Mellon, E.A., Jin, W.H., Frakes, J.M. et al. Predictors and survival for pathologic tumor response grade in borderline resectable and locally advanced pancreatic cancer treated with induction chemotherapy and neoadjuvant stereotactic body radiotherapy. Acta Oncol. 2017; 56: 391–397
  112. Schellenberg, D., Quon, A., Minn, A.Y. et al. 18Fluorodeoxyglucose PET is prognostic of progression-free and overall survival in locally advanced pancreas cancer treated with stereotactic radiotherapy. Int J Radiat Oncol Biol Phys. 2010; 77: 1420–1425
  113. Akita, H., Takahashi, H., Ohigashi, H. et al. FDG-PET predicts treatment efficacy and surgical outcome of pre-operative chemoradiation therapy for resectable and borderline resectable pancreatic cancer. Eur J Surg Oncol. 2017; 43: 1061–1067
  114. Fortner, J.G. Regional resection of cancer of the pancreas: A new surgical approach. Surgery. 1973; 73: 307–320
  115. Amano, R., Kimura, K., Nakata, B. et al. Pancreatectomy with major arterial resection after neoadjuvant chemoradiotherapy gemcitabine and S-1 and concurrent radiotherapy for locally advanced unresectable pancreatic cancer. Surgery. 2015; 158: 191–200
  116. Christians, K.K., Pilgrim, C.H., Tsai, S. et al. Arterial resection at the time of pancreatectomy for cancer. Surgery. 2014; 155: 919–926
  117. Helmink, B.A., Snyder, R.A., Idrees, K. et al. Advances in the surgical management of resectable and borderline resectable pancreas cancer. Surg Oncol Clin N Am. 2016; 25: 287–310
  118. Zhou, Y., Zhang, Z., Liu, Y. et al. Pancreatectomy combined with superior mesenteric vein-portal vein resection for pancreatic cancer: A meta-analysis. World J Surg. 2012; 36: 884–891
  119. Mollberg, N., Rahbari, N.N., Koch, M. et al. Arterial resection during pancreatectomy for pancreatic cancer: A systematic review and meta-analysis. Ann Surg. 2011; 254: 882–893
  120. Takahashi, Y., Kaneoka, Y., Maeda, A. et al. Distal pancreatectomy with celiac axis resection for carcinoma of the body and tail of the pancreas. World J Surg. 2011; 35: 2535–2542
  121. Hirono, S. and Yamaue, H. Tips and tricks of the surgical technique for borderline resectable pancreatic cancer: Mesenteric approach and modified distal pancreatectomy with en-bloc celiac axis resection. J Hepatobiliary Pancreat Sci. 2015; 22: E4–E7
  122. Kluger, M.D., Rashid, M.F., Rosario, V.L. et al. Resection of locally advanced pancreatic cancer without regression of arterial encasement after modern-era neoadjuvant therapy. J Gastrointest Surg. 2017; 152: S1224
  123. Amano, H., Miura, F., Toyota, N. et al. Pancreatectomy with reconstruction of the right and left hepatic arteries for locally advanced pancreatic cancer. J Hepatobiliary Pancreat Surg. 2009; 16: 777–780
  124. Jegatheeswaran, S., Baltatzis, M., Jamdar, S. et al. Superior mesenteric artery (SMA) resection during pancreatectomy for malignant disease of the pancreas: A systematic review. HPB (Oxford). 2017; 19: 483–490
  125. Versteijne, E., van Eijck, C.H., Punt, C.J. et al. Preoperative radiochemotherapy versus immediate surgery for resectable and borderline resectable pancreatic cancer (PREOPANC trial): Study protocol for a multicentre randomized controlled trial. Trials. 2016; 17: 127
  126. Hruban, R.H., Pitman, M.B., and Klimstra, D. Tumors of the Pancreas. Armed Forces Institute of Pathology, Washington, DC; 2007
  127. Verbeke, C.S., Leitch, D., Menon, K.V. et al. Redefining the R1 resection in pancreatic cancer. Br J Surg. 2006; 93: 1232–1237
  128. Esposito, I., Kleeff, J., Bergmann, F. et al. Most pancreatic cancer resections are R1 resections. Ann Surg Oncol. 2008; 15: 1651–1660
  129. Schlitter, A.M. and Esposito, I. Definition of microscopic tumor clearance (R0) in pancreatic cancer resections. Cancers (Basel). 2010; 2: 2001–2010
  130. Chandrasegaram, M.D., Goldstein, D., Simes, J. et al. Meta-analysis of radical resection rates and margin assessment in pancreatic cancer. Br J Surg. 2015; 102: 1459–1472
  131. Campbell, F., Smith, R.A., Whelan, P. et al. Classification of R1 resections for pancreatic cancer: The prognostic relevance of tumour involvement within 1 mm of a resection margin. Histopathology. 2009; 55: 277–283
  132. Sindelar, W.F. and Kinsella, T.J. Studies of intraoperative radiotherapy in carcinoma of the pancreas. Ann Oncol. 1999; 10: 226–230
  133. Zerbi, A., Fossati, V., Parolini, D. et al. Intraoperative radiation therapy adjuvant to resection in the treatment of pancreatic cancer. Cancer. 1994; 73: 2930–2935
  134. Tepper, J.E., Noyes, D., Krall, J.M. et al. Intraoperative radiation therapy of pancreatic carcinoma: A report of RTOG-8505. Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys. 1991; 21: 1145–1149
  135. Willett, C.G., Del Castillo, C.F., Shih, H.A. et al. Long-term results of intraoperative electron beam irradiation (IOERT) for patients with unresectable pancreatic cancer. Ann Surg. 2005; 241: 295–299
  136. Cai, S., Hong, T.S., Goldberg, S.I. et al. Updated long-term outcomes and prognostic factors for patients with unresectable locally advanced pancreatic cancer treated with intraoperative radiotherapy at the Massachusetts General Hospital, 1978 to 2010. Cancer. 2013; 119: 4196–4204
  137. Ashman, J.B., Moss, A.A., Rule, W.G. et al. Preoperative chemoradiation and IOERT for unresectable or borderline resectable pancreas cancer. J Gastrointest Oncol. 2013; 4: 352–360
  138. Ogawa, K., Karasawa, K., Ito, Y. et al. Intraoperative radiotherapy for resected pancreatic cancer: A multi-institutional retrospective analysis of 210 patients. Int J Radiat Oncol Biol Phys. 2010; 77: 734–742
  139. Alfieri, S., Morganti, A.G., Di Georgio, A. et al. Improved survival and local control after intraoperative radiation therapy and postoperative radiotherapy: A multivariate analysis of 46 patients undergoing surgery for pancreatic head cancer. Arch Surg. 2001; 136: 343–347
  140. Keane, F.K., Wo, J.Y., Ferrone, C.R. et al. Intraoperative radiotherapy in the era of intensive neoadjuvant chemotherapy and chemoradiotherapy for pancreatic adenocarcinoma. ([Epub ahead of print])Am J Clin Oncol. 2016;
  141. Palta, M., Willett, C., and Czito, B. The role of intraoperative radiation therapy in patients with pancreatic cancer. Semin Radiat Oncol. 2014; 24: 126–131
  142. Willett, C.G., Czito, B.G., Bendell, J.C. et al. Locally advanced pancreatic cancer. J Clin Oncol. 2005; 23: 4538–4544
  143. Hurt, C.N., Mukherjee, S., Bridgewater, J. et al. Health-related quality of life in SCALOP, a randomized phase 2 trial comparing chemoradiation therapy regimens in locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys. 2015; 93: 810–818
  144. Shugang, X., Hongfa, Y., Jianpeng, L. et al. Prognostic value of SMAD4 in pancreatic cancer: A meta-analysis. Transl Oncol. 2016; 9: 1–7
  145. Iacobuzio-Donahue, C.A., Fu, B., Yachida, S. et al. DPC4 gene status of the primary carcinoma correlates with patterns of failure in patients with pancreatic cancer. J Clin Oncol. 2009; 27: 1806–1813

Note—An online CME test for this article can be taken at https://academy.astro.org.

Conflict of interest: none.

© 2018 Elsevier Inc. All rights reserved.

alvleesklierkanker, Whipple operatie, radiotherapie, inwendige bestraling, iodine-125 implantatie, pancreaskanker, nanoknife, IRE - ireversible electroporation


Plaats een reactie ...

Reageer op "Bestraling vooraf aan operatie bij alvleesklierkanker zou significant langere overlevingstijd en overall overleving geven, aldus nieuwe studie. Maar bestraling vooraf blijft controversieel, aldus onderzoekers."


Gerelateerde artikelen
 

Gerelateerde artikelen

Protonenbestraling tijdens >> Regulier - alvleesklierkanker >>