Helpt u ons aan 500 donateurs?

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.

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

Conflict of interest: none.


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