RESUMEN
BACKGROUND/AIM: Pancreatic cancer (PC) has one of the highest mortality rates, with an overall five-year survival rate of only 7%. When diagnosed, PC is limited to the pancreas in only 20% of patients, whereas in 50% it has already metastasized. This is due to its late diagnosis, which makes the treatments used, such as radiotherapy, difficult, and reduces survival rates. Therefore, the importance of this study in detecting genes that may become possible biomarkers for this type of tumor, especially regarding the human secretome, is highlighted. These genes participate in pathways that are responsible for tumor migration and resistance to therapies, along with other important factors. MATERIALS AND METHODS: To achieve these goals, the following online tools and platforms have been expanded to discover and validate these biomarkers: The Human Protein Atlas database, the Xena Browser platform, Gene Expression Omnibus, the EnrichR platform and the Kaplan-Meier Plotter platform. RESULTS: Our study adopted a methodology that allows the identification of potential biomarkers related to the effectiveness of radiotherapy in PC. Inflammatory pathways were predominantly enriched, related to the regulation of biological processes, primarily in cytokine-derived proteins, which are responsible for tumor progression and other processes that contribute to the development of the disease. CONCLUSION: Radiotherapy treatment demonstrated greater efficacy when used in conjunction with other forms of therapy since it decreased the expression of essential genes involved in several inflammatory pathways linked to tumor progression.
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Biomarcadores de Tumor , Neoplasias Pancreáticas , Humanos , Biomarcadores de Tumor/genética , Biomarcadores de Tumor/metabolismo , Pronóstico , Neoplasias Pancreáticas/genética , Neoplasias Pancreáticas/radioterapia , Neoplasias Pancreáticas/metabolismo , Regulación Neoplásica de la Expresión Génica , Biología Computacional/métodos , Perfilación de la Expresión Génica/métodos , Neoplasias PancreáticasRESUMEN
BACKGROUND: To investigate the role of adjuvant radiotherapy in patients with pancreatic cancer. METHODS AND PATIENTS: The patients with pancreatic cancer from 18 registered institutions in the Surveillance Epidemiology and End Results (SEER) database were retrospectively analyzed. The characteristics of patients who would benefit from adjuvant radiotherapy were screened, as well as whether neoadjuvant or adjuvant radiotherapy conferred to a better clinical outcome. Propensity score matching was used to control for confounding features. RESULTS: Thirty thousand two hundred and forty-nine patients were included in this study (21,295 vs 8954 in surgery and adjuvant radiotherapy group); 1150 patients were matched in two groups. The median survivals in the surgery (S) group and adjuvant radiotherapy (S + R) group were 24 and 21 months, respectively. The 1-, 3-, and 5-year overall survival (OS) rates in the S group and S + R group were 68%, 40%, 31%, and 75%, 30%, 20%, respectively (p < 0.001), and the median OS was 22 and 25 months in S and S + R group after PSM, the former 1-, 2-, 3-, and 5-year OS were 73%, 45%, 30%, and 19%, and the later were 81%, 52%, 37%, and 24% (p = 0.0015), respectively; stratified analysis showed patients whose carcinoma located at pancreatic head with II stage infiltrating duct carcinoma (22 vs 25, p = 0.0276), T4 adenocarcinoma (28 vs 33, p = 0.0022), N1 stage adenocarcinoma (20 vs 23, p = 0.0203), and patients with infiltrating duct carcinoma received regional resection (23 vs 25, p = 0.028) and number of resected lymph node were ≥ 4 (22 vs 25, p = 0.009) had better OS after additional radiotherapy than surgery alone. Patients with pancreatic body/tail carcinoma III stage adenocarcinoma (13 vs, p = 0.0503) and T4 adenocarcinoma (14 vs, p = 0.0869) had survival advantage within 24 months for additional radiotherapy. However, patients with T2 stage adenocarcinoma located in pancreatic body/tail had better OS in surgery group than that in R + S group. CONCLUSIONS: Additional radiotherapy may contribute to improved prognosis for patients with pancreatic head II stage infiltrating duct carcinoma, III stage adenocarcinoma, T4 stage carcinoma, N1 stage adenocarcinoma, regional resection, or number of lymphadenectomy ≥ 4 in infiltrating duct carcinoma. A specific subgroup of patients with specific stage and histological type pancreatic cancer should be considered for additional radiotherapy.
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Adenocarcinoma/radioterapia , Neoplasias Pancreáticas/radioterapia , Radioterapia Adyuvante , Adenocarcinoma/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Bases de Datos Factuales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/mortalidad , Estudios Retrospectivos , Programa de VERF , Tasa de Supervivencia , Adulto JovenRESUMEN
PURPOSE/OBJECTIVE(S): To improve the curative resection rates and prognoses, a variety of neoadjuvant (NA) strategies have been explored in PDAC. In our institution, non-metastatic PDACs have been treated with a NA intent with induction multiagent chemotherapy and SBRT. The primary endpoint was to increase R0 resection rate. The secondary endpoints were the analysis of the clinical tolerance, the pathological response, the local control (LC) and the OS. MATERIALS/METHODS: All consecutive patients with non-metastatic PDAC underwent SBRT as part of the NA strategy were included. A total dose of 40-62 Gy were delivered in 5-10 fractions. Surgery was performed after SBRT and restaging. RESULTS: Since February 2014 to December 2018, 45 patients were enrolled. Thirty-two patients underwent surgery (71.1%), 10 out of 15 were initially unresectable disease patients (66.75%). R0 resection rate was 93% (30 patients) and pN0 status was achieved in 20 patients (60.6%). Tumour regression grade (TRG): 12 patients with complete response or marked response (TRG 0-1: 37.5%), 16 patients with moderate response (TRG 2: 50%) and four patients with poor response (TRG 3: 12.5%). The median follow-up was 16.2 m (range 6.6-59.6 m) since diagnosis. The LC rate achieved was very high (95.5%). Actuarial 12 and 24 m OS was 67.4% and 35.9% respectively. No grade 3 or higher toxicity related to SBRT was observed. CONCLUSION: The results are encouraging, suggesting that SBRT has a significant role in the management of these patients and further studies will be necessary to prove these findings.
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Pancreatectomía/métodos , Neoplasias Pancreáticas/tratamiento farmacológico , Neoplasias Pancreáticas/radioterapia , Radiocirugia/métodos , Adulto , Anciano , Anciano de 80 o más Años , Quimioradioterapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante , Neoplasias Pancreáticas/patología , Neoplasias Pancreáticas/cirugía , Pronóstico , Estudios Prospectivos , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
BACKGROUND AND OBJECTIVES: To compare outcomes in patients receiving neoadjuvant stereotactic body radiation therapy (SBRT) with those receiving intensity-modulated radiation therapy (IMRT) for pancreatic adenocarcinoma. METHODS: We analyzed patients receiving neoadjuvant SBRT for borderline resectable (BRPC) and locally advanced pancreatic cancer (LAPC) (2012-2016). Differences in baseline characteristics, perioperative outcomes, progression-free survival (PFS), and overall survival (OS) were compared. RESULTS: Seventy-five (82.4%) patients received SBRT and 16 (17.6%) received IMRT. There were no differences in surgical resection rates in the SBRT (n = 38, 50.7%) and IMRT (n = 11, 68.8%) groups (P = 0.188). Among resected patients, there was no difference in postoperative outcomes or pathologic outcomes including lymph node status, margin status, lymphovascular and perineural invasion, or pathologic response to neoadjuvant treatment (P > 0.05). Among all patients, median PFS and OS were 9.9 and 23.5 months in the SBRT group, respectively, and 15.3 and 21.8 months in the IMRT group, respectively (P > 0.05). Similarly, there was no difference in PFS or OS between groups when stratified by BRPC, LAPC, and surgically resected patients (P > 0.05). CONCLUSIONS: In the neoadjuvant setting, SBRT and IMRT appear to have similar rates of resection, perioperative outcomes, and survival outcomes, but additional studies with increased sample size and longer follow up are needed.
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Adenocarcinoma/mortalidad , Terapia Neoadyuvante/mortalidad , Neoplasias Pancreáticas/mortalidad , Radiocirugia/mortalidad , Radioterapia de Intensidad Modulada/mortalidad , Adenocarcinoma/radioterapia , Adenocarcinoma/cirugía , Anciano , Anciano de 80 o más Años , Terapia Combinada , Fraccionamiento de la Dosis de Radiación , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/radioterapia , Neoplasias Pancreáticas/cirugía , Atención Perioperativa , Pronóstico , Estudios Prospectivos , Estudios Retrospectivos , Tasa de Supervivencia , Neoplasias PancreáticasRESUMEN
OBJECTIVES: The aim of this study was to analyze in a retrospective cohort study the outcomes of a United States-based group of metastatic neuroendocrine tumor (NET) patients who underwent peptide receptor radionuclide therapy (PRRT). METHODS: Twenty-eight patients from a single US NET Center were treated with PRRT. Toxicities were assessed using Common Terminology Criteria for Adverse Events version 4.03. Progression was determined by the Response Evaluation Criteria in Solid Tumors version 1.1. Univariate and multivariate Cox regression was performed to identify potential predictors of progression-free survival (PFS) and overall survival (OS). RESULTS: The median age at NET diagnosis was 56 years, 50% of the patients were male, 46% of NET primaries were located in the pancreas, 71% of tumors were nonfunctional, 25% were World Health Organization (WHO) grade III, and 20% had at least a 25% hepatic tumor burden. Anemia (36%) was the most common post-PRRT toxicity, followed by leukopenia (31%), nephrotoxicity (27%), and thrombocytopenia (24%). Median PFS was 18 months, and median OS was 38 months. Having a WHO grade III NET and receiving systemic chemotherapy prior to PRRT were found to be to independent predictors of shorter PFS and OS. CONCLUSIONS: Peptide receptor radionuclide therapy is an effective therapy in a US population. Progression-free survival and OS were better in WHO grade I/II NETs and when PRRT was sequenced prior to systemic chemotherapy.
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Neoplasias Intestinales/radioterapia , Tumores Neuroendocrinos/radioterapia , Neoplasias Pancreáticas/radioterapia , Radiofármacos/uso terapéutico , Receptores de Péptidos , Adulto , Anciano , Femenino , Humanos , Neoplasias Intestinales/patología , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Análisis Multivariante , Metástasis de la Neoplasia , Tumores Neuroendocrinos/patología , Neoplasias Pancreáticas/patología , Estudios Retrospectivos , Resultado del Tratamiento , Estados UnidosRESUMEN
The role of radiation therapy in the management of pancreatic cancer represents an area of some controversy. However, local disease progression remains a significant cause of morbidity and even mortality for patients with this disease. Stereotactic body radiotherapy (SBRT) is an emerging treatment option for pancreatic cancer, primarily for locally advanced (unresectable) disease as it can provide a therapeutic benefit with significant advantages for patients' quality of life over standard conventional chemoradiation. There may also be a role for SBRT as neoadjuvant therapy for patients with borderline resectable disease to allow conversion to resectability. The objective of this review is to present the data supporting SBRT in pancreatic cancer as well as the potential limitations and caveats of current studies.
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Neoplasias Pancreáticas/radioterapia , Radiocirugia/métodos , HumanosRESUMEN
To compare the roles of intensity-modulated radiation therapy (IMRT) and volumetric- modulated arc therapy (VMAT) therapy as compared to simple and complex 3-dimensional chemoradiotherpy (3DCRT) planning for resectable and borderline resectable pancreatic cancer. In all, 12 patients who received postoperative radiotherapy (8) or neoadjuvant concurrent chemoradiotherapy (4) were evaluated retrospectively. Radiotherapy planning was performed for 4 treatment techniques: simple 4-field box, complex 5-field 3DCRT, 5 to 6-field IMRT, and single-arc VMAT. All volumes were approved by a single observer in accordance with Radiation Therapy Oncology Group (RTOG) Pancreas Contouring Atlas. Plans included tumor/tumor bed and regional lymph nodes to 45Gy; with tumor/tumor bed boosted to 50.4Gy, at least 95% of planning target volume (PTV) received the prescription dose. Dose-volume histograms (DVH) for multiple end points, treatment planning, and delivery time were assessed. Complex 3DCRT, IMRT, and VMAT plans significantly (p < 0.05) decreased mean kidney dose, mean liver dose, liver (V30, V35), stomach (D10%), stomach (V45), mean right kidney dose, and right kidney (V15) as compared with the simple 4-field plans that are most commonly reported in the literature. IMRT plans resulted in decreased mean liver dose, liver (V35), and left kidney (V15, V18, V20). VMAT plans decreased small bowel (D10%, D15%), small bowel (V35, V45), stomach (D10%, D15%), stomach (V35, V45), mean liver dose, liver (V35), left kidney (V15, V18, V20), and right kidney (V18, V20). VMAT plans significantly decreased small bowel (D10%, D15%), left kidney (V20), and stomach (V45) as compared with IMRT plans. Treatment planning and delivery times were most efficient for simple 4-field box and VMAT. Excluding patient setup and imaging, average treatment delivery was within 10minutes for simple and complex 3DCRT, IMRT, and VMAT treatments. This article shows significant improvements in 3D plan performance with complex planning over the more frequently compared 3- or 4-field simple 3D planning techniques. VMAT plans continue to demonstrate potential for the most organ sparing. However, further studies are required to identify if dosimetric benefits associated with inverse optimized planning can be translated into clinical benefits and if these treatment techniques are value-added therapies for this group of patients with cancer.
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Neoplasias Pancreáticas/radioterapia , Planificación de la Radioterapia Asistida por Computador/métodos , Radioterapia Conformacional/métodos , Radioterapia de Intensidad Modulada/métodos , Humanos , Órganos en Riesgo , Dosificación Radioterapéutica , Estudios RetrospectivosRESUMEN
The aim of this study was to evaluate the radiosensitizing effects of gemcitabine towards human pancreatic cancer xenografts. A human pancreatic cancer xenograft model was established in nude mice, 36 of which were randomly divided into 6 treatment groups. Tumors were measured every 2 days, and the tumor volumes, growth delays, and inhibition rates were compared to evaluate the gemcitabine enhancement factor. The apoptotic index was determined by terminal deoxynucleotidyl transferase dUTP nick end-labeling assay, and apoptosis inhibitory protein Bcl-2 and apoptosis-related protein Bax expression were detected by immunohistochemistry. Compared with the control group, xenograft growth was significantly inhibited in the 25 (G25) and 50 mg/kg gemcitabine (G50) groups (P < 0.05). In the 25 (G25R) and 50 (G50R) mg/kg gemcitabine + radiotherapy groups, local tumor growth was significantly inhibited, with inhibition rates of 88.22 and 91.23%, respectively, significantly higher than those of the simple radiotherapy (SR), G25, and G50 groups (44.11, 72.88, and 77.53%, respectively; P < 0.05). The tumor growth delay in the G25R and G50R groups were 9 and 15 days, respectively, higher than the SR, G25, and G50 groups (each 4 days, P < 0.05). The apoptosis of tumor cells in the intervention groups significantly increased, and the apoptotic index among the intervention groups exhibited significant differences (P < 0.05). The immunohistochemical results indicated that Bcl-2 was downregulated to different degrees in the intervention groups, whereas Bax was upregulated (P < 0.05). Therefore, gemcitabine appears to enhance the radiotherapeutic sensitivity of human pancreatic cancer xenografts significantly.
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Apoptosis/efectos de los fármacos , Apoptosis/efectos de la radiación , Desoxicitidina/análogos & derivados , Neoplasias Pancreáticas/metabolismo , Neoplasias Pancreáticas/patología , Proteínas Proto-Oncogénicas c-bcl-2/metabolismo , Tolerancia a Radiación/efectos de los fármacos , Proteína X Asociada a bcl-2/metabolismo , Animales , Línea Celular Tumoral , Desoxicitidina/farmacología , Modelos Animales de Enfermedad , Expresión Génica , Humanos , Inmunohistoquímica , Masculino , Ratones , Ratones Desnudos , Neoplasias Pancreáticas/tratamiento farmacológico , Neoplasias Pancreáticas/genética , Neoplasias Pancreáticas/radioterapia , Proteínas Proto-Oncogénicas c-bcl-2/genética , Carga Tumoral , Ensayos Antitumor por Modelo de Xenoinjerto , Proteína X Asociada a bcl-2/genética , GemcitabinaRESUMEN
Malignant insulinomas are frequently diagnosed at a late stage. Medical management is necessary to slow progression of the disease and control of hypoglycemic symptoms when cure by surgical treatment is not possible. Multimodal treatment, in these cases, has been used with variable clinical response. We describe a 68-yr-old woman who presented response failure to usual treatment and was alternatively treated with radiolabeled metaiodobenzylguanidine ([131I]-MIBG) analogue therapy with development of neurologic complications. We also present a review of the current role of [131I]-MIBG treatment in insulinomas.
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3-Yodobencilguanidina/análogos & derivados , Insulinoma/radioterapia , Neoplasias Pancreáticas/radioterapia , Radiofármacos/efectos adversos , Compresión de la Médula Espinal/etiología , 3-Yodobencilguanidina/efectos adversos , Anciano , Neoplasias Óseas/secundario , Terapia Combinada , Resultado Fatal , Femenino , Humanos , Insulinoma/secundario , Neoplasias Hepáticas/secundario , Metástasis LinfáticaRESUMEN
Malignant insulinomas are frequently diagnosed at a late stage. Medical management is necessary to slow progression of the disease and control of hypoglycemic symptoms when cure by surgical treatment is not possible. Multimodal treatment, in these cases, has been used with variable clinical response. We describe a 68-yr-old woman who presented response failure to usual treatment and was alternatively treated with radiolabeled metaiodobenzylguanidine ([131I]-MIBG) analogue therapy with development of neurologic complications. We also present a review of the current role of [131I]-MIBG treatment in insulinomas.
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Anciano , Femenino , Humanos , /análogos & derivados , Insulinoma/radioterapia , Neoplasias Pancreáticas/radioterapia , Radiofármacos/efectos adversos , Compresión de la Médula Espinal/etiología , /efectos adversos , Neoplasias Óseas/secundario , Terapia Combinada , Resultado Fatal , Insulinoma/secundario , Metástasis Linfática , Neoplasias Hepáticas/secundarioRESUMEN
With traditional photon therapy to treat large postoperative pancreatic target volume, it often leads to poor tolerance of the therapy delivered and may contribute to interrupted treatment course. This study was performed to evaluate the potential advantage of using passive-scattering (PS) and modulated-scanning (MS) proton therapy (PT) to reduce normal tissue exposure in postoperative pancreatic cancer treatment. A total of 11 patients with postoperative pancreatic cancer who had been previously treated with PS PT in University of Pennsylvania Roberts Proton Therapy Center from 2010 to 2013 were identified. The clinical target volume (CTV) includes the pancreatic tumor bed as well as the adjacent high-risk nodal areas. Internal (iCTV) was generated from 4-dimensional (4D) computed tomography (CT), taking into account target motion from breathing cycle. Three-field and 4-field 3D conformal radiation therapy (3DCRT), 5-field intensity-modulated radiation therapy, 2-arc volumetric-modulated radiation therapy, and 2-field PS and MS PT were created on the patients' average CT. All the plans delivered 50.4Gy to the planning target volume (PTV). Overall, 98% of PTV was covered by 95% of the prescription dose and 99% of iCTV received 98% prescription dose. The results show that all the proton plans offer significant lower doses to the left kidney (mean and V18Gy), stomach (mean and V20Gy), and cord (maximum dose) compared with all the photon plans, except 3-field 3DCRT in cord maximum dose. In addition, MS PT also provides lower doses to the right kidney (mean and V18Gy), liver (mean dose), total bowel (V20Gy and mean dose), and small bowel (V15Gy absolute volume ratio) compared with all the photon plans and PS PT. The dosimetric advantage of PT points to the possibility of treating tumor bed and comprehensive nodal areas while providing a more tolerable treatment course that could be used for dose escalation and combining with radiosensitizing chemotherapy.
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Neoplasias Pancreáticas/radioterapia , Terapia de Protones/métodos , Dosis de Radiación , Planificación de la Radioterapia Asistida por Computador , Radioterapia de Intensidad Modulada/métodos , Humanos , Neoplasias Pancreáticas/cirugía , Estudios RetrospectivosRESUMEN
BACKGROUND AND PURPOSE: External beam radiation therapy with concurrent chemotherapy (CRT) is widely used for the treatment of unresectable pancreatic cancer. Noncoplanar (NCP) 3D conformal radiotherapy (3DCRT) and coplanar (CP) IMRT have been reported to lower the radiation dose to organs at risk (OARs). The purpose of this article is to examine the utility of noncoplanar beam angles in IMRT for the management of pancreatic cancer. MATERIALS AND METHODS: Sixteen patients who were treated with CRT for unresectable adenocarcinoma of the pancreatic head or neck were re-planned using CP and NCP beams in 3DCRT and IMRT with the Varian Eclipse treatment planning system. RESULTS: Compared to CP IMRT, NCP IMRT had similar target coverage with slightly increased maximum point dose, 5,799 versus 5,775 cGy (p = 0.008). NCP IMRT resulted in lower mean kidney dose, 787 versus 1,210 cGy (p < 0.0001) and higher mean liver dose, 1,208 versus 1,061 cGy (p < 0.0001). Also, NCP IMRT resulted in similar mean stomach dose, 1,257 versus 1,248 cGy (p = 0.86) but slightly higher mean small bowel dose, 981 versus 866 cGy (p < 0.0001). CONCLUSIONS: The NCP IMRT was able to significantly decrease bilateral kidney dose, but did not improve other dose-volume criteria. The use of NCP beam angles is preferred only in patients with risk factors for treatment-related kidney dysfunction.
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Adenocarcinoma/radioterapia , Neoplasias Pancreáticas/radioterapia , Radioterapia de Intensidad Modulada/instrumentación , Radioterapia de Intensidad Modulada/métodos , Algoritmos , Humanos , Riñón/efectos de la radiación , Órganos en Riesgo , Radiometría/métodos , Dosificación Radioterapéutica , Planificación de la Radioterapia Asistida por Computador/métodos , Factores de RiesgoRESUMEN
UNLABELLED: Pancreatic carcinoid tumours are extremely infrequent. Usually, the biological behaviour is indolent and diagnosis is late and often casual. We present the case of a patient initially diagnosed as having liver metastasis of unknown origin. PET identified a primary pancreatic site and the initial histologic diagnosis was adenocarcinoma. Following an uncertain response to chemo- and radio-therapy the repeat histologic assessment indicated a carcinoid tumour of the pancreas. After complete surgical resection and liver transplantation, patient remains free of disease. CONCLUSIONS: The co-existence of several diseases with similar morpho-structural features makes diagnosis complicated. PET is of uncertain use in the evaluation of carcinoid tumours, and is considered inferior to 111Indium-octreotide scan. The only curative treatment is surgical resection, with liver transplantation as a valid option in the treatment of these tumours.
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Tumor Carcinoide/diagnóstico , Errores Diagnósticos , Neoplasias Pancreáticas/diagnóstico , Adenocarcinoma/diagnóstico , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Tumor Carcinoide/diagnóstico por imagen , Tumor Carcinoide/tratamiento farmacológico , Tumor Carcinoide/radioterapia , Tumor Carcinoide/secundario , Tumor Carcinoide/cirugía , Cisplatino/administración & dosificación , Terapia Combinada , Desoxicitidina/administración & dosificación , Desoxicitidina/análogos & derivados , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Trasplante de Hígado , Masculino , Pancreatectomía , Neoplasias Pancreáticas/diagnóstico por imagen , Neoplasias Pancreáticas/tratamiento farmacológico , Neoplasias Pancreáticas/radioterapia , Neoplasias Pancreáticas/cirugía , Tomografía de Emisión de Positrones , Inducción de Remisión , GemcitabinaRESUMEN
BACKGROUND: The pancreatic adenocarcinoma is an aggressive disease for which cure is only possible in less than 20% of the best cases. Adjuvant radiotherapy and chemotherapy so far have improved symptoms with little, but significant, increase in survival rates. METHODS: Retrospective assessment of 40 patients admitted at Department of Radiation Oncology of the Hospital Israelita Albert Einstein between April 1993 and August 1999 was done. Radical surgery with tumor resection was previously performed in 25 and palliative procedures or nothing in 15. RESULTS: Overall actuarial median survival was 14.8 months; and actuarial survival rates at 12 and 24 months were 70% and 22.2% respectively. Actuarial median survival for the group of patients with resected tumor was 21.4 and for the group of patients with non-resected tumor was 16.1 months. Expected survival rates at 12 and 24 months were 76% and 32% for the former group and 60% and 0% for the latter. CONCLUSIONS: Results were similar to other published series. Better drugs and more frequent intraoperative radiotherapy are necessary.
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Adenocarcinoma/radioterapia , Neoplasias Pancreáticas/radioterapia , Análisis Actuarial , Adenocarcinoma/mortalidad , Adulto , Anciano , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/mortalidad , Radioterapia Adyuvante/métodos , Estudios Retrospectivos , Análisis de SupervivenciaRESUMEN
BACKGROUND: Serum levels of CA 19-9 correlate with survival among patients with pancreatic cancer treated with surgery or radiation therapy. In addition, CA 19-9 responses have been shown to predict for a better prognosis among patients with advanced disease treated with chemotherapy. The present study evaluates the predictive role of CA 19-9 pretreatment levels and response among patients treated with gemcitabine. METHODS: We retrospectively identified 28 patients with advanced pancreatic cancer and baseline elevations of CA 19-9 (> 37 U/mL) who were treated with single agent gemcitabine. CA 19-9 response was defined as a > or = 50% decline at any time after treatment. Survival was estimated with the Kaplan-Meier method, and curves were compared with the log-rank test. RESULTS: Eleven patients (39%) had a CA 19-9 response. The median survival of responding patients was longer than that of non-responding patients (13.8 vs 8 mo, p = .0272). When pretreatment CA 19-9 levels were analyzed, patients who had CA 19-9 below the median for the entire sample (1212 U/mL) lived significantly longer than patients with a CA 19-9 above the median (14.9 vs 7.4 mo, p = .0013). On multivariable analysis, pretreatment CA 19-9 level was an independent, and stronger predictor of survival (p = .0005) than CA 19-9 response (p = .0497). Other variables were not associated with survival. CONCLUSIONS: CA 19-9 may be a useful adjunct to response evaluation is this setting. In addition to CA 19-9 responses, prechemotherapy levels of this marker seem to have strong prognostic significance.
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Adenocarcinoma/sangre , Antígenos de Neoplasias/sangre , Antimetabolitos Antineoplásicos/uso terapéutico , Antígeno CA-19-9/sangre , Desoxicitidina/análogos & derivados , Desoxicitidina/uso terapéutico , Neoplasias Pancreáticas/sangre , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Adenocarcinoma/radioterapia , Anciano , Anciano de 80 o más Años , Carcinoma Adenoescamoso/sangre , Carcinoma Adenoescamoso/tratamiento farmacológico , Carcinoma Adenoescamoso/mortalidad , Carcinoma Adenoescamoso/patología , Femenino , Humanos , Tablas de Vida , Masculino , Persona de Mediana Edad , Neoplasias Pancreáticas/tratamiento farmacológico , Neoplasias Pancreáticas/mortalidad , Neoplasias Pancreáticas/patología , Neoplasias Pancreáticas/radioterapia , Pronóstico , Estudios Retrospectivos , GemcitabinaRESUMEN
Pancreatic carcinoma has a dismal prognosis. In the last years, great efforts have been made to improve diagnosis and preoperative staging of potentially curable carcinomas. Actually, the diagnosis of fairly small tumours is possible. Chemoradiation therapy protocols prior to pancreatectomy, aiming to improve survival, are currently being held. This therapy allows radiation to be distributed into well oxygenated cells before surgical devascularization. This procedure can be done with acceptable morbidity and mortality rates. In selected cases of irresectable carcinoma, surgical palliation allows a better quality of life. Pancreatoduodenal resection, along with other traditional oncological therapies, will continue to be the therapy of choice for patients with carcinoma of the head of the pancreas, without local or regional metastases. However, an intensive search for new therapeutic strategies, specially in the field of molecular biology, is being carried out
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Humanos , Neoplasias Pancreáticas/cirugía , Pancreaticoduodenectomía , Oncogenes , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/etiología , Neoplasias Pancreáticas/radioterapia , Complicaciones Posoperatorias , Estadificación de Neoplasias , Cuidados PaliativosRESUMEN
Pancreatic carcinoma has a dismal prognosis. In the last years, great efforts have been made to improve diagnosis and preoperative staging of potentially curable carcinomas. Actually, the diagnosis of fairly small tumours is possible. Chemoradiation therapy protocols prior to pancreatectomy, aiming to improve survival, are currently being held. This therapy allows radiation to be distributed into well oxygenated cells before surgical devascularization. This procedure can be done with acceptable morbidity and mortality rates. In selected cases of irresectable carcinoma, surgical palliation allows a better quality of life. Pancreatoduodenal resection, along with other traditional oncological therapies, will continue to be the therapy of choice for patients with carcinoma of the head of the pancreas, without local or regional metastases. However, an intensive search for new therapeutic strategies, specially in the field of molecular biology, is being carried out.