Saudi Journal of Gastroenterology
Home About us Instructions Submission Subscribe Advertise Contact Login    Print this page  Email this page Small font sizeDefault font sizeIncrease font size 
Users Online: 303 


 
Table of Contents   
ORIGINAL ARTICLE  
Year : 2012  |  Volume : 18  |  Issue : 2  |  Page : 118-121
Early recurrence of pancreatic cancer after resection and during adjuvant chemotherapy


1 Department of Medicine II, University Medical Centre Freiburg, Germany
2 Department of Internal Medicine I, Klinik Kösching, Germany
3 Department of Visceral Surgery, University Medical Centre Freiburg, Germany
4 Diagnostic Radiology, University Medical Centre Freiburg, Germany
5 Department of Medicine II, Hegau-Bodensee-Klinikum Singen, Germany

Click here for correspondence address and email

Date of Submission19-Jul-2011
Date of Acceptance16-Nov-2011
Date of Web Publication14-Mar-2012
 

   Abstract 

Background/Aim: Adjuvant chemotherapy for 6 months is the current standard of care after potentially curative resection of pancreatic cancer and yields an overall survival of 15-20 months. Early tumor recurrence before or during adjuvant chemotherapy has not been evaluated so far. These patients may not benefit from adjuvant treatment. Patients and Methods: Thirty-five patients with resection of ductal pancreatic carcinoma and adjuvant chemotherapy with gemcitabine were analyzed between 2005 and 2007. All patients had a computed tomography (CT) scan before and during adjuvant chemotherapy after 2-3 months, 12/35 patients had a histologically confirmed R1 resection. Recurrence of pancreatic cancer was determined by CT scan and the clinical course. Results: Median survival of 35 patients with resected pancreatic cancer was 19.7 months, and the 2-year survival was 44%. Thirteen (37%) of the 35 patients analyzed with a CT scan showed tumor recurrence during adjuvant chemotherapy. Overall survival of patients with tumor recurrence was 9.3 months with a 2-year survival rate of 13%, whereas median overall survival of patients without early relapse was 26.3 months (P<0.001). Local recurrence of pancreatic cancer occurred in 38% (5/13); 46% (6/13) of patients developed distant metastasis, and 38% (5/13) developed lymph node metastasis. Early tumor recurrence during or adjuvant chemotherapy did not correlate with R status (R1 vs R0, P=0.69), whereas histologically confirmed lymph node invasion (pN0 vs pN1) and grading showed a statistically significant correlation with early relapse (P<0.05). Conclusion: A significant fraction of patients with resected pancreatic cancer have early relapse during adjuvant chemotherapy, especially those with lymph node metastasis. Radiologic examinations prior to and during adjuvant chemotherapy will help to identify patients with tumor recurrence who are unlikely to benefit from adjuvant treatment and will need individualized palliative chemotherapy.

Keywords: Adjuvant chemotherapy, pancreatic cancer, recurrence

How to cite this article:
Fischer R, Breidert M, Keck T, Makowiec F, Lohrmann C, Harder J. Early recurrence of pancreatic cancer after resection and during adjuvant chemotherapy. Saudi J Gastroenterol 2012;18:118-21

How to cite this URL:
Fischer R, Breidert M, Keck T, Makowiec F, Lohrmann C, Harder J. Early recurrence of pancreatic cancer after resection and during adjuvant chemotherapy. Saudi J Gastroenterol [serial online] 2012 [cited 2023 Feb 2];18:118-21. Available from: https://www.saudijgastro.com/text.asp?2012/18/2/118/93815


Pancreatic adenocarcinoma is the fourth leading cause of cancer-related death in the Western world with a 1-year survival rate of approximately 19% and a 5-year survival rate of less than 5%. [1] Only 5%-25% of patients present with resectable pancreatic cancer, but even in patients with R0 resected tumours, 5-year survival is no more than 20% with a median survival between 12 and 20 months. [2],[3],[4],[5] Randomized controlled Phase III trials have demonstrated that adjuvant chemotherapy with gemcitabine improves median disease-free survival of R0 as well as of R1 resected pancreatic adenocarcinoma from 5-7 months to 10-13 months. [3],[6],[7] Recent Phase III trials have confirmed a survival benefit for adjuvant chemotherapy with 5-fluorouracil that is comparable to gemcitabine. [5],[8],[9],[10] Adjuvant chemotherapy is therefore the standard of care in Europe for resectable pancreatic cancer. [11],[12] However, the majority of patients will die of pancreatic cancer after tumor resection within a year. Nevertheless, no data are available about the onset and proportion of patients with tumor recurrence during or before adjuvant therapy. Identification of patients who may benefit from early combination chemotherapy with gemcitabine, [13] eg, gemcitabine-erlotinib, [14] oxaliplatin-irinotecan-leucovorin-5-fluorouracil, [15] or second-line therapies, [16],[17] will allow longer survival in selected individual patients, whereas best supportive care will prevent unnecessary toxicity in patients with poor performance status. The role of postoperative Ca19-9 level as a predictor for tumor recurrence has been well established [8] and will therefore not be examined in this work. The aim of this study is to determine the rate of tumor recurrence before or during adjuvant therapy and to identify risk factors that may predict early recurrence.


   Patients and Methods Top


Between January 2005 and December 2007, 35 patients with histologically proven adenocarcinoma of the pancreas underwent tumor resection with curative intent at the University Hospital Freiburg, Germany. All patients received adjuvant chemotherapy with gemcitabine (1000 mg/m 2 per week), according to the protocol of the CONKO-001 trial, [3] and had routine computed tomography (CT) scan before and every 2-3 months during adjuvant chemotherapy with gemcitabine. Tumor recurrence was determined by follow-up with a CT scan and the clinical course. In 2 cases, questionable lesions were histologically proven by needle biopsy. Statistical analysis of overall survival was performed using the Kaplan-Meier method using PASW Statistics for Windows (IBM SPSS Statistics, version 18.0).


   Results Top


The median postoperative overall survival of the 36 patients was 19.7 months and the 2-year survival rate was 44%. Thirteen of 35 patients (38%) displayed early tumor recurrence during (n=13) the time period of adjuvant chemotherapy (6 months), the median time to tumor recurrence was 3.7 months after initial resection. Median overall survival of the patients with early tumor recurrence was 9.3 months, which was significantly less than 26.3 months for the patients without early tumor recurrence [P<0.001, [Figure 1]]. The 2-year survival rate of patients with early tumor recurrence was 13%, as compared with 60% in patients without early recurrence. Early local tumor recurrence occurred in 38% (5/13) of patients, and distant metastasis in 46% (6/13) of patients. Early lymph node metastases were detected in 38% (5/13) of patients.
Figure 1: Kaplan-Meier curve of overall survival (n=35). Green: patients with early tumor recurrence during adjuvant chemotherapy, blue: no early tumour recurrence (median survival 9.3 months vs 26.3 months, P ≤ 0.001)

Click here to view


In order to determine potential factors that may predict early pancreatic cancer recurrence, the correlation of different features of the tumor with early recurrence was statistically analyzed using the Chi-square test. R0 vs R1 resections were not associated with early tumor recurrence (35% vs 42% early recurrence; P=0.69), whereas histologically confirmed lymph node metastasis (pN0 vs pN1) at initial tumour resection correlated (borderline) with early tumor recurrence (20% vs 50% early recurrence; P=0.07). In addition, tumor grading strongly correlated with early tumor recurrence (early recurrence in 7 out of 10 (70%) patients with G3 or G4 tumors vs 6 out of 25 (24%) patients with G1 or G2 tumors; P<0.02).


   Discussion Top


The median disease-free survival following complete resection of pancreatic cancer and adjuvant chemotherapy with gemcitabine was reported as 13.4 months and 6.9 months for untreated patients. [3],[18] The CONKO-001 trial demonstrated a longer disease-free survival with adjuvant chemotherapy in R0- and R1-resected patients, [3] and other studies confirmed the benefit of adjuvant chemotherapy. [10],[19],[20] We identified initial lymph node involvement and tumor grade as risk factors for early tumor recurrence, but not the resection status R0 vs R1. In general, overall survival remains poor due to tumor recurrence in almost all patients. European Society for Medical Oncology guidelines [21] as well as the national German Society for Digestive and Metabolic Diseases guidelines [11] lack any recommendation for systematic follow-up of patients during adjuvant therapy. Likewise, National Comprehensive Cancer Network (NCCN) guidelines suggest baseline CT scan before adjuvant treatment, but no imaging during chemotherapy. [22] This may be due to the lack of data evaluating the onset of tumor recurrence during adjuvant chemotherapy. In our population, 37% (13/35) patients had an early tumor recurrence during adjuvant chemotherapy that resulted in a significant shorter overall survival of 9.3 months as compared with 26.3 months in patients without early recurrence. Only very limited data are available on early tumor recurrence during adjuvant treatment, because existing trials on adjuvant therapy examined only general, clinical evident tumor recurrence, and did not analyze the onset of tumor recurrence during adjuvant chemotherapy. [3],[4],[12],[18] Recently, it was shown that postoperative Ca-19 levels, which were not routinely determined in our study, have a discriminatory value. [23] In the postoperative setting the authors stated that patients with a postoperative CA 19-9 level >180 U/mL have a worse survival than those with CA 19-9 lower than 180 U/mL. These patients should be considered for other therapeutic strategies.

Given the significantly longer overall survival of patients without early pancreatic cancer recurrence in our population, detection of early recurrence has important prognostic consequences. In addition, the therapeutic algorithm will change when patients develop metastasis or tumor recurrence during adjuvant therapy. [11],[21],[24] Tumor recurrence during adjuvant treatment with gemcitabine, 5-fluorouracil or chemoradiation demonstrates a lack of efficacy of the regimen used. Chemoradiation, second-line chemotherapy [16],[17] or intensification of therapy, eg, combination therapies with gemcitabine/erlotinib, gemcitabine/capecitabine, or 5-FU/irinotecan/oxaliplatin [13],[14],[25],[26] are able to prolong survival in selected patients, even though a survival benefit of an intensified survival strategy has not been demonstrated in randomized trials so far. On the other hand, patients with a poor performance status may be best served by best supportive care without any systemic treatment. [15],[26] Identification of patients with early recurrence of pancreatic cancer is therefore an important issue, as regular staging of the tumor during chemotherapeutic treatment, eg, using CT scans, allows the selection of an appropriate regimen and avoids unnecessary cytotoxic treatment. Clinical practice guidelines should therefore include a recommendation for regular staging of patients during adjuvant treatment. Because the median time to early tumor recurrence was only 3.6 months in our study, we propose an initial postoperative CT scan, followed by regular staging every 2-3 months as recommended in the palliative setting [21] and by the current NCCN guidelines.

We identified initial lymph node involvement and tumor grade as risk factors for early tumor recurrence, but not the resection status R0 vs R1, even though R1 resection is known to be an important risk factor for overall survival. [12],[21] In the near future there may be important molecular prognostic factors for the selection of appropriate chemotherapy regimens (eg, MMP7, RRM1, ERCC1), which will lead to better identification of patients for treatment than CT follow-up screening. [27],[28],[29]

In summary, especially patients with lymph node metastasis should receive regular response evaluation during adjuvant chemotherapy. At present, not only the patients with lymph node metastasis should receive regular response evaluation but all of the patients should have a baseline CT before any adjuvant treatment. These findings point to a potential benefit for patients undergoing resection of pancreatic cancer, even in those with extensive disease.

 
   References Top

1.Jemal A, Siegel R, Xu J, Ward E. Cancer statistics 2010. CA Cancer J Clin 2010;60:277-300.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Klinkenbijl JH, Jeekel J, Sahmoud T, van Pel R, Couvreur ML, Veenhof CH, et al. Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase III trial of the EORTC gastrointestinal tract cancer cooperative group. Ann Surg 1999;230:776-82; discussion 782-4.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Oettle H, Post S, Neuhaus P, Gellert K, Langrehr J, Ridwelski K, et al. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: A randomized controlled trial. JAMA 2007;297:267-77.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Herman JM, Swartz MJ, Hsu CC, Winter J, Pawlik TM, Sugar E, et al. Analysis of fluorouracil-based adjuvant chemotherapy and radiation after pancreaticoduodenectomy for ductal adenocarcinoma of the pancreas: Results of a large, prospectively collected database at the Johns Hopkins Hospital. J Clin Oncol 2008;26:3503-10.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Neoptolemos JP, Stocken DD, Tudur Smith C, Bassi C, Ghaneh P, Owen E, et al. Adjuvant 5-fluorouracil and folinic acid vs observation for pancreatic cancer: Composite data from the ESPAC-1 and -3(v1) trials. Br J Cancer 2009;100:246-50  Back to cited text no. 5
    
6.Neuhaus P, Riess H, Post S, Gellert K, Ridwelski K, Schramm H, et al. CONKO-001: Final results of the randomized, prospective, multicenter phase III trial of adjuvant chemotherapy with gemcitabine versus observation in patients with resected pancreatic cancer. J Clin Oncol 2008;26:abstr. LBA4504.  Back to cited text no. 6
    
7.Ueno H, Kosuge T, Matsuyama Y, Yamamoto J, Nakao A, Egawa S, et al. A randomized phase III trial comparing gemcitabine with surgery-only in patients with resected pancreatic cancer: Japanese study group of adjuvant therapy of pancreatic cancer. Br J Cancer 2009;101:908-15.  Back to cited text no. 7
[PUBMED]    
8.Regine WF, Winter KA, Abrams RA, Safran H, Hoffman JP, Konski A, et al. Fluorouracil vs. gemcitabine chemotherapy before and after fluorouracil-based chemoradiation following resection of pancreatic adenocarcinoma: a randomized controlled trial. JAMA 2008;299:1019-26.  Back to cited text no. 8
[PUBMED]  [FULLTEXT]  
9.Neoptolemos JP, Stocken DD, Friess H, Bassi C, Dunn JA, Hickey H, et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 2004;350:1200-10.  Back to cited text no. 9
[PUBMED]  [FULLTEXT]  
10.Neoptolemos JP, Stocken DD, Bassi C, Ghaneh P, Cunningham D, Goldstein D, et al. Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection: A randomized controlled trial. JAMA 2010;304:1073-81.  Back to cited text no. 10
[PUBMED]  [FULLTEXT]  
11.Adler G, Seufferlein T, Bischoff SC, Brambs HJ, Feuerbach S, Grabenbauer G, et al. S3-Guidelines "Exocrine pancreatic cancer" 2007. Z Gastroenterol 2007;45:487-523.  Back to cited text no. 11
[PUBMED]  [FULLTEXT]  
12.Heinemann V, Boeck S. Perioperative management of pancreatic cancer. Ann Oncol 2008;19 Suppl 7:vii273-8  Back to cited text no. 12
    
13.Xie DR, Yang Q, Chen DL, Jiang ZM, Bi ZF, Ma W, et al. Gemcitabine-based cytotoxic doublets chemotherapy for advanced pancreatic cancer: Updated subgroup meta-analyses of overall survival. Jpn J Clin Oncol 2010;40:432-41.  Back to cited text no. 13
[PUBMED]  [FULLTEXT]  
14.Moore MJ, Goldstein D, Hamm J, Figer A, Hecht JR, Gallinger S, 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;25:1960-6.  Back to cited text no. 14
[PUBMED]  [FULLTEXT]  
15.Conroy T, Desseigne F, Ychou M, Bouché O, Guimbaud R, Bécouarn Y, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med 2011;364:1817-25.  Back to cited text no. 15
    
16.Brus C, Saif MW. Second line therapy for advanced pancreatic adenocarcinoma: where are we and where are we going? Highlights from the "2010 ASCO Annual Meeting". Chicago, IL, USA. June 4-8, 2010. JOP 2010;11:321-3.  Back to cited text no. 16
    
17.Petrelli F, Borgonovo K, Ghilardi M, Cabiddu M, Barni S. What else in gemcitabine-pretreated advanced pancreatic cancer? An update of second line therapies. Rev Recent Clin Trials 2010;5:43-56.  Back to cited text no. 17
[PUBMED]  [FULLTEXT]  
18.Pliarchopoulou K, Pectasides D. Pancreatic cancer: Current and future treatment strategies. Cancer Treat Rev 2009;35:431-6.  Back to cited text no. 18
[PUBMED]  [FULLTEXT]  
19.Vanderveen KA, Chen SL, Yin D, Cress RD, Bold RJ. Benefit of postoperative adjuvant therapy for pancreatic cancer: A population-based analysis. Cancer 2009;115:2420-9.  Back to cited text no. 19
[PUBMED]  [FULLTEXT]  
20.Mayo SC, Austin DF, Sheppard BC, Mori M, Shipley DK, Billingsley KG. Adjuvant therapy and survival after resection of pancreatic adenocarcinoma: a population-based analysis. Cancer 2010;116:2932-40.  Back to cited text no. 20
[PUBMED]  [FULLTEXT]  
21.Cascinu S, Falconi M, Valentini V, Jelic S. Pancreatic cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2010;21 Suppl 5:v55-8.  Back to cited text no. 21
    
22.Tempero MA, Arnoletti JP, Behrman S, Ben-Josef E, Benson AB 3rd, Berlin JD, et al. Pancreatic adenocarcinoma. J Natl Compr Canc Netw 2010;8:972-1017.  Back to cited text no. 22
[PUBMED]  [FULLTEXT]  
23.Berger AC, Garcia M Jr, Hoffman JP, Regine WF, Abrams RA, Safran H, et al. Postresection CA 19-9 predicts overall survival in patients with pancreatic cancer treated with adjuvant chemoradiation: a prospective validation by RTOG 9704. J Clin Oncol 2008;26:5918-22.  Back to cited text no. 23
[PUBMED]  [FULLTEXT]  
24.Boeck S, Bruns CJ, Sargent M, Schafer C, Seufferlein T, Jauch KW, et al. Current oncological treatment of patients with pancreatic cancer in Germany: results from a national survey on behalf of the Arbeitsgemeinschaft Internistische Onkologie and the Chirurgische Arbeitsgemeinschaft Onkologie of the Germany Cancer Society. Oncology 2009;77:40-8.  Back to cited text no. 24
[PUBMED]  [FULLTEXT]  
25.Pelzer U, Schwaner I, Stieler J, Adler M, Seraphin J, Dörken B, et al. Best supportive care (BSC) versus oxaliplatin, folinic acid and 5-fluorouracil (OFF) plus BSC in patients for second-line advanced pancreatic cancer: A phase III-study from the German CONKO-study group. Eur J Cancer 2011;47:1676-81.  Back to cited text no. 25
    
26.Merl MY, Abdelghany O, Li J, Saif MW. First-line treatment of metastatic pancreatic adenocarcinoma: Can we do better? Highlights from the "2010 ASCO Annual Meeting". Chicago, IL, USA. June 4-8, 2010. JOP 2010;11:317-20.  Back to cited text no. 26
    
27.Tamahashi U, Kumagai J, Takizawa T, Sekine M, Eishi Y. Expression and intracellular localization of matrix metalloproteinases in intraductal papillary mucinous neoplasms of the pancreas. Virchows Arch 2008;453:79-87.  Back to cited text no. 27
[PUBMED]  [FULLTEXT]  
28.Kurata N, Fujita H, Ohuchida K, Mizumoto K, Mahawithitwong P, Sakai H, et al. Predicting the chemosensitivity of pancreatic cancer cells by quantifying the expression levels of genes associated with the metabolism of gemcitabine and 5-fluorouracil. Int J Oncol 2011;39:473-82.  Back to cited text no. 28
[PUBMED]  [FULLTEXT]  
29.Maithel SK, Coban I, Kneuertz PJ, Kooby DA, El-Rayes BF, Kauh JS, et al. Differential expression of ERCC1 in pancreas adenocarcinoma: High tumor expression is associated with earlier recurrence and shortened survival after resection. Ann Surg Oncol 2011;18:2699-705.  Back to cited text no. 29
[PUBMED]  [FULLTEXT]  

Top
Correspondence Address:
Matthias Breidert
Department of Internal Medicine I, District Hospital Clinic Altmühltal, Krankenhausstrasse 19, D-85092 Kösching
Germany
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-3767.93815

Rights and Permissions


    Figures

  [Figure 1]

This article has been cited by
1 Necroptosis activation is associated with greater methylene blue-photodynamic therapy-induced cytotoxicity in human pancreatic ductal adenocarcinoma cells
Daria R. Q. de Almeida, Ancély F. dos Santos, Rosangela A. M. Wailemann, Letícia F. Terra, Vinícius M. Gomes, Gabriel S. Arini, Ester R. M. Bertoldi, Eduardo M. Reis, Maurício S. Baptista, Leticia Labriola
Photochemical & Photobiological Sciences. 2022;
[Pubmed] | [DOI]
2 Regional lymph node metastasis detected on preoperative CT and/or FDG-PET may predict early recurrence of pancreatic adenocarcinoma after curative resection
Ja Kyung Yoon, Mi-Suk Park, Seung-Seob Kim, Kyunghwa Han, Hee Seung Lee, Seungmin Bang, Ho Kyoung Hwang, Sang Hyun Hwang, Mijin Yun, Myeong-Jin Kim
Scientific Reports. 2022; 12(1)
[Pubmed] | [DOI]
3 Ratio of CA19-9 Level to Total Tumor Volume as a Prognostic Predictor of Pancreatic Carcinoma After Curative Resection
Junming Xu, Shaocheng Lyu, Yang Zhao, Xinxue Zhang, Zhe Liu, Xin Zhao, Qiang He
Technology in Cancer Research & Treatment. 2022; 21: 1533033822
[Pubmed] | [DOI]
4 The Urokinase Plasminogen Activation System in Pancreatic Cancer: Prospective Diagnostic and Therapeutic Targets
Ashna A. Kumar, Benjamin J. Buckley, Marie Ranson
Biomolecules. 2022; 12(2): 152
[Pubmed] | [DOI]
5 Prognostic Implications of Portal Venous Circulating Tumor Cells in Resectable Pancreatic Cancer
Young Hoon Choi, Tae Ho Hong, Seung Bae Yoon, In Seok Lee, Myung Ah Lee, Ho Joong Choi, Moon Hyung Choi, Eun Sun Jung
Biomedicines. 2022; 10(6): 1289
[Pubmed] | [DOI]
6 Predicting Early Disease Recurrence of Pancreatic Cancer following Surgery: Determining the Role of NUDT15 as a Prognostic Biomarker
Daniel Llwyd Hughes, Frances Willenbrock, Zahir Soonawalla, Somnath Mukherjee, Eric O’Neill
Current Oncology. 2022; 29(4): 2516
[Pubmed] | [DOI]
7 Neoadjuvant therapy vs. upfront surgery for resectable pancreatic cancer: An update on a systematic review and meta-analysis
Youyao Xu, Yizhen Chen, Fang Han, Jia Wu, Yuhua Zhang
BioScience Trends. 2021;
[Pubmed] | [DOI]
8 Zebrafish Patient-Derived Xenografts Identify Chemo-Response in Pancreatic Ductal Adenocarcinoma Patients
Alice Usai, Gregorio Di Franco, Margherita Piccardi, Perla Cateni, Luca Emanuele Pollina, Caterina Vivaldi, Enrico Vasile, Niccola Funel, Matteo Palmeri, Luciana Dente, Alfredo Falcone, Dimitri Giunchi, Alessandro Massolo, Vittoria Raffa, Luca Morelli
Cancers. 2021; 13(16): 4131
[Pubmed] | [DOI]
9 A Novel Ferroptosis-Related Gene Signature Predicts Recurrence in Patients With Pancreatic Ductal Adenocarcinoma
Zengyu Feng, Peng Chen, Kexian Li, Jianyao Lou, Yulian Wu, Tao Li, Chenghong Peng
Frontiers in Molecular Biosciences. 2021; 8
[Pubmed] | [DOI]
10 Innovative Approaches in the Battle Against Cancer Recurrence: Novel Strategies to Combat Dormant Disseminated Tumor Cells
Scott Sauer, Damon R. Reed, Michael Ihnat, Robert E. Hurst, David Warshawsky, Dalit Barkan
Frontiers in Oncology. 2021; 11
[Pubmed] | [DOI]
11 The impact of body composition on short-term outcomes of neoadjuvant chemotherapy with gemcitabine plus S-1 in patients with resectable pancreatic cancer
Tsuyoshi Takeda, Takashi Sasaki, Takafumi Mie, Takaaki Furukawa, Yuto Yamada, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Naoki Sasahira
Japanese Journal of Clinical Oncology. 2021; 51(4): 604
[Pubmed] | [DOI]
12 Pancreatic Cancer Stem-Like Cells With High Calreticulin Expression Associated With Immune Surveillance
Yasuhiro Fujiwara, Ryouichi Tsunedomi, Kiyoshi Yoshimura, Satoshi Matsukuma, Nobuyuki Fujiwara, Mitsuo Nishiyama, Shinsuke Kanekiyo, Hiroto Matsui, Yoshitaro Shindo, Yukio Tokumitsu, Shin Yoshida, Michihisa Iida, Nobuaki Suzuki, Shigeru Takeda, Tatsuya Ioka, Shoichi Hazama, Hiroaki Nagano
Pancreas. 2021; 50(3): 405
[Pubmed] | [DOI]
13 Antibody therapy in pancreatic cancer: mAb-ye we’re onto something?
Anna J. Boland, Anthony A. O’Kane, Richard Buick, Daniel B. Longley, Christopher J. Scott
Biochimica et Biophysica Acta (BBA) - Reviews on Cancer. 2021; 1876(1): 188557
[Pubmed] | [DOI]
14 The current role of blood-based biomarkers in surgical decision-making in patients with localised pancreatic cancer: A systematic review
Hadi M.H. Diab, Henry G. Smith, Kristian K. Jensen, Lars N. Jørgensen
European Journal of Cancer. 2021; 154: 73
[Pubmed] | [DOI]
15 Margin ACcentuation for resectable Pancreatic cancer using Irreversible Electroporation – Results from the MACPIE-I study
Kaushal Kundalia, Abdul Hakeem, Michail Papoulas, Mark Mcphail, Shruthi Reddy, Praveen Peddu, Nabil Kibriya, Simon Atkinson, Andreas Prachalias, Parthi Srinivasan, Nigel Heaton, Debashis Sarker, Paul Ross, Yoh Zen, Krishna Menon
European Journal of Surgical Oncology. 2021; 47(10): 2571
[Pubmed] | [DOI]
16 Novel strategies using modern radiotherapy to improve pancreatic cancer outcomes: toward a new standard?
Christelle Bouchart, Julie Navez, Jean Closset, Alain Hendlisz, Dirk Van Gestel, Luigi Moretti, Jean-Luc Van Laethem
Therapeutic Advances in Medical Oncology. 2020; 12: 1758835920
[Pubmed] | [DOI]
17 Preoperative detection of KRAS G12D mutation in ctDNA is a powerful predictor for early recurrence of resectable PDAC patients
Shiwei Guo, Xiaohan Shi, Jing Shen, Suizhi Gao, Huan Wang, Shuo Shen, Yaqi Pan, Bo Li, Xiongfei Xu, Zhuo Shao, Gang Jin
British Journal of Cancer. 2020; 122(6): 857
[Pubmed] | [DOI]
18 Prediction of survival and recurrence in patients with pancreatic cancer by integrating multi-omics data
Bin Baek, Hyunju Lee
Scientific Reports. 2020; 10(1)
[Pubmed] | [DOI]
19 Systemic neoadjuvant chemotherapy in modern pancreatic cancer treatment: a systematic review and meta-analysis
K Rangarajan, PH Pucher, T Armstrong, A Bateman, ZZR Hamady
The Annals of The Royal College of Surgeons of England. 2019; 101(7): 453
[Pubmed] | [DOI]
20 COMPARATIVE ANALYSIS IMAGE RESULTS OF PANCREAS IN PORTAL VEIN PHASE ON CT SCAN ABDOMEN CONTRAST WITHOUT AND WITH MINIMUM INTENSITY PROJECTION IN CT SCAN 64 SLICE
Maria Ramandita, Lailatul Muqmiroh, Pramono Pramono
Journal Of Vocational Health Studies. 2019; 2(3): 101
[Pubmed] | [DOI]
21 Emerging Roles of Electrospun Nanofibers in Cancer Research
Shixuan Chen, Sunil Kumar Boda, Surinder K. Batra, Xiaoran Li, Jingwei Xie
Advanced Healthcare Materials. 2018; 7(6): 1701024
[Pubmed] | [DOI]
22 Selection of optimal molecular targets for tumor-specific imaging in pancreatic ductal adenocarcinoma
Willemieke S. Tummers, Arantza Farina-Sarasqueta, Martin C. Boonstra, Hendrica A. Prevoo, Cornelis F. Sier, Jan S. Mieog, Johannes Morreau, Casper H. van Eijck, Peter J. Kuppen, Cornelis J. van de Velde, Bert A. Bonsing, Alexander L. Vahrmeijer, Rutger-Jan Swijnenburg
Oncotarget. 2017; 8(34): 56816
[Pubmed] | [DOI]
23 Laparoscopic Completion Pancreatectomy for Local Recurrence in the Pancreatic Remnant after Pancreaticoduodenectomy: Case Reports and Review of the Literature
Mushegh A. Sahakyan, Sheraz Yaqub, Airazat M. Kazaryan, Olaug Villanger, Audun Elnæs Berstad, Knut Jørgen Labori, Bjørn Edwin, Bård Ingvald Røsok
Journal of Gastrointestinal Cancer. 2016; 47(4): 509
[Pubmed] | [DOI]
24 Stromal SLIT2 impacts on pancreatic cancer-associated neural remodeling
V Secq, J Leca, C Bressy, F Guillaumond, P Skrobuk, J Nigri, S Lac, M-N Lavaut, T-t Bui, A K Thakur, N Callizot, R Steinschneider, P Berthezene, N Dusetti, M Ouaissi, V Moutardier, E Calvo, C Bousquet, S Garcia, G Bidaut, S Vasseur, J L Iovanna, R Tomasini
Cell Death & Disease. 2015; 6(1): e1592
[Pubmed] | [DOI]
25 Factors Influencing Survival after Pancreatoduodenectomy for Ductal Adenocarcinoma Depend on Patients' Age
Kestutis Urbonas, Antanas Gulbinas, Giedre Smailyte, Darius Pranys, Aldona Jakstaite, Juozas Pundzius, Giedrius Barauskas
Digestive Surgery. 2015; 32(1): 60
[Pubmed] | [DOI]
26 Randomized Phase III Multi-Institutional Study of TNFerade Biologic With Fluorouracil and Radiotherapy for Locally Advanced Pancreatic Cancer: Final Results
Joseph M. Herman, Aaron T. Wild, Hao Wang, Phuoc T. Tran, Kenneth J. Chang, Gretchen E. Taylor, Ross C. Donehower, Timothy M. Pawlik, Mark A. Ziegler, Hongyan Cai, Dionne T. Savage, Marcia I. Canto, Jason Klapman, Tony Reid, Raj J. Shah, Sarah E. Hoffe, Alexander Rosemurgy, Christopher L. Wolfgang, Daniel A. Laheru
Journal of Clinical Oncology. 2013; 31(7): 886
[Pubmed] | [DOI]
27 Clinical implications of EphB4 receptor expression in pancreatic cancer
Li, M. and Zhao, Z.
Molecular Biology Reports. 2013; 40(2): 1735-1741
[Pubmed]
28 Randomized phase iii multi-institutional study of tnferade biologic with fluorouracil and radiotherapy for locally advanced pancreatic cancer: Final results
Herman, J.M. and Wild, A.T. and Wang, H. and Tran, P.T. and Chang, K.J. and Taylor, G.E. and Donehower, R.C. and Pawlik, T.M. and Ziegler, M.A. and Cai, H. and Savage, D.T. and Canto, M.I. and Klapman, J. and Reid, T. and Shah, R.J. and Hoffe, S.E. and Rosemurgy, A. and Wolfgang, C.L. and Laheru, D.A.
Journal of Clinical Oncology. 2013; 31(7): 886-894
[Pubmed]



 

Top
  
 
  Search
 
  
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
   Patients and Methods
   Results
   Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed7749    
    Printed155    
    Emailed0    
    PDF Downloaded943    
    Comments [Add]    
    Cited by others 28    

Recommend this journal