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Erschienen in: Annals of Surgical Oncology 8/2013

01.08.2013 | Pancreatic Tumors

Borderline Resectable Pancreatic Cancer: Need for Standardization and Methods for Optimal Clinical Trial Design

verfasst von: Matthew H. G. Katz, MD, Robert Marsh, MD, Joseph M. Herman, MD, Qian Shi, PhD, Eric Collison, MD, Alan P. Venook, MD, Hedy L. Kindler, MD, Steven R. Alberts, MD, Philip Philip, MD, Andrew M. Lowy, MD, Peter W. T. Pisters, MD, Mitchell C. Posner, MD, Jordan D. Berlin, MD, Syed A. Ahmad, MD

Erschienen in: Annals of Surgical Oncology | Ausgabe 8/2013

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Abstract

Background

Methodological limitations of prior studies have prevented progress in the treatment of patients with borderline resectable pancreatic adenocarcinoma. Shortcomings have included an absence of staging and treatment standards and pre-existing biases with regard to the use of neoadjuvant therapy and the role of vascular resection at pancreatectomy.

Methods

In this manuscript, we review limitations of studies of borderline resectable PDAC reported to date, highlight important controversies related to this disease stage, emphasize the research infrastructure necessary for its future study, and present a recently-approved Intergroup pilot study (Alliance A021101) that will provide a foundation upon which subsequent well-designed clinical trials can be performed.

Results

We identified twenty-three studies published since 2001 which report outcomes of patients with tumors labeled as borderline resectable and who were treated with neoadjuvant therapy prior to planned pancreatectomy. These studies were heterogeneous in terms of the populations studied, the metrics used to characterize therapeutic response, and the indications used to select patients for surgery. Mechanisms used to standardize these and other issues that are incorporated into Alliance A021101 are reviewed.

Conclusions

Rigorous standards of clinical trial design incorporated into trials of other disease stages must be adopted in all future studies of borderline resectable pancreatic cancer. The Intergroup trial should serve as a paradigm for such investigations.
Literatur
1.
Zurück zum Zitat Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, et al. 1,423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg. 2006;10:1199–210; discussion 1210–1.PubMedCrossRef Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, et al. 1,423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg. 2006;10:1199–210; discussion 1210–1.PubMedCrossRef
2.
Zurück zum Zitat Ishikawa O, Ohigashi H, Imaoka S, Furukawa H, Sasaki Y, Fujita M, et al. Preoperative indications for extended pancreatectomy for locally advanced pancreas cancer involving the portal vein. Ann Surg. 1992;215:231–6.PubMedCrossRef Ishikawa O, Ohigashi H, Imaoka S, Furukawa H, Sasaki Y, Fujita M, et al. Preoperative indications for extended pancreatectomy for locally advanced pancreas cancer involving the portal vein. Ann Surg. 1992;215:231–6.PubMedCrossRef
3.
Zurück zum Zitat Lu DS, Reber HA, Krasny RM, Kadell BM, Sayre J. Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT. AJR Am J Roentgenol. 1997;168:1439–43.PubMedCrossRef Lu DS, Reber HA, Krasny RM, Kadell BM, Sayre J. Local staging of pancreatic cancer: criteria for unresectability of major vessels as revealed by pancreatic-phase, thin-section helical CT. AJR Am J Roentgenol. 1997;168:1439–43.PubMedCrossRef
4.
Zurück zum Zitat Nakao A, Kanzaki A, Fujii T, Kodera Y, Yamada S, Sugimoto H, et al. Correlation between radiographic classification and pathological grade of portal vein wall invasion in pancreatic head cancer. Ann Surg. 2012;255:103–8.PubMedCrossRef Nakao A, Kanzaki A, Fujii T, Kodera Y, Yamada S, Sugimoto H, et al. Correlation between radiographic classification and pathological grade of portal vein wall invasion in pancreatic head cancer. Ann Surg. 2012;255:103–8.PubMedCrossRef
5.
Zurück zum Zitat Tseng JF, Raut CP, Lee JE, Pisters PW, Vauthey JN, Abdalla EK, et al. Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J Gastrointest Surg. 2004;8:935–49; discussion 949–50.PubMedCrossRef Tseng JF, Raut CP, Lee JE, Pisters PW, Vauthey JN, Abdalla EK, et al. Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J Gastrointest Surg. 2004;8:935–49; discussion 949–50.PubMedCrossRef
6.
Zurück zum Zitat Mollberg N, Rahbari NN, Koch M, Hartwig W, Hoeger Y, Büchler MW, et al. Arterial resection during pancreatectomy for pancreatic cancer: a systematic review and meta-analysis. Ann Surg. 2011;254:882–93.PubMedCrossRef Mollberg N, Rahbari NN, Koch M, Hartwig W, Hoeger Y, Büchler MW, et al. Arterial resection during pancreatectomy for pancreatic cancer: a systematic review and meta-analysis. Ann Surg. 2011;254:882–93.PubMedCrossRef
7.
Zurück zum Zitat Stitzenberg KB, Watson JC, Roberts A, Kagan SA, Cohen SJ, Konski AA, et al. Survival after pancreatectomy with major arterial resection and reconstruction. Ann Surg Oncol. 2008;15:1399–406.PubMedCrossRef Stitzenberg KB, Watson JC, Roberts A, Kagan SA, Cohen SJ, Konski AA, et al. Survival after pancreatectomy with major arterial resection and reconstruction. Ann Surg Oncol. 2008;15:1399–406.PubMedCrossRef
8.
Zurück zum Zitat Kim HJ, Czischke K, Brennan MF, Conlon KC. Does neoadjuvant chemoradiation downstage locally advanced pancreatic cancer? J Gastrointest Surg. 2002;6:763–9.PubMedCrossRef Kim HJ, Czischke K, Brennan MF, Conlon KC. Does neoadjuvant chemoradiation downstage locally advanced pancreatic cancer? J Gastrointest Surg. 2002;6:763–9.PubMedCrossRef
9.
Zurück zum Zitat Mehta VK, Fisher G, Ford JA, Poen JC, Vierra MA, Oberhelman H, et al. Preoperative chemoradiation for marginally resectable adenocarcinoma of the pancreas. J Gastrointest Surg. 2001;5:27–35.PubMedCrossRef Mehta VK, Fisher G, Ford JA, Poen JC, Vierra MA, Oberhelman H, et al. Preoperative chemoradiation for marginally resectable adenocarcinoma of the pancreas. J Gastrointest Surg. 2001;5:27–35.PubMedCrossRef
10.
Zurück zum Zitat Allema JH, Reinders ME, van Gulik TM, van Leeuwen DJ, de Wit LT, Verbeek PC, et al. Portal vein resection in patients undergoing pancreatoduodenectomy for carcinoma of the pancreatic head. Br J Surg. 1994;81:1642–6.PubMedCrossRef Allema JH, Reinders ME, van Gulik TM, van Leeuwen DJ, de Wit LT, Verbeek PC, et al. Portal vein resection in patients undergoing pancreatoduodenectomy for carcinoma of the pancreatic head. Br J Surg. 1994;81:1642–6.PubMedCrossRef
11.
Zurück zum Zitat Spitz FR, Abbruzzese JL, Lee JE, Pisters PW, Lowy AM, Fenoglio CJ, et al. Preoperative and postoperative chemoradiation strategies in patients treated with pancreaticoduodenectomy for adenocarcinoma of the pancreas. J Clin Oncol. 1997;15:928–37.PubMed Spitz FR, Abbruzzese JL, Lee JE, Pisters PW, Lowy AM, Fenoglio CJ, et al. Preoperative and postoperative chemoradiation strategies in patients treated with pancreaticoduodenectomy for adenocarcinoma of the pancreas. J Clin Oncol. 1997;15:928–37.PubMed
12.
Zurück zum Zitat Landry J, Catalano PJ, Staley C, Harris W, Hoffman J, Talamonti M, 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;101:587–92.PubMedCrossRef Landry J, Catalano PJ, Staley C, Harris W, Hoffman J, Talamonti M, 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;101:587–92.PubMedCrossRef
13.
Zurück zum Zitat Katz MH, Pisters PW, Lee JE, Fleming JB. Borderline resectable pancreatic cancer: what have we learned and where do we go from here? Ann Surg Oncol. 2011;18:608–10.PubMedCrossRef Katz MH, Pisters PW, Lee JE, Fleming JB. Borderline resectable pancreatic cancer: what have we learned and where do we go from here? Ann Surg Oncol. 2011;18:608–10.PubMedCrossRef
14.
Zurück zum Zitat Abrams RA, Lowy AM, O’Reilly EM, Wolff RA, Picozzi VJ, Pisters PW. Combined modality treatment of resectable and borderline resectable pancreas cancer: expert consensus statement. Ann Surg Oncol. 2009;16:1751–6.PubMedCrossRef Abrams RA, Lowy AM, O’Reilly EM, Wolff RA, Picozzi VJ, Pisters PW. Combined modality treatment of resectable and borderline resectable pancreas cancer: expert consensus statement. Ann Surg Oncol. 2009;16:1751–6.PubMedCrossRef
15.
Zurück zum Zitat Callery MP, Chang KJ, Fishman EK, Talamonti MS, William Traverso L, Linehan DC. Pretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensus statement. Ann Surg Oncol. 2009;16:1727–33.PubMedCrossRef Callery MP, Chang KJ, Fishman EK, Talamonti MS, William Traverso L, Linehan DC. Pretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensus statement. Ann Surg Oncol. 2009;16:1727–33.PubMedCrossRef
16.
Zurück zum Zitat Loyer EM, David CL, Dubrow RA, Evans DB, Charnsangavej C. Vascular involvement in pancreatic adenocarcinoma: reassessment by thin-section CT. Abdom Imaging. 1996;21:202–6.PubMedCrossRef Loyer EM, David CL, Dubrow RA, Evans DB, Charnsangavej C. Vascular involvement in pancreatic adenocarcinoma: reassessment by thin-section CT. Abdom Imaging. 1996;21:202–6.PubMedCrossRef
17.
Zurück zum Zitat Tempero MA, Arnoletti JP, Behrman SW, Ben-Josef E, Benson AB 3rd, Casper ES, et al. Pancreatic Adenocarcinoma, version 2.2012: featured updates to the NCCN guidelines. J Natl Compr Canc Netw. 2012;10:703–13.PubMed Tempero MA, Arnoletti JP, Behrman SW, Ben-Josef E, Benson AB 3rd, Casper ES, et al. Pancreatic Adenocarcinoma, version 2.2012: featured updates to the NCCN guidelines. J Natl Compr Canc Netw. 2012;10:703–13.PubMed
18.
Zurück zum Zitat Evans DB, Farnell MB, Lillemoe KD, Vollmer C, Jr., Strasberg SM, Schulick RD. Surgical treatment of resectable and borderline resectable pancreas cancer: expert consensus statement. Ann Surg Oncol. 2009;16:1736–44.PubMedCrossRef Evans DB, Farnell MB, Lillemoe KD, Vollmer C, Jr., Strasberg SM, Schulick RD. Surgical treatment of resectable and borderline resectable pancreas cancer: expert consensus statement. Ann Surg Oncol. 2009;16:1736–44.PubMedCrossRef
19.
Zurück zum Zitat Gillen S, Schuster T, Meyer Zum Buschenfelde C, Friess H, Kleeff J. Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. PLoS Med. 2010;7:e1000267.PubMedCrossRef Gillen S, Schuster T, Meyer Zum Buschenfelde C, Friess H, Kleeff J. Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. PLoS Med. 2010;7:e1000267.PubMedCrossRef
20.
Zurück zum Zitat Morganti AG, Massaccesi M, La Torre G, Caravatta L, Piscopo A, Tambaro R, et al. A systematic review of resectability and survival after concurrent chemoradiation in primarily unresectable pancreatic cancer. Ann Surg Oncol. 2010;17:194–205.PubMedCrossRef Morganti AG, Massaccesi M, La Torre G, Caravatta L, Piscopo A, Tambaro R, et al. A systematic review of resectability and survival after concurrent chemoradiation in primarily unresectable pancreatic cancer. Ann Surg Oncol. 2010;17:194–205.PubMedCrossRef
21.
Zurück zum Zitat Katz MH, Fleming JB, Bhosale P, Varadhachary G, Lee JE, Wolff R, et al. Response of borderline resectable pancreatic cancer to neoadjuvant therapy is not reflected by radiographic indicators. Cancer. 2012;118:5749–56.PubMedCrossRef Katz MH, Fleming JB, Bhosale P, Varadhachary G, Lee JE, Wolff R, et al. Response of borderline resectable pancreatic cancer to neoadjuvant therapy is not reflected by radiographic indicators. Cancer. 2012;118:5749–56.PubMedCrossRef
22.
Zurück zum Zitat Katz MH, Merchant NB, Brower S, Branda M, Posner MC, William Traverso L, et al. Standardization of surgical and pathologic variables is needed in multicenter trials of adjuvant therapy for pancreatic cancer: results from the ACOSOG Z5031 trial. Ann Surg Oncol. 2011;18:337–44.PubMedCrossRef Katz MH, Merchant NB, Brower S, Branda M, Posner MC, William Traverso L, et al. Standardization of surgical and pathologic variables is needed in multicenter trials of adjuvant therapy for pancreatic cancer: results from the ACOSOG Z5031 trial. Ann Surg Oncol. 2011;18:337–44.PubMedCrossRef
23.
Zurück zum Zitat Katz MH, Wang H, Balachandran A, Bhosale P, Crane CH, Wang X, et al. Effect of neoadjuvant chemoradiation and surgical technique on recurrence of localized pancreatic cancer. J Gastrointest Surg. 2012;16:68–78; discussion 78–9.PubMedCrossRef Katz MH, Wang H, Balachandran A, Bhosale P, Crane CH, Wang X, et al. Effect of neoadjuvant chemoradiation and surgical technique on recurrence of localized pancreatic cancer. J Gastrointest Surg. 2012;16:68–78; discussion 78–9.PubMedCrossRef
24.
Zurück zum Zitat McClaine RJ, Lowy AM, Sussman JJ, Schmulewitz N, Grisell DL, Ahmad SA. Neoadjuvant therapy may lead to successful surgical resection and improved survival in patients with borderline resectable pancreatic cancer. HPB (Oxford). 2010;12:73–9.CrossRef McClaine RJ, Lowy AM, Sussman JJ, Schmulewitz N, Grisell DL, Ahmad SA. Neoadjuvant therapy may lead to successful surgical resection and improved survival in patients with borderline resectable pancreatic cancer. HPB (Oxford). 2010;12:73–9.CrossRef
25.
Zurück zum Zitat Abrams RA, Winter KA, Regine WF, Safran H, Hoffman JP, Lustig R, et al. Failure to adhere to protocol specified radiation therapy guidelines was associated with decreased survival in RTOG 9704: a phase III trial of adjuvant chemotherapy and chemoradiotherapy for patients with resected adenocarcinoma of the pancreas. Int J Radiat Oncol Biol Phys. 2012;82:809–16.PubMedCrossRef Abrams RA, Winter KA, Regine WF, Safran H, Hoffman JP, Lustig R, et al. Failure to adhere to protocol specified radiation therapy guidelines was associated with decreased survival in RTOG 9704: a phase III trial of adjuvant chemotherapy and chemoradiotherapy for patients with resected adenocarcinoma of the pancreas. Int J Radiat Oncol Biol Phys. 2012;82:809–16.PubMedCrossRef
26.
Zurück zum Zitat Verbeke CS, Menon KV. Variability in reporting resection margin status in pancreatic cancer. Ann Surg. 2008;247:716–7.PubMedCrossRef Verbeke CS, Menon KV. Variability in reporting resection margin status in pancreatic cancer. Ann Surg. 2008;247:716–7.PubMedCrossRef
27.
Zurück zum Zitat Leone F, Gatti M, Massucco P, Colombi F, Sperti E, Campanella D, 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;119:277–84.PubMedCrossRef Leone F, Gatti M, Massucco P, Colombi F, Sperti E, Campanella D, 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;119:277–84.PubMedCrossRef
28.
Zurück zum Zitat Lee JL, Kim SC, Kim JH, Lee SS, Kim TW, Park do 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;152:851–62.PubMedCrossRef Lee JL, Kim SC, Kim JH, Lee SS, Kim TW, Park do 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;152:851–62.PubMedCrossRef
29.
Zurück zum Zitat Hosein PJ, Macintyre J, Kawamura C, Maldonado JC, Ernani V, Loaiza-Bonilla A, et al. A retrospective study of neoadjuvant FOLFIRINOX in unresectable or borderline-resectable locally advanced pancreatic adenocarcinoma. BMC Cancer. 2012;12:199.PubMedCrossRef Hosein PJ, Macintyre J, Kawamura C, Maldonado JC, Ernani V, Loaiza-Bonilla A, et al. A retrospective study of neoadjuvant FOLFIRINOX in unresectable or borderline-resectable locally advanced pancreatic adenocarcinoma. BMC Cancer. 2012;12:199.PubMedCrossRef
30.
Zurück zum Zitat Barugola G, Partelli S, Crippa S, Capelli P, Onofrio M, Pederzoli P, et al. Outcomes after resection of locally advanced or borderline resectable pancreatic cancer after neoadjuvant therapy. Am J Surg. 2012;203:132–9.PubMedCrossRef Barugola G, Partelli S, Crippa S, Capelli P, Onofrio M, Pederzoli P, et al. Outcomes after resection of locally advanced or borderline resectable pancreatic cancer after neoadjuvant therapy. Am J Surg. 2012;203:132–9.PubMedCrossRef
31.
Zurück zum Zitat Kang CM, Chung YE, Park JY, Sung JS, Hwang HK, Choi HJ, et al. Potential contribution of preoperative neoadjuvant concurrent chemoradiation therapy on margin-negative resection in borderline resectable pancreatic cancer. J Gastrointest Surg. 2012;16:509–17.PubMedCrossRef Kang CM, Chung YE, Park JY, Sung JS, Hwang HK, Choi HJ, et al. Potential contribution of preoperative neoadjuvant concurrent chemoradiation therapy on margin-negative resection in borderline resectable pancreatic cancer. J Gastrointest Surg. 2012;16:509–17.PubMedCrossRef
32.
Zurück zum Zitat Chuong MD, Hayman TJ, Patel MR, 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;4:128–34.PubMed Chuong MD, Hayman TJ, Patel MR, 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;4:128–34.PubMed
33.
Zurück zum Zitat Stokes JB, Nolan NJ, Stelow EB, Walters DM, Weiss GR, de Lange EE, et al. Preoperative capecitabine and concurrent radiation for borderline resectable pancreatic cancer. Ann Surg Oncol. 2011;18:619–27.PubMedCrossRef Stokes JB, Nolan NJ, Stelow EB, Walters DM, Weiss GR, de Lange EE, et al. Preoperative capecitabine and concurrent radiation for borderline resectable pancreatic cancer. Ann Surg Oncol. 2011;18:619–27.PubMedCrossRef
34.
Zurück zum Zitat Arvold ND, Niemierko A, Mamon HJ, Fernandez-del Castillo C, Hong TS. Pancreatic cancer tumor size on CT scan versus pathologic specimen: implications for radiation treatment planning. Int J Radiat Oncol Biol Phys. 2011;80:1383–90.PubMedCrossRef Arvold ND, Niemierko A, Mamon HJ, Fernandez-del Castillo C, Hong TS. Pancreatic cancer tumor size on CT scan versus pathologic specimen: implications for radiation treatment planning. Int J Radiat Oncol Biol Phys. 2011;80:1383–90.PubMedCrossRef
35.
Zurück zum Zitat Sahora K, Kuehrer I, Schindl M, Koelblinger C, Goetzinger P, Gnant M. NeoGemTax: gemcitabine and docetaxel as neoadjuvant treatment for locally advanced nonmetastasized pancreatic cancer. World J Surg. 2011;35:1580–9.PubMedCrossRef Sahora K, Kuehrer I, Schindl M, Koelblinger C, Goetzinger P, Gnant M. NeoGemTax: gemcitabine and docetaxel as neoadjuvant treatment for locally advanced nonmetastasized pancreatic cancer. World J Surg. 2011;35:1580–9.PubMedCrossRef
36.
Zurück zum Zitat Sahora K, Kuehrer I, Eisenhut A, Akan B, Koellblinger C, Goetzinger P, et al. NeoGemOx: gemcitabine and oxaliplatin as neoadjuvant treatment for locally advanced, nonmetastasized pancreatic cancer. Surgery. 2011;149:311–20.PubMedCrossRef Sahora K, Kuehrer I, Eisenhut A, Akan B, Koellblinger C, Goetzinger P, et al. NeoGemOx: gemcitabine and oxaliplatin as neoadjuvant treatment for locally advanced, nonmetastasized pancreatic cancer. Surgery. 2011;149:311–20.PubMedCrossRef
37.
Zurück zum Zitat Takahashi S, Kinoshita T, Konishi M, Gotohda N, Kato Y, Kinoshita T, et al. Borderline resectable pancreatic cancer: rationale for multidisciplinary treatment. J Hepatobiliary Pancreat Sci. 2011;18:567–74.PubMedCrossRef Takahashi S, Kinoshita T, Konishi M, Gotohda N, Kato Y, Kinoshita T, et al. Borderline resectable pancreatic cancer: rationale for multidisciplinary treatment. J Hepatobiliary Pancreat Sci. 2011;18:567–74.PubMedCrossRef
38.
Zurück zum Zitat Chun YS, Milestone BN, Watson JC, Cohen SJ, Burtness B, Engstrom PF, et al. Defining venous involvement in borderline resectable pancreatic cancer. Ann Surg Oncol. 2010;17:2832–8.PubMedCrossRef Chun YS, Milestone BN, Watson JC, Cohen SJ, Burtness B, Engstrom PF, et al. Defining venous involvement in borderline resectable pancreatic cancer. Ann Surg Oncol. 2010;17:2832–8.PubMedCrossRef
39.
Zurück zum Zitat Turrini O, Viret F, Moureau-Zabotto L, Guiramand J, Moutardier V, Lelong B, et al. Neoadjuvant chemoradiation and pancreaticoduodenectomy for initially locally advanced head pancreatic adenocarcinoma. Eur J Surg Oncol. 2009;35:1306–11.PubMedCrossRef Turrini O, Viret F, Moureau-Zabotto L, Guiramand J, Moutardier V, Lelong B, et al. Neoadjuvant chemoradiation and pancreaticoduodenectomy for initially locally advanced head pancreatic adenocarcinoma. Eur J Surg Oncol. 2009;35:1306–11.PubMedCrossRef
40.
Zurück zum Zitat Satoi S, Yanagimoto H, Toyokawa H, Takahashi K, Matsui Y, Kitade H, et al. Surgical results after preoperative chemoradiation therapy for patients with pancreatic cancer. Pancreas. 2009;38:282–8.PubMedCrossRef Satoi S, Yanagimoto H, Toyokawa H, Takahashi K, Matsui Y, Kitade H, et al. Surgical results after preoperative chemoradiation therapy for patients with pancreatic cancer. Pancreas. 2009;38:282–8.PubMedCrossRef
41.
Zurück zum Zitat Brown KM, Siripurapu V, Davidson M, Cohen SJ, Konski A, Watson JC, et al. Chemoradiation followed by chemotherapy before resection for borderline pancreatic adenocarcinoma. Am J Surg. 2008;195:318–21.PubMedCrossRef Brown KM, Siripurapu V, Davidson M, Cohen SJ, Konski A, Watson JC, et al. Chemoradiation followed by chemotherapy before resection for borderline pancreatic adenocarcinoma. Am J Surg. 2008;195:318–21.PubMedCrossRef
42.
Zurück zum Zitat Small W, Jr, Berlin J, Freedman GM, Lawrence T, Talamonti MS, Mulcahy MF, et al. Full-dose gemcitabine with concurrent radiation therapy in patients with nonmetastatic pancreatic cancer: a multicenter phase II trial. J Clin Oncol. 2008;26:942–7.PubMedCrossRef Small W, Jr, Berlin J, Freedman GM, Lawrence T, Talamonti MS, Mulcahy MF, et al. Full-dose gemcitabine with concurrent radiation therapy in patients with nonmetastatic pancreatic cancer: a multicenter phase II trial. J Clin Oncol. 2008;26:942–7.PubMedCrossRef
43.
Zurück zum Zitat Massucco P, Capussotti L, Magnino A, Sperti E, Gatti M, Muratore A, et al. Pancreatic resections after chemoradiotherapy for locally advanced ductal adenocarcinoma: analysis of perioperative outcome and survival. Ann Surg Oncol. 2006;13:1201–8.PubMedCrossRef Massucco P, Capussotti L, Magnino A, Sperti E, Gatti M, Muratore A, et al. Pancreatic resections after chemoradiotherapy for locally advanced ductal adenocarcinoma: analysis of perioperative outcome and survival. Ann Surg Oncol. 2006;13:1201–8.PubMedCrossRef
44.
Zurück zum Zitat Pipas JM, Barth RJ, Jr, Zaki B, Tsapakos MJ, Suriawinata AA, Bettmann MA, et al. Docetaxel/gemcitabine followed by gemcitabine and external beam radiotherapy in patients with pancreatic adenocarcinoma. Ann Surg Oncol. 2005;12:995–1004.PubMedCrossRef Pipas JM, Barth RJ, Jr, Zaki B, Tsapakos MJ, Suriawinata AA, Bettmann MA, et al. Docetaxel/gemcitabine followed by gemcitabine and external beam radiotherapy in patients with pancreatic adenocarcinoma. Ann Surg Oncol. 2005;12:995–1004.PubMedCrossRef
45.
Zurück zum Zitat Zimmermann FB, Schuhmacher C, Lersch C, Bernhardt B, Pickel P, Siewert JR, et al. Sequential and/or concurrent hypofractionated radiotherapy and concurrent chemotherapy in neoadjuvant treatment of advanced adenocarcinoma of the pancreas. Outcome and patterns of failure. Hepatogastroenterology. 2004;51:1842–6.PubMed Zimmermann FB, Schuhmacher C, Lersch C, Bernhardt B, Pickel P, Siewert JR, et al. Sequential and/or concurrent hypofractionated radiotherapy and concurrent chemotherapy in neoadjuvant treatment of advanced adenocarcinoma of the pancreas. Outcome and patterns of failure. Hepatogastroenterology. 2004;51:1842–6.PubMed
46.
Zurück zum Zitat Kelly KJ, Kooby D, Parikh A, Cho C, Winslow E, Scoggins CR, et al. Venous involvement during pancreaticoduodenectomy: is there a need for redefinition of ‘borderline resectable disease’? Abstract presented at the 53rd annual meeting of the Society for Surgery of the Alimentary Tract, San Diego, CA; 2012. Kelly KJ, Kooby D, Parikh A, Cho C, Winslow E, Scoggins CR, et al. Venous involvement during pancreaticoduodenectomy: is there a need for redefinition of ‘borderline resectable disease’? Abstract presented at the 53rd annual meeting of the Society for Surgery of the Alimentary Tract, San Diego, CA; 2012.
Metadaten
Titel
Borderline Resectable Pancreatic Cancer: Need for Standardization and Methods for Optimal Clinical Trial Design
verfasst von
Matthew H. G. Katz, MD
Robert Marsh, MD
Joseph M. Herman, MD
Qian Shi, PhD
Eric Collison, MD
Alan P. Venook, MD
Hedy L. Kindler, MD
Steven R. Alberts, MD
Philip Philip, MD
Andrew M. Lowy, MD
Peter W. T. Pisters, MD
Mitchell C. Posner, MD
Jordan D. Berlin, MD
Syed A. Ahmad, MD
Publikationsdatum
01.08.2013
Verlag
Springer US
Erschienen in
Annals of Surgical Oncology / Ausgabe 8/2013
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-013-2886-9

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S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.