Primary resection versus neoadjuvant chemoradiation followed by resection for locally resectable or potentially resectable pancreatic carcinoma without distant metastasis. A multi-centre prospectively randomised phase II-study of the Interdisciplinary Working Group Gastrointestinal Tumours (AIO, ARO, and CAO)

BACKGROUND: The disappointing results of surgical therapy alone of ductal pancreatic cancer can only be improved using multimodal approaches. In contrast to adjuvant therapy, neoadjuvant chemoradiation is able to facilitate resectability with free margins and to lower lymphatic spread. Another advantage is better tolerability which consecutively allows applying multimodal treatment in a higher number of patients. Furthermore, the synopsis of the overall survival results of neoadjuvant trials suggests a higher rate compared to adjuvant trials. METHODS/DESIGN: As there are no prospectively randomised studies for neoadjuvant therapy, the Interdisciplinary Study Group of Gastrointestinal Tumours of the German Cancer Aid has started such a trial. The study investigates the effect of neoadjuvant chemoradiation in locally resectable or probably resectable cancer of the pancreatic head without distant metastasis on median overall survival time compared to primary surgery. Adjuvant chemotherapy is integrated into both arms. DISCUSSION: The protocol of the study is presented in condensed form after an introducing survey on adjuvant and neoadjuvant therapy in pancreatic cancer

Weekly full-dose gemcitabine and single-dose cisplatin with concurrent radiotherapy in patients with locally advanced pancreatic cancer

The aim of this study was to evaluate the efficacy and the toxicity of a full dose of gemcitabine and a single dose of cisplatin with concurrent radiotherapy in patients with locally advanced pancreatic cancer. Forty-one patients with locally advanced pancreatic cancer were enrolled. Patients received gemcitabine (1000 mg m−2 on days 1, 8, 15, 29, and 36) and cisplatin (70 mg m−2 on days 1 and 29) with concurrent radiotherapy (45 Gy in 25 fractions). Treatment was completed in 38 out of 41 patients (92.7%). The overall response rate was 24.4% (two complete and eight partial). Six patients (14.6%) underwent definite pancreatic resection and four had negative surgical margins. The intention of the treatment analysis showed that the median survival time and median time to tumour progression were 16.7 and 8.9 months. The 1- and 2-year survival rates were 63.3 and 27.9%, respectively. Overall survival was significantly longer in the low baseline CA19-9 group and therapeutic responders. Toxicities were tolerable and successfully managed by conservative treatments. The therapeutic scheme of a weekly full dose of gemcitabine and a single dose of cisplatin combined with external radiation is effective and might prolong the survival of patients with locally advanced pancreatic cancer

Identification of major retroperitoneal vascular anatomy with endoscopic ultrasonography

Les relations anatomiques des vaisseaux et organes rétropéritonéaux peuvent être clairement observées à partir de l'estomac et du duodenum avec des échoendoscopes à balayages radial et linéaire. Sont revues les méthodes pour placer et manoeuvrer l'échoendoscope dans six positions standard faciles à reconnaître ainsi que dans la position « calé en retrait». A partir de ces positions, la plupart des vaisseaux rétropéritonéaux peuvent être investigués. Le rétropéritoine est difficile à imager avec précision, quel que soit le test utilisé mais il peut l'être avec l'ultrasonographie endoscopique (USE). L'USE rétropéritonéale devrait fournir l'impact le plus important sur la conduite clinique car l'USE est plus précise que tout autre test pour évaluer cette région

Can endoscopic ultrasonography influence management and outcome of pancreatic cancer ?

La prise en charge du cancer pancréatique concerne surtout les patients présentant une tumeur potentiellement résécable. Les informations fournies par l'échoendoscopie permettent une approche thérapeutique multidisciplinaire en fonction de la stadification TNM. Cependant cette approche sélective ne peut modifier l'évolution clinique que si les traitements proposés sont efficaces. Une approche thérapeutique multidisciplinaire dépendant du stade d'envahissement devrait permettre d'améliorer le pronostic des patients présentant un cancer pancréatique. Puisque l'USE est devenue la technique la plus fiable pour l'évaluation du cancer pancréatique, l'utilisation de la classification TNM basée sur l'USE devrait permettre des nouveaux progrès grâce à l'application de traitements mieux sélectionnés