196 research outputs found
Measuring the effectiveness of advertising in a positioning context with multi dimensional scaling techniques
Measuring the effectiveness of advertising in a positioning context with multi dimensional scaling techniques
Advertising;marketing
De toepassing en toekomst van public private partnership's bij de grote en middelgrote Nederlandse gemeenten
Local Government;Privatization;economische sektoren
OC-0282: Considerable intra-breath-hold motion and inter-breathhold position variation of pancreatic tumors
De toepassing en toekomst van public private partnership's bij de grote en middelgrote Nederlandse gemeenten
Neoadjuvant Treatment for Resectable and Borderline Resectable Pancreatic Cancer:Chemotherapy or Chemoradiotherapy?
Worldwide, there is a shifting paradigm from immediate surgery with adjuvant treatment to a neoadjuvant approach for patients with resectable or borderline resectable pancreatic cancer (RPC or BRPC). Comparison of neoadjuvant and adjuvant studies is extremely difficult because of a great difference in patient selection. The evidence from randomized studies shows that overall survival by intention-to-treat improves after neoadjuvant gemcitabine-based chemoradiotherapy or chemotherapy (various regimens), as compared to immediate surgery followed by adjuvant chemotherapy. Radiotherapy appears to play an important role in mediating locoregional effects. Yet, since more effective chemotherapy regimens are currently available, in particular FOLFIRINOX and Gemcitabine/Nab-paclitaxel, these chemotherapy regimens should be investigated in future randomized trials combined with (stereotactic) radiotherapy to further improve outcomes of RPC and BRPC
Gemcitabine-Based Neoadjuvant Treatment in Borderline Resectable Pancreatic Ductal Adenocarcinoma: A Meta-Analysis of Individual Patient Data
Background: Non-randomized studies have investigated multi-agent gemcitabinebased neo-adjuvant therapies (GEM-NAT) in borderline resectable pancreatic
ductal adenocarcinoma (BR-PDAC). Treatment sequencing and specific elements
of neoadjuvant treatment are still under investigation. The present meta-analysis aims to
assess the effectiveness of GEM-NAT on overall survival (OS) in BR-PDAC.
Patients and Methods: A meta-analysis of individual participant data (IPD) on GEMNAT for BR-PDAC were performed. The primary outcome was OS after treatment with
GEM-based chemotherapy. In the Individual Patient Data analysis data were reappraised
and confirmed as BR-PDAC on provided radiological data.
Results: Six studies investigating GEM-NAT were included in the IPD metanalysis.
The IPD metanalysis was conducted on 271 patients who received GEM-NAT.
Pooled median patient-level OS was 22.2 months (95%CI 19.1–25.2). R0 rates
ranged between 81 and 95% (I
2 = 0%, p = 0.64), respectively. Median OS was
27.8 months (95%CI 23.9–31.6) in the patients who received NAT-GEM followed
by resection compared to 15.4 months (95%CI 12.3–18.4) for NAT-GEM without
resection and 13.0 months (95%CI 7.4–18.5) in the group of patients who received
upfront surgery (p < 0.0001). R0 rates ranged between 81 and 95% (I
2 = 0%,
p = 0.64), respectively. Overall survival in the R0 group was 29.3 months (95%
CI 24.3–34.2) vs. 16.2 months (95% CI 7·9–24.5) in the R1 group (p = 0·001). Conclusions: The present study is the first meta-analysis combining IPD from a
number of international centers with BR-PDAC in a cohort that underwent multi-agent
gemcitabine neoadjuvant therapy (GEM-NAT) before surgery. GEM-NAT followed by
surgical resection improve sur
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