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Current Oncology
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New Frontiers in Treatment of Pancreatic Cancer
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New Frontiers in Treatment of Pancreatic Cancer

A special issue of Current Oncology (ISSN 1718-7729). This special issue belongs to the section "Gastrointestinal Oncology".

Deadline for manuscript submissions: closed (15 November 2024) | Viewed by 28813

Special Issue Editors

Dr. Olav F. Dajani

E-Mail Website
Guest Editor
Department of Oncology, Oslo University Hospital, Oslo, Norway
Interests: pancreatic cancer; hepatobilary cancer; phase II/III trials; symptom mangement; cancer cachexia; patient reported outcomes
Dr. Knut Jørgen Labori

E-Mail Website
Co-Guest Editor
Department of HBP Surgery, Oslo University Hospital, Oslo, Norway
Interests: pancreatic cancer; clinical trials; biomarkers
Dr. Arne Westgaard

E-Mail Website
Co-Guest Editor
Department of Oncology, Oslo University Hospital, Oslo, Norway
Interests: pancreatic cancer; clinical trials; pathology

Special Issue Information

Dear Colleagues,

Pancreatic cancer remains a challenging clinical problem. It is foreseen that the disease will become the second cause of cancer deaths in the western world. To avoid this epidemic, progress will be needed through multiple approaches. In this Special Edition, we therefore welcome original papers and reviews in the following fields of pancreatic cancer research: improved prevention and early diagnostic strategies, molecular tumor stratification for personalized and molecularly targeted antitumor treatment, and the development of rational and tolerable multimodal therapies in the neoadjuvant, adjuvant, and palliative setting, also including radiotherapy.

In addition to tumor-directed treatment, there is a great need to improve quality of life in patients with pancreatic cancer through better symptom control, such as pain management, treatment of cachexia, and psychosocial support, and we also encourage the submission of papers focusing on these.

Dr. Olav F. Dajani
Dr. Knut Jørgen Labori
Dr. Arne Westgaard
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Current Oncology is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pancreatic cancer (adenocarcinoma)
  • chemotherapy
  • immunotherapy
  • radiotherapy
  • personalized medicine
  • predictive biomarkers
  • prognostic biomarkers
  • symptom management
  • cachexia
  • pain management

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Published Papers (10 papers)

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Research

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13 pages, 1245 KiB  
Article
Sharing Mono-Institutional Experience of Treating Pancreatic Cancer with Stereotactic Body Radiation Therapy (SBRT)
by Asmara Waheed, Shannah Murland, Eugene Yip, Amr Heikal, Sunita Ghosh, Aswin Abraham, Kim Paulson, Keith Tankel, Nawaid Usmani, Diane Severin, Clarence Wong and Kurian Joseph
Curr. Oncol. 2024, 31(10), 5974-5986; https://doi.org/10.3390/curroncol31100446 - 4 Oct 2024
Cited by 1 | Viewed by 1465
Abstract
Background: Stereotactic body radiotherapy (SBRT) is an evolving treatment for the local management of pancreatic cancer (PC). The main purpose of this study is to report our initial experience in terms of local control (LC) and toxicity for PC patients treated with SBRT. [...] Read more.
Background: Stereotactic body radiotherapy (SBRT) is an evolving treatment for the local management of pancreatic cancer (PC). The main purpose of this study is to report our initial experience in terms of local control (LC) and toxicity for PC patients treated with SBRT. Methods: We conducted a retrospective review of patients treated with SBRT using abdominal compression (AC) or an end-expiratory breath-holding (EEBH) technique. The median prescribed dose was 35 Gy, delivered in five fractions. Toxicities were recorded using Common Terminology Criteria for Adverse Events (CTCAE) v5.0, and survival was estimated using the Kaplan–Meier method. Results: From 2017 to 2023, 17 PC patients were offered SBRT. Their median age was 69 years. The median follow-up from the date of diagnosis was 22.37 months. The overall survival (OS) was 94% at 1 year and 60.9% at 2 years. The progression-free survival (PFS) was 63.1% at 6 months and 56.1% at 9 months. The median OS was 26.3 months, and the median PFS was 20.6 months. The 6-month and 1-year LC rates were 71% and 50.8%, respectively. Conclusion: We are successful in implementing the SBRT program at our centre. SBRT appears to be a promising treatment option for achieving LC with limited acute toxicities. Full article
(This article belongs to the Special Issue New Frontiers in Treatment of Pancreatic Cancer)
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10 pages, 1325 KiB  
Article
Prognostic Value of Performance Status, Albumin, and CRP in Last-Line Chemotherapy for Pancreatic vs. Other Gastrointestinal Cancers—Simple Tools Matter
by Arne Westgaard, Aleksandra Pirnat, Marianne Jensen Hjermstad, Nina Aass, Stein Kaasa and Olav Faisal Dajani
Curr. Oncol. 2024, 31(9), 5462-5471; https://doi.org/10.3390/curroncol31090404 - 14 Sep 2024
Cited by 1 | Viewed by 1417
Abstract
Patients with advanced gastrointestinal cancers often receive chemotherapy near the end of life (EoL), raising concerns about overtreatment. The PALLiON trial, a cluster-randomized trial, assessed the impact of a complex intervention on frequency of EoL treatment; the intervention involved palliative care referrals and [...] Read more.
Patients with advanced gastrointestinal cancers often receive chemotherapy near the end of life (EoL), raising concerns about overtreatment. The PALLiON trial, a cluster-randomized trial, assessed the impact of a complex intervention on frequency of EoL treatment; the intervention involved palliative care referrals and the use of PROMs. The present secondary analysis evaluated the prognostic value of baseline performance status (PS), albumin (alb), C-reactive protein (CRP), and body mass index (BMI) for overall survival, comparing pancreatic (PAN, n = 189) vs. other gastrointestinal cancer patients (GI, n = 286). Baseline PS, alb, CRP, mGPS (modified Glasgow prognostic score), and BMI were analyzed using Cox regression. Adjusted for age, sex, and hospital size, PS ≥ 2 and alb < 35 g/L predicted shorter survival in both PAN and GI cancers, while CRP > 10 predicted shorter survival only in GI cancers. In PAN, PS ≥ 2 predicted a 78.4% higher probability of shorter survival, and mGPS 2 predicted a 68.7% higher probability. In GI, mGPS 2 predicted a 70.8% higher probability, whereas PS was not significant. BMI did not improve predictive models. PS ≥ 2 and low albumin are strong predictors of short survival in PAN, whereas increased CRP and low albumin (mGPS 2) are predictors in GI. Full article
(This article belongs to the Special Issue New Frontiers in Treatment of Pancreatic Cancer)
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14 pages, 850 KiB  
Article
Comparative Effectiveness of Chemotherapy Alone Versus Radiotherapy-Based Regimens in Locally Advanced Pancreatic Cancer: A Real-World Multicenter Analysis (PAULA-1)
by Alessandra Arcelli, Giuseppe Tarantino, Francesco Cellini, Milly Buwenge, Gabriella Macchia, Federica Bertini, Alessandra Guido, Francesco Deodato, Savino Cilla, Valerio Scotti, Maria Elena Rosetto, Igor Djan, Salvatore Parisi, Gian Carlo Mattiucci, Michele Fiore, Pierluigi Bonomo, Liliana Belgioia, Rita Marina Niespolo, Pietro Gabriele, Mariacristina Di Marco, Nicola Simoni, Johnny Ma, Lidia Strigari, Renzo Mazzarotto and Alessio Giuseppe Morgantiadd Show full author list remove Hide full author list
Curr. Oncol. 2023, 30(6), 5690-5703; https://doi.org/10.3390/curroncol30060427 - 10 Jun 2023
Cited by 2 | Viewed by 2480
Abstract
Different options for locally advanced pancreatic cancer (LAPC) are available based on international guidelines: chemotherapy (CHT), chemoradiation (CRT), and stereotactic body radiotherapy (SBRT). However, the role of radiotherapy is debated in LAPC. We retrospectively compared CHT, CRT, and SBRT ± CHT in a [...] Read more.
Different options for locally advanced pancreatic cancer (LAPC) are available based on international guidelines: chemotherapy (CHT), chemoradiation (CRT), and stereotactic body radiotherapy (SBRT). However, the role of radiotherapy is debated in LAPC. We retrospectively compared CHT, CRT, and SBRT ± CHT in a real-world setting in terms of overall survival (OS), local control (LC), and distant metastasis-free survival (DMFS). LAPC patients from a multicentric retrospective database were included (2005–2018). Survival curves were calculated using the Kaplan–Meier method. Multivariable Cox analysis was performed to identify predictors of LC, OS, and DMFS. Of the 419 patients included, 71.1% were treated with CRT, 15.5% with CHT, and 13.4% with SBRT. Multivariable analysis showed higher LC rates for CRT (HR: 0.56, 95%CI 0.34–0.92, p = 0.022) or SBRT (HR: 0.27, 95%CI 0.13–0.54, p < 0.001), compared to CHT. CRT (HR: 0.44, 95%CI 0.28–0.70, p < 0.001) and SBRT (HR: 0.40, 95%CI 0.22–0.74, p = 0.003) were predictors of prolonged OS with respect to CHT. No significant differences were recorded in terms of DMFS. In selected patients, the addition of radiotherapy to CHT is still an option to be considered. In patients referred for radiotherapy, CRT can be replaced by SBRT considering its duration, higher LC rate, and OS rate, which are at least comparable to that of CRT. Full article
(This article belongs to the Special Issue New Frontiers in Treatment of Pancreatic Cancer)
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13 pages, 1135 KiB  
Article
Early Recurrence after Upfront Surgery for Pancreatic Ductal Adenocarcinoma
by Gennaro Nappo, Greta Donisi, Giovanni Capretti, Cristina Ridolfi, Michele Pagnanelli, Martina Nebbia, Silvia Bozzarelli, Tommasangelo Petitti, Francesca Gavazzi and Alessandro Zerbi
Curr. Oncol. 2023, 30(4), 3708-3720; https://doi.org/10.3390/curroncol30040282 - 27 Mar 2023
Cited by 5 | Viewed by 2233
Abstract
Background. Survival after surgery for pancreatic ductal adenocarcinoma (PDAC) remains poor, due to early recurrence (ER) of the disease. A global definition of ER is lacking and different cut-off values (6, 8, and 12 months) have been adopted. The aims of this study [...] Read more.
Background. Survival after surgery for pancreatic ductal adenocarcinoma (PDAC) remains poor, due to early recurrence (ER) of the disease. A global definition of ER is lacking and different cut-off values (6, 8, and 12 months) have been adopted. The aims of this study were to define the optimal cut-off for the definition of ER and predictive factors for ER. Methods. Recurrence was recorded for all consecutive patients undergoing upfront surgery for PDAC at our institute between 2010 and 2017. Receiver operating characteristic (ROC) curves were utilized, to estimate the optimal cut-off for the definition of ER as a predictive factor for poor post-progression survival (PPS). To identify predictive factors of ER, univariable and multivariable logistic regression models were used. Results. Three hundred and fifty one cases were retrospectively evaluated. The recurrence rate was 76.9%. ER rates were 29.0%, 37.6%, and 47.6%, when adopting 6, 8, and 12 months as cut-offs, respectively. A significant difference in median PPS was only shown between ER and late recurrence using 12 months as cut-off (p = 0.005). In the multivariate analysis, a pre-operative value of CA 19-9 > 70.5 UI/L (OR 3.10 (1.41–6.81); p = 0.005) and the omission of adjuvant treatment (OR 0.18 (0.08–0.41); p < 0.001) were significant predictive factors of ER. Conclusions. A twelve-months cut-off should be adopted for the definition of ER. Almost 50% of upfront-resected patients presented ER, and it significantly affected the prognosis. A high preoperative value of CA 19-9 and the omission of adjuvant treatment were the only predictive factors for ER. Full article
(This article belongs to the Special Issue New Frontiers in Treatment of Pancreatic Cancer)
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14 pages, 2558 KiB  
Article
Predicting Early Disease Recurrence of Pancreatic Cancer following Surgery: Determining the Role of NUDT15 as a Prognostic Biomarker
by Daniel Llwyd Hughes, Frances Willenbrock, Zahir Soonawalla, Somnath Mukherjee and Eric O’Neill
Curr. Oncol. 2022, 29(4), 2516-2529; https://doi.org/10.3390/curroncol29040206 - 6 Apr 2022
Cited by 1 | Viewed by 2981
Abstract
Surgical resection remains the only curative treatment strategy for Pancreatic Ductal Adenocarcinoma (PDAC). A proportion of patients succumb to early disease recurrence post-operatively despite receiving adjuvant chemotherapy. The ability to identify these high-risk individuals at their initial diagnosis, prior to surgery, could potentially [...] Read more.
Surgical resection remains the only curative treatment strategy for Pancreatic Ductal Adenocarcinoma (PDAC). A proportion of patients succumb to early disease recurrence post-operatively despite receiving adjuvant chemotherapy. The ability to identify these high-risk individuals at their initial diagnosis, prior to surgery, could potentially alter their treatment algorithm. This unique patient cohort may benefit from neo-adjuvant chemotherapy, even in the context of resectable disease, as this may secure systemic control over their disease burden. It may also improve patient selection for surgery. Using the Cancer Genome Atlas dataset, we first confirmed the poor overall survival associated with early disease recurrence (p < 0.0001). The transcriptomic profiles of these tumours were analysed, and we identified key aberrant signalling pathways involved in early disease relapse; downregulation across several immune signalling pathways was noted. Differentially expressed genes that could serve as biomarkers were identified (BPI, C6orf58, CD177, MCM7 and NUDT15). Receiver operating characteristic curves were constructed in order to identify biomarkers with a high diagnostic ability to identify patients who developed early disease recurrence. NUDT15 expression had the highest discriminatory capability as a biomarker (AUC 80.8%). Its expression was confirmed and validated in an independent cohort of patients with resected PDAC (n = 13). Patients who developed an early recurrence had a statistically higher tumour expression of NUDT15 when compared to patients who did not recur early (p < 0.01). Our results suggest that NUDT15 can be used as a prognostic biomarker that can stratify patients according to their risk of developing early disease recurrence. Full article
(This article belongs to the Special Issue New Frontiers in Treatment of Pancreatic Cancer)
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12 pages, 1009 KiB  
Article
Implication of ERBB2 as a Predictive Tool for Survival in Patients with Pancreatic Cancer in Histological Studies
by Miguel A. Ortega, Leonel Pekarek, Oscar Fraile-Martinez, Cielo Garcia-Montero, Miguel A. Saez, Angel Asúnsolo, Miguel A. Alvarez-Mon, Jorge Monserrat, Lidia Ruiz-Llorente, Natalio García-Honduvilla, Agustin Albillos, Julia Buján, Melchor Alvarez-Mon and Luis G. Guijarro
Curr. Oncol. 2022, 29(4), 2442-2453; https://doi.org/10.3390/curroncol29040198 - 30 Mar 2022
Cited by 13 | Viewed by 3875
Abstract
Pancreatic cancer will be positioned by the year 2030 as the second cause of oncological death after lung cancer. The pathophysiology of the most common variety, which involves the adenocarcinoma of the pancreas, represents one of the main challenges for current oncology to [...] Read more.
Pancreatic cancer will be positioned by the year 2030 as the second cause of oncological death after lung cancer. The pathophysiology of the most common variety, which involves the adenocarcinoma of the pancreas, represents one of the main challenges for current oncology to explain its tumorigenesis and create a targeted treatment. The tumor microenvironment, metastatic capacity, and lack of early diagnosis lead patients to present advanced stages at the time of diagnosis. Despite numerous efforts, little progress has been made in clinical outcomes and with respect to the improved survival of these patients. For this reason, in recent years, numerous diagnostic tests, treatments, and possible approaches in the fields of radiotherapy, chemotherapy, immunotherapy, and surgery have been developed to find a combination of methods that improves life expectancy in patients diagnosed with this disease. On the other hand, the scientific community has made numerous advances in the molecular bases of pancreatic cancer since several oncogenetic pathways have been described and the markers expressed by the tumor have proven to be useful in the prognosis of pancreatic adenocarcinoma. These molecular alterations allow the study of possible therapeutic targets that improve the prognosis of these patients, but even numerous tumor cell-individual interactions must be explained to understand the underlying pathophysiology causing the high mortality. Therefore, the purpose of our study is to examine the expression of markers such as EGFR, Cyclin D1, andCDK4 in order to find a relationship with the possible long-term prognostic factors of patients affected by pancreatic ductal adenocarcinoma. Our results show that there is a prognostic role for ErbB2, EGFR, beta catenin, cyclin D1, and CDK4. Of these, we highlight the clinical importance of ErbB2 in the survival rates of patients who overexpress this component. Full article
(This article belongs to the Special Issue New Frontiers in Treatment of Pancreatic Cancer)
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Review

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18 pages, 414 KiB  
Review
Radiotherapy for Locally Advanced Pancreatic Adenocarcinoma—A Critical Review of Randomised Trials
by Mathilde Weisz Ejlsmark, Tine Schytte, Uffe Bernchou, Rana Bahij, Britta Weber, Michael Bau Mortensen and Per Pfeiffer
Curr. Oncol. 2023, 30(7), 6820-6837; https://doi.org/10.3390/curroncol30070499 - 18 Jul 2023
Cited by 9 | Viewed by 3497
Abstract
Pancreatic cancer is rising as one of the leading causes of cancer-related death worldwide. Patients often present with advanced disease, limiting curative treatment options and therefore making management of the disease difficult. Systemic chemotherapy has been an established part of the standard treatment [...] Read more.
Pancreatic cancer is rising as one of the leading causes of cancer-related death worldwide. Patients often present with advanced disease, limiting curative treatment options and therefore making management of the disease difficult. Systemic chemotherapy has been an established part of the standard treatment in patients with both locally advanced and metastatic pancreatic cancer. In contrast, the use of radiotherapy has no clear defined role in the treatment of these patients. With the evolving imaging and radiation techniques, radiation could become a plausible intervention. In this review, we give an overview over the available data regarding radiotherapy, chemoradiation, and stereotactic body radiation therapy. We performed a systematic search of Embase and the PubMed database, focusing on studies involving locally advanced pancreatic cancer (or non-resectable pancreatic cancer) and radiotherapy without any limitation for the time of publication. We included randomised controlled trials involving patients with locally advanced pancreatic cancer, including radiotherapy, chemoradiation, or stereotactic body radiation therapy. The included articles represented mainly small patient groups and had a high heterogeneity regarding radiation delivery and modality. This review presents conflicting results concerning the addition of radiation and modality in the treatment regimen. Further research is needed to improve outcomes and define the role of radiation therapy in pancreatic cancer. Full article
(This article belongs to the Special Issue New Frontiers in Treatment of Pancreatic Cancer)
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15 pages, 307 KiB  
Review
Review of Current Systemic Therapy and Novel Systemic Therapy for Pancreatic Ductal Adenocarcinoma
by Humaira Sarfraz, Aditi Saha, Khushali Jhaveri and Dae Won Kim
Curr. Oncol. 2023, 30(6), 5322-5336; https://doi.org/10.3390/curroncol30060404 - 26 May 2023
Cited by 7 | Viewed by 3338
Abstract
Background: This review aims to describe the systemic treatment options for pancreatic ductal adenocarcinoma and includes a summary of the current treatments as well as the ongoing clinical trials which may be efficacious in the treatment of this aggressive malignancy. Methods: A literature [...] Read more.
Background: This review aims to describe the systemic treatment options for pancreatic ductal adenocarcinoma and includes a summary of the current treatments as well as the ongoing clinical trials which may be efficacious in the treatment of this aggressive malignancy. Methods: A literature review was performed using MEDLINE/PubMed between August 1996 and February 2023. The reviewed studies are categorized into these categories: current standard of care treatments, targeted therapies, immunotherapy and clinical trials. The current treatment modality for the treatment of advanced pancreatic cancer is mainly systemic chemotherapy. Results: The introduction of polychemotherapy regimens including gemcitabine/nab-paclitaxel and FOLFIRINOX (oxaliplatin, irinotecan, folinic acid and fluorouracil) has improved the clinical outcome of advanced pancreatic cancer. For further improvement in clinical outcomes, several novel approaches have been extensively studied in pancreatic cancer. The review discusses the current standard chemotherapy regimen and the novel treatment options in the field. Conclusions: While there are novel treatments being explored for metastatic pancreatic, it remains a debilitating and aggressive disease with high mortality that warrants continued efforts to advance therapeutic options. Full article
(This article belongs to the Special Issue New Frontiers in Treatment of Pancreatic Cancer)
22 pages, 4357 KiB  
Review
Complement and Fungal Dysbiosis as Prognostic Markers and Potential Targets in PDAC Treatment
by Cornelia Speth, Ruben Bellotti, Georg Schäfer, Günter Rambach, Bernhard Texler, Gudrun C. Thurner, Dietmar Öfner, Cornelia Lass-Flörl and Manuel Maglione
Curr. Oncol. 2022, 29(12), 9833-9854; https://doi.org/10.3390/curroncol29120773 - 14 Dec 2022
Cited by 4 | Viewed by 2704
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is still hampered by a dismal prognosis. A better understanding of the tumor microenvironment within the pancreas and of the factors affecting its composition is of utmost importance for developing new diagnostic and treatment tools. In this context, the [...] Read more.
Pancreatic ductal adenocarcinoma (PDAC) is still hampered by a dismal prognosis. A better understanding of the tumor microenvironment within the pancreas and of the factors affecting its composition is of utmost importance for developing new diagnostic and treatment tools. In this context, the complement system plays a prominent role. Not only has it been shown to shape a T cell-mediated immune response, but it also directly affects proliferation and apoptosis of the tumor cells, influencing angiogenesis, metastatic spread and therapeutic resistance. This makes complement proteins appealing not only as early biomarkers of PDAC development, but also as therapeutic targets. Fungal dysbiosis is currently the new kid on the block in tumorigenesis with cancer-associated mycobiomes extracted from several cancer types. For PDAC, colonization with the yeast Malassezia seems to promote cancer progression, already in precursor lesions. One responsible mechanism appears to be complement activation via the lectin pathway. In the present article, we review the role of the complement system in tumorigenesis, presenting observations that propose it as the missing link between fungal dysbiosis and PDAC development. We also present the results of a small pilot study supporting the crucial interplay between the complement system and Malassezia colonization in PDAC pathogenesis. Full article
(This article belongs to the Special Issue New Frontiers in Treatment of Pancreatic Cancer)
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13 pages, 1568 KiB  
Review
Prognostic Impact of Resection Margin Status on Distal Pancreatectomy for Ductal Adenocarcinoma
by Maia Blomhoff Holm and Caroline Sophie Verbeke
Curr. Oncol. 2022, 29(9), 6551-6563; https://doi.org/10.3390/curroncol29090515 - 14 Sep 2022
Cited by 9 | Viewed by 2775
Abstract
Pancreatic cancer is associated with a poor prognosis. While surgical resection is the only treatment option with curative intent, most patients die of locoregional and/or distant recurrence. The prognostic impact of the resection margin status has received much attention. However, the evidence is [...] Read more.
Pancreatic cancer is associated with a poor prognosis. While surgical resection is the only treatment option with curative intent, most patients die of locoregional and/or distant recurrence. The prognostic impact of the resection margin status has received much attention. However, the evidence is almost exclusively related to pancreatoduodenectomies, while corresponding data for distal pancreatectomy specimens are limited. The key data, such as the rate of microscopic margin involvement (“R1”), the site of margin involvement, and the impact of R1 on patient outcome, are divergent between studies and do not currently allow any general conclusions. The main reasons for the variability in the published data are the small size of the study cohorts and their heterogeneity, as well as the marked divergence in pathology examination practices. The latter is a consequence of the lack of concrete guidance, both for grossing and microscopic examination. The increasing administration of neoadjuvant chemo(radio)therapy introduces a further factor of uncertainty as the conventional definition of a tumour-free margin (“R0”) based on 1 mm clearance is inadequate for these specimens. This review discusses the published data regarding the prognostic impact of margin status in distal pancreatectomy specimens along with the challenges and uncertainties that are related to the assessment of the margins. Full article
(This article belongs to the Special Issue New Frontiers in Treatment of Pancreatic Cancer)
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