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1. Aloysius MM, Zaitoun AM, Bates TE, Ilyas M, Constantin-Teodosiu D, Rowlands BJ, Lobo DN: Immunohistochemical expression of mitochondrial membrane complexes (MMCs) I, III, IV and V in malignant and benign periampullary epithelium: a potential target for drug therapy of periampullary cancer? BMC Cancer; 2010;10:80
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  • [Title] Immunohistochemical expression of mitochondrial membrane complexes (MMCs) I, III, IV and V in malignant and benign periampullary epithelium: a potential target for drug therapy of periampullary cancer?
  • No published data are available on the relative abundance of MMCs in different periampullary cancers.
  • Therefore, we studied the expression profile of MMCs I, III, IV and V in periampullary cancers, reactive pancreatitis, normal pancreas and chronic pancreatitis.
  • METHODS: This was a retrospective study on tissue microarrays constructed from formalin-fixed paraffin-embedded tissue from 126 consecutive patients (cancer = 104, chronic pancreatitis = 22) undergoing pancreatic resections between June 2001 and June 2006.
  • 78 specimens of chronic pancreatitis tissue were obtained adjacent to areas of cancer.
  • Normal pancreatic tissue was obtained from the resection specimens in a total of 30 patients.
  • RESULTS: MMCs I, III, IV and V were highly expressed (p < 0.05) in all primary periampullary cancers compared with metastatic lymph nodes and adjacent benign pancreas.
  • MMCs III, IV and V were highly expressed in all cancers regardless of type compared with chronic pancreatitis (p < 0.05).
  • CONCLUSIONS: Differential expression of MMCs III, IV and V in primary periampullary cancers compared with adjacent benign periampullary tissue and chronic pancreatitis is a novel finding, which may render them attractive anticancer targets.
  • [MeSH-minor] Adult. Aged. Cell Proliferation. Epithelium / drug effects. Female. Humans. Lymphatic Metastasis. Male. Middle Aged. Neoplasm Metastasis. Oxidative Stress. Pancreas / pathology. Pancreatitis / pathology. Phosphorylation. Retrospective Studies

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  • (PMID = 20202214.001).
  • [ISSN] 1471-2407
  • [Journal-full-title] BMC cancer
  • [ISO-abbreviation] BMC Cancer
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Antineoplastic Agents
  • [Other-IDs] NLM/ PMC2841142
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2. Stauffer JA, Steers JL, Bonatti H, Dougherty MK, Aranda-Michel J, Dickson RC, Harnois DM, Nguyen JH: Liver transplantation and pancreatic resection: a single-center experience and a review of the literature. Liver Transpl; 2009 Dec;15(12):1728-37
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  • Indications for pancreatic resection included cholangiocarcinoma (n = 6), neuroendocrine tumor (n = 5), pancreatic cancer (n = 2), gastrointestinal stromal tumor (n = 1), periampullary adenocarcinoma (n = 1), duodenal adenomas (n = 1), and benign pancreatic mass (n = 1).
  • Indications for liver transplantation were metastatic neuroendocrine tumor disease (n = 5), primary sclerosing cholangitis (n = 5), hepatitis C virus (n = 2), metastatic gastrointestinal stromal tumor (n = 1), Klatskin tumor (n = 1), alcohol cirrhosis (n = 1), alpha-1 antitrypsin deficiency (n = 1), and chemotherapy-induced cirrhosis (n = 1).
  • [MeSH-minor] Adolescent. Adult. Aged. Aged, 80 and over. Female. Humans. Male. Middle Aged. Patient Selection. Recurrence. Risk Assessment. Time Factors. Treatment Outcome. Young Adult

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  • (PMID = 19938125.001).
  • [ISSN] 1527-6473
  • [Journal-full-title] Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
  • [ISO-abbreviation] Liver Transpl.
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 47
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3. Morak MJ, Pek CJ, Kompanje EJ, Hop WC, Kazemier G, van Eijck CH: Quality of life after adjuvant intra-arterial chemotherapy and radiotherapy versus surgery alone in resectable pancreatic and periampullary cancer: a prospective randomized controlled study. Cancer; 2010 Feb 15;116(4):830-6
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  • [Title] Quality of life after adjuvant intra-arterial chemotherapy and radiotherapy versus surgery alone in resectable pancreatic and periampullary cancer: a prospective randomized controlled study.
  • BACKGROUND: Adjuvant therapies for pancreatic and periampullary cancer reportedly achieve only a marginal survival benefit.
  • In this randomized controlled trial, 120 patients with resected pancreatic or periampullary cancer received either adjuvant celiac axis infusion chemotherapy combined with radiotherapy (CAI/RT) or no adjuvant treatment.
  • The objective of the study was to compare the quality of life (QoL) in patients who received CAI/RT after pancreatoduodenectomy with the QoL in patients who did not receive adjuvant treatment.
  • METHODS: During and after CAI/RT, QoL was assessed using the European Organization for Research and Treatment of Cancer QoL Questionnaire C30 every 3 months during the first 24 months after randomization.
  • CONCLUSIONS: Over a period of 24 months, CAI/RT improved QoL compared with observation alone in patients with resected pancreatic and periampullary cancer.
  • [MeSH-major] Pancreatic Neoplasms / psychology. Pancreatic Neoplasms / therapy. Quality of Life
  • [MeSH-minor] Adult. Aged. Chemotherapy, Adjuvant. Combined Modality Therapy. Female. Humans. Infusions, Intra-Arterial. Male. Middle Aged. Radiotherapy, Adjuvant. Time Factors. Treatment Outcome

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  • (PMID = 20029974.001).
  • [ISSN] 0008-543X
  • [Journal-full-title] Cancer
  • [ISO-abbreviation] Cancer
  • [Language] eng
  • [Publication-type] Journal Article; Randomized Controlled Trial
  • [Publication-country] United States
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4. Imrie CW, Connett G, Hall RI, Charnley RM: Review article: enzyme supplementation in cystic fibrosis, chronic pancreatitis, pancreatic and periampullary cancer. Aliment Pharmacol Ther; 2010 Nov;32 Suppl 1:1-25
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  • [Title] Review article: enzyme supplementation in cystic fibrosis, chronic pancreatitis, pancreatic and periampullary cancer.
  • BACKGROUND:   Over 11000 UK patients each year develop pancreatic exocrine insufficiency--the major causes are not rare: cystic fibrosis (>300 new cases/year), pancreatic cancer (>7000 new cases/year) and chronic pancreatitis (>4000 new cases/year).
  • AIM: To raise awareness of key clinical issues specific to patients with pancreatic exocrine insufficiency through experience from UK clinicians, and to offer advice regarding appropriate treatment with pancreatic enzymes.
  • METHODS: Three case studies describe clinical issues relating to pancreatic enzyme supplementation that may lead to underuse in patients with cystic fibrosis, pancreatic and periampullary cancer or chronic pancreatitis.
  • RESULTS: The efficacy of the treatment of exocrine pancreatic insufficiency is dependent on adequate meal-time enzyme replacement therapy.
  • Improvements in patients' weight and nutritional status are what is aimed for - an important reason for all doctors, nurses and dieticians to give this therapy close attention.
  • [MeSH-major] Cystic Fibrosis / drug therapy. Enzyme Replacement Therapy. Pancreatic Neoplasms / drug therapy. Pancreatitis, Chronic / drug therapy
  • [MeSH-minor] Female. Humans. Male. Palliative Care. Treatment Outcome


5. Mielko J, Polkowski WP, Skomra DG, Stanisławek AJ, Kurylcio AM, Korobowicz EM: Prognostic value of p27 kip1 expression in adenocarcinoma of the pancreatic head region. HPB (Oxford); 2006;8(3):216-22
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  • [Title] Prognostic value of p27 kip1 expression in adenocarcinoma of the pancreatic head region.
  • Conflicting data are reported for adenocarcinoma of the pancreas.
  • The aim of this study was to establish the prognostic value of p27(kip1) expression in adenocarcinoma of the pancreatic head region.
  • PATIENTS AND METHODS: The study included 45 patients (male/female ratio 2:1; mean age 59, range 38-82 years) with adenocarcinomas of the pancreatic head region: 24 - pancreatic head, 18 - periampullary and 3 - uncinate process.
  • Eight patients received adjuvant chemotherapy postoperatively.
  • Follow-up time ranged from 3 to 60 months.
  • Median survival time in patients with p27(kip1)-positive tumours was 19 months, whereas in patients with p27(kip1)-negative tumours it was 18 months (p=0.53).
  • Multivariate survival analysis revealed that the localization of the tumour (pancreatic head/uncinate process vs periampullary) was the only significant and independent prognosticator (p = 0.01, Cox regression model).

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  • (PMID = 18333280.001).
  • [ISSN] 1365-182X
  • [Journal-full-title] HPB : the official journal of the International Hepato Pancreato Biliary Association
  • [ISO-abbreviation] HPB (Oxford)
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] England
  • [Other-IDs] NLM/ PMC2131676
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6. Chakravarthy A, Abrams RA, Yeo CJ, Korman LT, Donehower RC, Hruban RH, Zahurek ML, Grochow LB, O'Reilly S, Hurwitz H, Jaffee EM, Lillemoe KD, Cameron JL: Intensified adjuvant combined modality therapy for resected periampullary adenocarcinoma: acceptable toxicity and suggestion of improved 1-year disease-free survival. Int J Radiat Oncol Biol Phys; 2000 Nov 1;48(4):1089-96
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  • [Title] Intensified adjuvant combined modality therapy for resected periampullary adenocarcinoma: acceptable toxicity and suggestion of improved 1-year disease-free survival.
  • PURPOSE:. (1) To determine the toxicity of an intensified postoperative adjuvant regimen for periampullary adenocarcinoma (pancreatic and nonpancreatic) utilizing concurrent 5-fluorouracil (5-FU), leucovorin (LV), dipyridamole (DPM), and mitomycin-C (MMC) combined with split-course locoregional external beam radiotherapy (EBRT) to 50 Gy.
  • This was followed by 4 cycles of the same chemotherapy as adjuvant therapy. (2) To determine preliminary estimates of the overall and disease-free survival associated with the use of this regimen. (3) To compare the toxicities and early survival results of patients treated with the current regimen to those of patients who completed our prior trial of concurrent chemoradiation infusion with 5-FU/LV chemotherapy and regional nodal and prophylactic hepatic irradiation.
  • METHODS: Postpancreaticoduodenectomy, patients received every 4 weeks bolus administration of 5-FU, (400 mg/m(2)), and LV, (20 mg/m(2), Days l-3), DPM (75 mg p.o., 4 times per day, Days 0-3, and every 8 weeks), MMC, (10 mg/m(2); maximum of 20 mg, Day l during EBRT).
  • This was followed by 4 months of the same chemotherapy, beginning 1 month following the completion of EBRT.
  • There were 29 patients with pancreatic cancer and 16 with nonpancreatic periampullary cancer.
  • The mean time to start of treatment was 63 days following surgery.
  • During chemoradiation therapy there were no Grade 3 or worse nonhematologic toxicities and 47% Grade 3 or Grade 4 hematologic toxicities of short duration.
  • Following chemoradiation, during chemotherapy treatment only, there was one Grade 3 hepatic and one Grade 3 pulmonary toxicity which was nondebilitating (2% each case) and 42% Grade 3 or 4 hematologic toxicity.
  • There were 2 episodes of neutropenic fever requiring admission and no treatment-related mortalities.
  • One patient developed a mild case of HUS, which responded to standard management.
  • One patient developed persistent shortness of breath (nondebilitating), and another patient had occasional dyspnea on exertion, both occurring after all therapy.
  • The majority of patients complained of increased fatigue (Grade 1-2), greatest during the combined therapy and improving post all treatment.
  • Early survival analysis suggests a trend toward increased median disease-free survival (8.3 vs. 17 months), especially for patients with nonpancreatic periampullary adenocarcinoma.
  • [MeSH-major] Adenocarcinoma / therapy. Pancreatic Neoplasms / therapy
  • [MeSH-minor] Adult. Aged. Antineoplastic Combined Chemotherapy Protocols / adverse effects. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Chemotherapy, Adjuvant. Dipyridamole / administration & dosage. Dipyridamole / adverse effects. Disease-Free Survival. Duodenal Neoplasms / mortality. Duodenal Neoplasms / pathology. Duodenal Neoplasms / therapy. Female. Fluorouracil / administration & dosage. Fluorouracil / adverse effects. Follow-Up Studies. Humans. Leucovorin / administration & dosage. Leucovorin / adverse effects. Male. Middle Aged. Mitomycin / administration & dosage. Mitomycin / adverse effects. Neoplasm Recurrence, Local. Pancreaticoduodenectomy. Radiotherapy Dosage. Radiotherapy, Adjuvant. Time Factors

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  • (PMID = 11072167.001).
  • [ISSN] 0360-3016
  • [Journal-full-title] International journal of radiation oncology, biology, physics
  • [ISO-abbreviation] Int. J. Radiat. Oncol. Biol. Phys.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] UNITED STATES
  • [Chemical-registry-number] 50SG953SK6 / Mitomycin; 64ALC7F90C / Dipyridamole; Q573I9DVLP / Leucovorin; U3P01618RT / Fluorouracil
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7. Schwarz RE, Smith DD, Keny H, Iklé DN, Shibata SI, Chu DZ, Pezner RD: Impact of intraoperative radiation on postoperative and disease-specific outcome after pancreatoduodenectomy for adenocarcinoma: a propensity score analysis. Am J Clin Oncol; 2003 Feb;26(1):16-21
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  • [Title] Impact of intraoperative radiation on postoperative and disease-specific outcome after pancreatoduodenectomy for adenocarcinoma: a propensity score analysis.
  • For periampullary cancer,intraoperative radiation therapy (IORT) administered to the site with the highest locoregional recurrence risk carries the rationale to improve tumor control.
  • IORT impact on postoperative outcomes after pancreatectomy for adenocarcinoma was analyzed, with a specific attempt to correct for the nonrandom IORT treatment assignment, and to account for treatment group imbalances in the interpretation of outcome differences.
  • A propensity-score-adjusted analysis, based on variable selection by logistic regression, was used to rebalance treatments.
  • Between 1989 and 1999, 61 patients underwent partial or total pancreatectomy for a primary periampullary adenocarcinoma at the City of Hope National Medical Center.
  • Diagnoses included pancreatic (n = 36), duodenal (n = 11), ampullary (n = 10), and bile duct cancer (n = 4).
  • Thirty patients received IORT to the resection area, with a median dose of 15 Gy (range: 10-20), followed by postoperative external beam radiation (n = 24).
  • IORT had no significant impact on hospital stay (overall median: 17 days), disease-free survival (16 months), and overall survival (23 months) when adjusted for those most relevant variables reflecting IORT treatment group assignment propensity.
  • We continue to explore IORT in combination with systemic chemotherapy.
  • [MeSH-major] Adenocarcinoma / radiotherapy. Ampulla of Vater. Bile Duct Neoplasms / radiotherapy. Duodenal Neoplasms / radiotherapy. Pancreatic Neoplasms / radiotherapy. Pancreaticoduodenectomy
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Female. Humans. Intraoperative Period. Male. Middle Aged. Neoplasm Recurrence, Local. Proportional Hazards Models. Radiotherapy, Adjuvant. Retrospective Studies. Survival Analysis. Treatment Outcome

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  • (PMID = 12576918.001).
  • [ISSN] 0277-3732
  • [Journal-full-title] American journal of clinical oncology
  • [ISO-abbreviation] Am. J. Clin. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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8. Lin LL, Picus J, Drebin JA, Linehan DC, Solis J, Strasberg SM, Tan B, Thorstad WL, Myerson R: A phase II study of alternating cycles of split course radiation therapy and gemcitabine chemotherapy for inoperable pancreatic or biliary tract carcinoma. Am J Clin Oncol; 2005 Jun;28(3):234-41
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  • [Title] A phase II study of alternating cycles of split course radiation therapy and gemcitabine chemotherapy for inoperable pancreatic or biliary tract carcinoma.
  • Because of increased toxicity, full doses of gemcitabine and radiation therapy cannot routinely be given concurrently.
  • The purpose of the present study was to determine the toxicity and response to treatment with full-dose gemcitabine given between cycles of split-course radiation therapy (nonconcurrent treatment) for inoperable periampullary adenocarcinoma.
  • Treatment consisted of 3 6 week courses for a total of 18 weeks: 1000 mg/m gemcitabine intravenous bolus once a week x 2 weeks; 1 week break; 2 weeks of radiation therapy (1.8 Gy per fraction); 1 week break x 3.
  • The total dose of radiation consisted of 45 Gy to the tumor + regional nodes followed by a 5.4-Gy boost.
  • Patients were restaged at week 15 and at the completion of all treatment.
  • Alternating cycles of split-course radiotherapy and gemcitabine chemotherapy permits the delivery of full doses of both modalities with acceptable tolerance.
  • Despite the prolongation in radiation treatment time because of split-course treatment, patients with sufficient response were able to undergo resection.
  • [MeSH-major] Antimetabolites, Antineoplastic / therapeutic use. Bile Duct Neoplasms / therapy. Carcinoma / therapy. Deoxycytidine / analogs & derivatives. Dose Fractionation. Gallbladder Neoplasms / therapy. Neoadjuvant Therapy. Pancreatic Neoplasms / therapy. Radiation-Sensitizing Agents / therapeutic use
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Combined Modality Therapy. Disease Progression. Disease-Free Survival. Drug Administration Schedule. Female. Humans. Intestine, Small / radiation effects. Life Tables. Lymphatic Irradiation. Male. Middle Aged. Palliative Care. Pancreaticoduodenectomy. Prospective Studies. Radiation Injuries / etiology. Survival Analysis. Treatment Outcome

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  • (PMID = 15923794.001).
  • [ISSN] 1537-453X
  • [Journal-full-title] American journal of clinical oncology
  • [ISO-abbreviation] Am. J. Clin. Oncol.
  • [Language] eng
  • [Publication-type] Clinical Trial; Clinical Trial, Phase II; Journal Article; Multicenter Study
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antimetabolites, Antineoplastic; 0 / Radiation-Sensitizing Agents; 0W860991D6 / Deoxycytidine; B76N6SBZ8R / gemcitabine
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9. Morak MJ, van der Gaast A, Incrocci L, van Dekken H, Hermans JJ, Jeekel J, Hop WC, Kazemier G, van Eijck CH: Adjuvant intra-arterial chemotherapy and radiotherapy versus surgery alone in resectable pancreatic and periampullary cancer: a prospective randomized controlled trial. Ann Surg; 2008 Dec;248(6):1031-41
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  • [Title] Adjuvant intra-arterial chemotherapy and radiotherapy versus surgery alone in resectable pancreatic and periampullary cancer: a prospective randomized controlled trial.
  • BACKGROUND: Success of surgical treatment for pancreatic and periampullary cancer is often limited due to locoregional recurrence and/or the development of distant metastases.
  • OBJECTIVE: The survival benefit of celiac axis infusion (CAI) and radiotherapy (RT) versus observation after resection of pancreatic or periampullary cancer was investigated.
  • METHODS: In a randomized controlled trial, 120 consecutive patients with histopathologically proven pancreatic or periampullary cancer received either adjuvant treatment consisting of intra-arterial mitoxantrone, 5-FU, leucovorin, and cisplatinum in combination with 30 x 1.8 Gy radiotherapy (group A) or no adjuvant treatment (group B).
  • Groups were stratified for tumor type (pancreatic vs. periampullary tumors).
  • RESULTS: After surgery, 120 patients were randomized (59 patients in the treatment group, 61 in the observation group).
  • Subgroup analysis showed significantly less liver metastases after adjuvant treatment in periampullary tumors (log-rank P < 0.03) without effect on local recurrence.
  • In patients with pancreatic cancer, CAI/RT had no significant effect on local recurrence (log-rank P = 0.12) neither on the development of liver metastases (log-rank P = 0.76) and consequently, no effect on overall survival.
  • CONCLUSION: This adjuvant treatment schedule results in a prolonged time to progression.
  • For periampullary tumors, CAI/RT induced a significant reduction in the development of liver metastases, with a possible effect on overall survival.
  • [MeSH-major] Adenocarcinoma / mortality. Adenocarcinoma / therapy. Ampulla of Vater. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Common Bile Duct Neoplasms / mortality. Common Bile Duct Neoplasms / surgery. Common Bile Duct Neoplasms / therapy. Fluorouracil / administration & dosage. Mitoxantrone / administration & dosage. Pancreatic Neoplasms / mortality. Pancreatic Neoplasms / therapy
  • [MeSH-minor] Adult. Aged. Chemotherapy, Adjuvant. Cycloleucine / administration & dosage. Cycloleucine / analogs & derivatives. Disease Progression. Female. Humans. Infusions, Intra-Arterial. Lead. Male. Middle Aged. Prognosis. Prospective Studies. Radiotherapy, Adjuvant. Sulfides. Treatment Outcome

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  • (PMID = 19092348.001).
  • [ISSN] 1528-1140
  • [Journal-full-title] Annals of surgery
  • [ISO-abbreviation] Ann. Surg.
  • [Language] eng
  • [Publication-type] Journal Article; Randomized Controlled Trial
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Sulfides; 0TQU7668EI / Cycloleucine; 2425D15SYM / lead sulfide; 2P299V784P / Lead; 3814-46-8 / cispentacin; BZ114NVM5P / Mitoxantrone; U3P01618RT / Fluorouracil
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10. Niu GM, Jin DY, Ji Y, Hou J, Wang DS, Lou WH: Survival analysis of pancreatic and periampullary collision cancers. J Dig Dis; 2010 Aug;11(4):231-6
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  • [Title] Survival analysis of pancreatic and periampullary collision cancers.
  • Collision cancers are very rare in the pancreas and periampullary region.
  • The aim of this study was to analyze the clinical and pathological features and prognosis of collision cancer in the pancreas and periampullary region.
  • METHODS: Patients with collision cancers of the pancreas and periampullary region (n= 10) who had undergone radical surgery were retrospectively studied.
  • Their clinical and pathological features were summarized and the prognostic data were compared with patients with pancreatic adenocarcinomas who underwent radical surgery (n= 87) and with patients with pancreatic or periampullary malignancies who underwent palliative surgery (n= 89).
  • RESULTS: Compared with other cancers at these sites, collision cancer presents no specific clinical features.
  • CONCLUSION: Collision cancers of the pancreas and periampullary region are difficult to diagnose preoperatively.
  • Their prognosis is poor even after radical resection and adjuvant chemotherapy were given.
  • [MeSH-major] Adenocarcinoma / pathology. Ampulla of Vater / pathology. Common Bile Duct Neoplasms / pathology. Neoplasms, Multiple Primary / pathology. Pancreatic Neoplasms / pathology
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Antimetabolites, Antineoplastic / therapeutic use. Chemotherapy, Adjuvant. Deoxycytidine / analogs & derivatives. Deoxycytidine / therapeutic use. Female. Humans. Male. Middle Aged. Retrospective Studies. Survival Analysis. Treatment Outcome

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  • (PMID = 20649736.001).
  • [ISSN] 1751-2980
  • [Journal-full-title] Journal of digestive diseases
  • [ISO-abbreviation] J Dig Dis
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Australia
  • [Chemical-registry-number] 0 / Antimetabolites, Antineoplastic; 0W860991D6 / Deoxycytidine; B76N6SBZ8R / gemcitabine
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11. Abrams RA, Yeo CJ: Combined modality adjuvant therapy for resected periampullary pancreatic and nonpancreatic adenocarcinoma: a review of studies and experience at The Johns Hopkins Hospital, 1991-2003. Surg Oncol Clin N Am; 2004 Oct;13(4):621-38, ix
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  • [Title] Combined modality adjuvant therapy for resected periampullary pancreatic and nonpancreatic adenocarcinoma: a review of studies and experience at The Johns Hopkins Hospital, 1991-2003.
  • This article discusses the studies, data, and conclusions generated to date, in some cases preliminarily, for the clinical trials and algorithms the Johns Hopkins team applied to the postoperative adjuvant management of periampullary pancreatic and nonpancreatic periampullary adenocarcinomas during the interval 1991 to 2003.
  • [MeSH-major] Adenocarcinoma / drug therapy. Adenocarcinoma / radiotherapy. Ampulla of Vater / pathology. Pancreatic Neoplasms / drug therapy. Pancreatic Neoplasms / radiotherapy
  • [MeSH-minor] Adult. Aged. Algorithms. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Baltimore. Chemotherapy, Adjuvant. Clinical Trials, Phase I as Topic. Combined Modality Therapy. Female. Hospitals, University. Humans. Male. Middle Aged. Pancreaticoduodenectomy / methods. Prognosis. Radiotherapy Dosage. Radiotherapy, Adjuvant. Risk Assessment. Survival Analysis. Treatment Outcome

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  • (PMID = 15350938.001).
  • [ISSN] 1055-3207
  • [Journal-full-title] Surgical oncology clinics of North America
  • [ISO-abbreviation] Surg. Oncol. Clin. N. Am.
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 39
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12. Stănciulea O, Preda C, Herlea V, Popa M, Ulmeanu D, Vasilescu C: [Rare indication of cephalic duodenopancreatectomy with total gastrectomy--periampullary carcinoma in moderate form of familial adenomatous polyposis]. Chirurgia (Bucur); 2007 Mar-Apr;102(2):215-20
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  • [Title] [Rare indication of cephalic duodenopancreatectomy with total gastrectomy--periampullary carcinoma in moderate form of familial adenomatous polyposis].
  • The histopathological exam revealed duodenal G2 adenocarcinoma pT3N0, and gastric hyperplastic polyps with no signs of dysplasia.
  • The surgical procedure was followed by chemotherapy.
  • In 2005 was noted a pulmonary nodule, located in the postero-apical segment of upper left lobe, for which left superior lobe resection was performed (the histopathological exam: metastatic adenocarcinoma).
  • The surgical procedure recommended in patients with attenuated form of familial adenomatous polyposis and suspect periampullary lesions is duodenopancreatectomy.
  • [MeSH-minor] Ampulla of Vater. Humans. Male. Middle Aged. Stomach Neoplasms / surgery. Treatment Outcome

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  • (PMID = 17615925.001).
  • [ISSN] 1221-9118
  • [Journal-full-title] Chirurgia (Bucharest, Romania : 1990)
  • [ISO-abbreviation] Chirurgia (Bucur)
  • [Language] rum
  • [Publication-type] Case Reports; English Abstract; Journal Article
  • [Publication-country] Romania
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13. Nakakura EK, Bergsland EK: Islet cell carcinoma: neuroendocrine tumors of the pancreas and periampullary region. Hematol Oncol Clin North Am; 2007 Jun;21(3):457-73; viii
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  • [Title] Islet cell carcinoma: neuroendocrine tumors of the pancreas and periampullary region.
  • In contrast with patients who have adenocarcinoma of the pancreas, those who have islet cell carcinomas can achieve long-term survival even if their disease is advanced.
  • Liver-directed therapies, somatostatin analogs, and interferon are not curative but can be used to relieve tumor-associated symptoms.
  • Similarly, palliative chemotherapy has been used with limited success.

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  • (PMID = 17548034.001).
  • [ISSN] 0889-8588
  • [Journal-full-title] Hematology/oncology clinics of North America
  • [ISO-abbreviation] Hematol. Oncol. Clin. North Am.
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 57
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14. Swartz MJ, Hughes MA, Frassica DA, Herman J, Yeo CJ, Riall TS, Lillemoe KD, Cameron JL, Donehower RC, Laheru DA, Hruban RH, Abrams RA: Adjuvant concurrent chemoradiation for node-positive adenocarcinoma of the duodenum. Arch Surg; 2007 Mar;142(3):285-8
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  • [Title] Adjuvant concurrent chemoradiation for node-positive adenocarcinoma of the duodenum.
  • HYPOTHESIS: Adjuvant chemoradiation improves local control and survival in patients with node-positive duodenal adenocarcinoma treated with pancreaticoduodenectomy.
  • PATIENTS: All patients with periampullary carcinoma treated with pancreaticoduodenectomy and adjuvant chemoradiotherapy at The Johns Hopkins Hospital between 1994 and 2003.
  • Fourteen cases of node-positive duodenal adenocarcinoma were identified.
  • Concurrent fluorouracil-based chemotherapy was given with radiation therapy, followed by maintenance chemotherapy.
  • Compared with historical controls treated with surgery alone, patients who received adjuvant chemoradiation therapy had an improved median survival (21 months vs 41 months, respectively).
  • CONCLUSION: Adjuvant chemoradiation therapy after pancreaticoduodenectomy for node-positive duodenal adenocarcinoma may improve local control and median survival but does not impact 5-year overall survival.
  • [MeSH-major] Adenocarcinoma. Antimetabolites, Antineoplastic / therapeutic use. Duodenal Neoplasms. Fluorouracil / therapeutic use
  • [MeSH-minor] Adult. Aged. Chemotherapy, Adjuvant. Female. Follow-Up Studies. Humans. Lymphatic Metastasis. Male. Maryland / epidemiology. Middle Aged. Retrospective Studies. Survival Rate / trends. Time Factors. Treatment Outcome

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  • (PMID = 17372054.001).
  • [ISSN] 0004-0010
  • [Journal-full-title] Archives of surgery (Chicago, Ill. : 1960)
  • [ISO-abbreviation] Arch Surg
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antimetabolites, Antineoplastic; U3P01618RT / Fluorouracil
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15. Nitsche M, Horstmann O, Christiansen H, Hermann RM, Hess CF, Becker H, Pradier O, Schmidberger H: Chemoradioimmunotherapy with 5-fluorouracil, cisplatin and interferon-alpha in pancreatic and periampullary cancer: results of a feasibility study. Cancer Radiother; 2008 Dec;12(8):817-21
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  • [Title] Chemoradioimmunotherapy with 5-fluorouracil, cisplatin and interferon-alpha in pancreatic and periampullary cancer: results of a feasibility study.
  • BACKGROUND: Recent studies give rise to the hypothesis, that adjuvant chemoradioimmunotherapy with 5-fluorouracil (5-FU), cisplatin and interferon-alpha (IFN-alpha) might be a possible new treatment of pancreatic cancer in resected patients.
  • PATIENTS AND METHODS: Eleven patients with histological diagnosis of localized carcinoma of the pancreas (n=7) or periampullary (n=4) were prospectively analyzed.
  • External conformal irradiation to a total dose of 50.4 Gy with 1.8 Gy per day was delivered.
  • All patients received a concomitant chemotherapy with continuous 5-FU 200 mg/m2 per day on 28 treatment days and intravenous bolus cisplatin 30 mg/m2 per week (Day 2, 9, 16, 23, 30).
  • CONCLUSION: Our data strengthens the hypothesis of concomitant chemoradioimmunotherapy with 5-FU, IFN-alpha and cisplatin as a possible new treatment of pancreatic cancer in resected patients.
  • [MeSH-major] Cisplatin / therapeutic use. Fluorouracil / therapeutic use. Pancreatic Neoplasms / drug therapy. Pancreatic Neoplasms / radiotherapy
  • [MeSH-minor] Antineoplastic Agents / therapeutic use. Combined Modality Therapy / adverse effects. Feasibility Studies. Female. Humans. Immunotherapy / methods. Interferon Type I / therapeutic use. Male. Neoplasm Invasiveness. Neoplasm Staging. Patient Selection. Radiotherapy Dosage. Recombinant Proteins. Risk Assessment. Survival Rate

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  • (PMID = 18996727.001).
  • [ISSN] 1278-3218
  • [Journal-full-title] Cancer radiothérapie : journal de la Société française de radiothérapie oncologique
  • [ISO-abbreviation] Cancer Radiother
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] France
  • [Chemical-registry-number] 0 / Antineoplastic Agents; 0 / Interferon Type I; 0 / Recombinant Proteins; Q20Q21Q62J / Cisplatin; U3P01618RT / Fluorouracil
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16. Heinrich S, Clavien PA: Ampullary cancer. Curr Opin Gastroenterol; 2010 May;26(3):280-5
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  • [Title] Ampullary cancer.
  • PURPOSE OF REVIEW: This manuscript reviews the recent literature on ampullary cancer, including new staging definitions, histological characteristics and treatment options.
  • RECENT FINDINGS: Recent publications emphasize the importance of the histological differentiation (intestinal vs. pancreatobiliary), which is one of the most important prognostic factors for ampullary cancer.
  • Also, different mechanisms of cancer development have been described, which might be related to the type of differentiation.
  • Due to the very low risk of lymphatic spread, local resections appear sufficient for well differentiated T1 cancer smaller than 1 cm, whereas larger, less differentiated or more invasive cancer requires a radical resection.
  • As cancer with intestinal differentiation shares a similar biology with colon cancer, and the pancreatobiliary differentiation is close to ductal adenocarcinoma of the pancreas, adjuvant chemotherapy should probably be given according to colon cancer (intestinal) and pancreatic cancer (pancreatobiliary), respectively.
  • SUMMARY: The recent research suggests that the histological differentiation of periampullary cancer is more important than the anatomical location (ampulla).

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  • (PMID = 20168227.001).
  • [ISSN] 1531-7056
  • [Journal-full-title] Current opinion in gastroenterology
  • [ISO-abbreviation] Curr. Opin. Gastroenterol.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't; Review
  • [Publication-country] United States
  • [Number-of-references] 43
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17. Bogoevski D, Chayeb H, Cataldegirmen G, Schurr PG, Kaifi JT, Mann O, Yekebas EF, Izbicki JR: Nodal microinvolvement in patients with carcinoma of the papilla of vater receiving no adjuvant chemotherapy. J Gastrointest Surg; 2008 Nov;12(11):1830-7; discussion 1837-8
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  • [Title] Nodal microinvolvement in patients with carcinoma of the papilla of vater receiving no adjuvant chemotherapy.
  • METHODS: From 1993 to 2003 at the University Clinic Hamburg, 777 patients were operated upon pancreatic and periampullary carcinomas.
  • The vast majority of patients were operated upon pancreatic ductal adenocarcinoma (n = 566, 73%), followed by carcinomas of the papilla of Vater (n = 112, 14%), pancreatic neuroendocrine carcinomas (n = 39, 5%), intraductal papillary mucinous neoplasms (n = 33, 4%), and distal bile duct carcinomas (n = 27, 3%).
  • Fresh-frozen tissue sections from 169 lymph nodes (LNs) classified as tumor free by routine histopathology from 57 patients with R0 resected carcinoma of the papilla of Vater who had been spared from adjuvant chemotherapy were immunohistochemically (IHC) examined, using a sensitive IHC assay with the anti-epithelial monoclonal antibody Ber-EP4 for tumor cell detection.
  • [MeSH-major] Adenocarcinoma / secondary. Adenocarcinoma / surgery. Ampulla of Vater / pathology. Common Bile Duct Neoplasms / pathology. Common Bile Duct Neoplasms / surgery. Lymph Nodes / pathology
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Biopsy, Needle. Chemotherapy, Adjuvant. Cohort Studies. Female. Humans. Immunohistochemistry. Kaplan-Meier Estimate. Lymph Node Excision. Lymphatic Metastasis. Male. Middle Aged. Multivariate Analysis. Neoplasm Staging. Pancreatic Neoplasms / drug therapy. Pancreatic Neoplasms / mortality. Pancreatic Neoplasms / pathology. Pancreatic Neoplasms / surgery. Probability. Prognosis. Proportional Hazards Models. Retrospective Studies. Risk Assessment. Statistics, Nonparametric. Survival Analysis. Treatment Outcome

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  • (PMID = 18791769.001).
  • [ISSN] 1873-4626
  • [Journal-full-title] Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
  • [ISO-abbreviation] J. Gastrointest. Surg.
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article
  • [Publication-country] United States
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18. Gerke H, White R, Byrne MF, Stiffier H, Mitchell RM, Hurwitz HI, Morse MA, Branch MS, Jowell PS, Czito B, Clary B, Pappas TN, Tyler DS, Baillie J: Complications of pancreaticoduodenectomy after neoadjuvant chemoradiation in patients with and without preoperative biliary drainage. Dig Liver Dis; 2004 Jun;36(6):412-8
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  • AIMS: The aim of this study was to assess complications related to biliary stents/drains and postoperative morbidity in patients undergoing neoadjuvant chemoradiotherapy for periampullary cancer.
  • PATIENTS: One hundred and eighty-four patients with periampullary neoplasms were prospectively selected for neoadjuvant external beam radiation therapy and 5-fluorouracil-based chemotherapy between 1995 and 2002.
  • [MeSH-major] Drainage. Pancreatic Neoplasms / therapy. Pancreaticoduodenectomy / adverse effects
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Ampulla of Vater. Antimetabolites, Antineoplastic / therapeutic use. Bile. Chemotherapy, Adjuvant. Endoscopy, Digestive System. Female. Fluorouracil / therapeutic use. Humans. Jaundice, Obstructive / etiology. Jaundice, Obstructive / therapy. Male. Middle Aged. Neoadjuvant Therapy. Preoperative Care. Prospective Studies. Radiotherapy, Adjuvant. Retrospective Studies. Stents

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  • (PMID = 15248382.001).
  • [ISSN] 1590-8658
  • [Journal-full-title] Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
  • [ISO-abbreviation] Dig Liver Dis
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] Netherlands
  • [Chemical-registry-number] 0 / Antimetabolites, Antineoplastic; U3P01618RT / Fluorouracil
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19. Bassi C, Falconi M, Salvia R, Caldiron E, Butturini G, Pederzoli P: Role of octreotide in the treatment of external pancreatic pure fistulas: a single-institution prospective experience. Langenbecks Arch Surg; 2000 Jan;385(1):10-3
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  • [Title] Role of octreotide in the treatment of external pancreatic pure fistulas: a single-institution prospective experience.
  • INTRODUCTION: Octreotide was studied in the treatment of pure external pancreatic fistulas.
  • Six patients (four after radical surgery for periampullary cancer, one endocrine tumor enucleation and one pancreojejunostomy in chronic pancreatitis) were treated as outpatients with octreotide alone because of low basal fistula output (mean+/-SD: 96.6+/-27.4 cc/24 h).
  • Twelve (five radical surgery for cancer, five surgery for severe pancreatitis, one enucleation and one pancreojejunostomy) were treated as inpatients with octreotide plus total parenteral nutrition because of the high output (mean+/-SD: 448.4+/-248.2 cc/24 h).
  • CONCLUSION: Octreotide appears useful in the treatment of external pancreatic fistulas.

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  • (PMID = 10664113.001).
  • [ISSN] 1435-2443
  • [Journal-full-title] Langenbeck's archives of surgery
  • [ISO-abbreviation] Langenbecks Arch Surg
  • [Language] ENG
  • [Publication-type] Journal Article
  • [Publication-country] Germany
  • [Chemical-registry-number] 0 / Hormones; RWM8CCW8GP / Octreotide
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20. Chang MC, Chang YT, Sun CT, Chiu YF, Lin JT, Tien YW: Differential expressions of cyclin D1 associated with better prognosis of cancers of ampulla of Vater. World J Surg; 2007 May;31(5):1135-41
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  • BACKGROUND: Periampullary cancers, the incidence of which increases gradually with industrialization, still pose a significant challenge to clinicians and researchers.
  • METHODS: Tissue samples were obtained from patients with periampullary cancers who underwent surgery at the National Taiwan University Hospital without receiving previous chemotherapy or radiation therapy.
  • All periampullary cancer tissue samples were examined by a pathologist, who was unaware of the parameters to be investigated.
  • A total of 68 patients with periampullary cancers (29 ampulla of Vater cancers (AVCs) and 39 pancreatic ductal cancers (PDCs), including various stages and histological subtypes, were enrolled.

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  • (PMID = 17420962.001).
  • [ISSN] 0364-2313
  • [Journal-full-title] World journal of surgery
  • [ISO-abbreviation] World J Surg
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Biomarkers, Tumor; 136601-57-5 / Cyclin D1
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21. Pisters PW, Hudec WA, Lee JE, Raijman I, Lahoti S, Janjan NA, Rich TA, Crane CH, Lenzi R, Wolff RA, Abbruzzese JL, Evans DB: Preoperative chemoradiation for patients with pancreatic cancer: toxicity of endobiliary stents. J Clin Oncol; 2000 Feb;18(4):860-7
Hazardous Substances Data Bank. FLUOROURACIL .

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Preoperative chemoradiation for patients with pancreatic cancer: toxicity of endobiliary stents.
  • PURPOSE: A recent multicenter study of preoperative chemoradiation and pancreaticoduodenectomy for localized pancreatic adenocarcinoma suggested that biliary stent-related complications are frequent and severe and may prevent the delivery of all components of multimodality therapy in many patients.
  • The present study was designed to evaluate the rates of hepatic toxicity and biliary stent-related complications and to evaluate the impact of this morbidity on the delivery of preoperative chemoradiation for pancreatic cancer at a tertiary care cancer center.
  • PATIENTS AND METHODS: Preoperative chemoradiation was used in 154 patients with resectable pancreatic adenocarcinoma (142 patients, 92%) or other periampullary tumors (12 patients, 8%).
  • Patients were treated with preoperative fluorouracil (115 patients), paclitaxel (37 patients), or gemcitabine (two patients) plus concurrent rapid-fractionation (30 Gy; 123 patients) or standard-fractionation (50.4 Gy; 31 patients) radiation therapy.
  • CONCLUSION: Preoperative chemoradiation for pancreatic cancer is associated with low rates of hepatic toxicity and biliary stent-related complications.
  • The need for biliary decompression is not a clinically significant concern in the delivery of preoperative therapy to patients with localized pancreatic cancer.
  • [MeSH-major] Adenocarcinoma / surgery. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Bile Ducts / pathology. Neoadjuvant Therapy. Pancreatic Neoplasms / surgery. Pancreaticoduodenectomy. Stents / adverse effects
  • [MeSH-minor] Adult. Aged. Aged, 80 and over. Ampulla of Vater. Antimetabolites, Antineoplastic / administration & dosage. Antineoplastic Agents, Phytogenic / administration & dosage. Common Bile Duct Neoplasms / drug therapy. Common Bile Duct Neoplasms / radiotherapy. Common Bile Duct Neoplasms / surgery. Deoxycytidine / administration & dosage. Deoxycytidine / analogs & derivatives. Female. Fluorouracil / administration & dosage. Follow-Up Studies. Hospitalization. Humans. Incidence. Liver / drug effects. Liver / radiation effects. Male. Middle Aged. Paclitaxel / administration & dosage. Radiotherapy Dosage. Retrospective Studies

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  • (PMID = 10673529.001).
  • [ISSN] 0732-183X
  • [Journal-full-title] Journal of clinical oncology : official journal of the American Society of Clinical Oncology
  • [ISO-abbreviation] J. Clin. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Antimetabolites, Antineoplastic; 0 / Antineoplastic Agents, Phytogenic; 0W860991D6 / Deoxycytidine; B76N6SBZ8R / gemcitabine; P88XT4IS4D / Paclitaxel; U3P01618RT / Fluorouracil
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22. Jarnagin WR, Shoup M: Surgical management of cholangiocarcinoma. Semin Liver Dis; 2004 May;24(2):189-99
MedlinePlus Health Information. consumer health - Bile Duct Cancer.

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  • Biliary tract cancer affects approximately 7500 Americans each year.
  • Complete resection remains the most effective and only potentially curative therapy for cholangiocarcinoma.
  • Distal cholangiocarcinomas, on the other hand, are treated like all periampullary malignancies and typically require pancreaticoduodenectomy.
  • Most patients with cholangiocarcinoma present with advanced disease that is not amenable to surgical treatment, and even with a complete resection, recurrence rates are high.
  • Adjuvant therapy (chemotherapy and radiation therapy) has not been shown clearly to reduce recurrence risk.
  • [MeSH-minor] Adenocarcinoma / diagnosis. Adenocarcinoma / surgery. Bile Ducts, Extrahepatic / surgery. Bile Ducts, Intrahepatic / surgery. Hepatectomy. Humans. Neoplasm Staging. Palliative Care

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  • (PMID = 15192791.001).
  • [ISSN] 0272-8087
  • [Journal-full-title] Seminars in liver disease
  • [ISO-abbreviation] Semin. Liver Dis.
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 68
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23. Sonkar AA, Poston GJ: Adjuvant therapy following surgery for periampullary and pancreatic cancers. Eur J Surg Oncol; 2004 Nov;30(9):911-2
MedlinePlus Health Information. consumer health - Pancreatic Cancer.

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Adjuvant therapy following surgery for periampullary and pancreatic cancers.
  • [MeSH-major] Adenocarcinoma / drug therapy. Adenocarcinoma / radiotherapy. Pancreatic Neoplasms / drug therapy. Pancreatic Neoplasms / radiotherapy
  • [MeSH-minor] Ampulla of Vater / pathology. Chemotherapy, Adjuvant. Humans. Pancreaticoduodenectomy. Radiotherapy, Adjuvant

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  • (PMID = 15498632.001).
  • [ISSN] 0748-7983
  • [Journal-full-title] European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
  • [ISO-abbreviation] Eur J Surg Oncol
  • [Language] eng
  • [Publication-type] Editorial
  • [Publication-country] England
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24. Barreto SG, Ramadwar MR, Shukla PJ, Shrikhande SV: Vitamin D3 in operable periampullary and pancreatic cancer: perioperative outcomes in a pilot study assessing safety. Pancreas; 2008 Apr;36(3):315-7
Hazardous Substances Data Bank. CALCIUM, ELEMENTAL .

  • [Source] The source of this record is MEDLINE®, a database of the U.S. National Library of Medicine.
  • [Title] Vitamin D3 in operable periampullary and pancreatic cancer: perioperative outcomes in a pilot study assessing safety.
  • [MeSH-major] Cholecalciferol / therapeutic use. Common Bile Duct Neoplasms / drug therapy. Pancreatic Neoplasms / drug therapy
  • [MeSH-minor] Adenocarcinoma / blood. Adenocarcinoma / drug therapy. Adenocarcinoma / surgery. Calcium / blood. Cholangiocarcinoma / blood. Cholangiocarcinoma / drug therapy. Cholangiocarcinoma / surgery. Humans. Pancreaticoduodenectomy. Pilot Projects. Prospective Studies. Safety

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  • (PMID = 18362848.001).
  • [ISSN] 1536-4828
  • [Journal-full-title] Pancreas
  • [ISO-abbreviation] Pancreas
  • [Language] eng
  • [Publication-type] Letter
  • [Publication-country] United States
  • [Chemical-registry-number] 1C6V77QF41 / Cholecalciferol; SY7Q814VUP / Calcium
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