review of literature on clinical pancreatology - The Pancreapedia

interval 0.80 to 0.96]. On subgroup analysis, only stage IIB (T1-3N1) patients enjoyed astatistically significant benefit associated with radiotherapy (hazaed ratio, 0.70; 95 %confidence interval 0.62 to 0.79). Although radiotherapy is associated with a survival benefitfor nonmetastatic patients as a whole, this trend appears to predominantly derive from asurvival benefit in patients with stage IIB disease [532].Adjuvants among elderlyIt was conducted a population-based study to describe the utilization, determinants, andsurvival effects <strong>of</strong> adjuvant therapies after surgery among older patients with pancreaticcancer. Using Surveillance, Epidemiology, and End Results-Medicare data, it was identifiedpatients older than 65 years who received surgical resection for pancreatic cancer during1992-2002. Approximately 49 percent <strong>of</strong> patients received adjuvant therapy after surgery.Patient factors associated with increased receipt <strong>of</strong> adjuvant therapy included more recentdiagnosis, younger age, stage II disease, higher income, and geographic location. Hospitalfactors associated with increased receipt <strong>of</strong> adjuvant therapy included cooperative groupmembership and larger size. Adjuvant treatments associated with a significant reduction in 2-year mortality (relative to surgery alone) were chemoradiation or radiation alone but notchemotherapy alone. The findings suggest that adjuvant chemoradiation and, to a lesserdegree, radiation only are associated with a reduction in the risk <strong>of</strong> mortality among olderpatients who undergo surgery for pancreatic cancer. However, receipt <strong>of</strong> adjuvant therapyvaried by period and geography as well as by certain patient and hospital factors [533].Palliative cytotoxic treatmentEvaluation <strong>of</strong> effectsA study was conducted to assess changes in tumor vascularity using contrast-enhancedultrasonography in patients with pancreatic carcinoma under systemic chemotherapy and toexamine the correlation among vascular change, clinicopathologic factors, and outcome.Forty-one consecutive patients with histopathologically confirmed pancreatic carcinoma whohad distant metastases and were under systemic chemotherapy were recruited. Contrastenhancedultrasonography was performed before and after 1 and 2 cycles <strong>of</strong> treatment.Thevascular signals from the tumor were continuously recorded,and the highest signal intensitywas selected and classified into 5 categories by their intensity. As for the tumor responsedetermined by dynamic computed tomography after 2 cycles, 6 patients showed a partialresponse, 25 remained stable, and in 10 patients, the disease progressed. A significantrelationship was observed between vascular change after 1 cycle and tumor response.Progression-free survival and overall survival were significantly short in the case <strong>of</strong> patientsshowing increased vascularity after 1 and 2 cycles <strong>of</strong> chemotherapy, compared with thosewho did not. It was concluded that contrast-enhanced ultrasonography was useful toevaluate tumor vascular changes and thereby the effect <strong>of</strong> systemic chemotherapy, as wellas the prognosis <strong>of</strong> patients with advanced pancreatic carcinoma [534].GemcitabineGemcitabine is an anti-cancer drug known to be safe and effective for pancreatic or biliarytract cancers, but lung injury is also known to be a rare side effect that sometimes becomessevere. It was report seven cases <strong>of</strong> lung injury during gemcitabine treatment. Drug-inducedlung injury was suspected in all cases. The male : female ratio was 5:2, and the averagepatient age was 71. Four had pancreatic cancers and three had biliary tract cancers.Gemcitabine had been administered an average 5.9 times at a dose <strong>of</strong> 1141 mg. Patientsshowed a diffuse or patchy shadow mainly in the lower lung on computed tomographyexamination. Grades <strong>of</strong> adverse events were greater than 3 in all cases. Three patients died<strong>of</strong> the lung injury. Five cases had pulmonary emphysema, 2 had metastatic lung tumor asunderlying pulmonary lesions, and these were assumed to have been important risk factorsfor drug-induced interstitial lung injury during gemcitabine treatment [535].