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Pancreatic cancer–palliative therapy: stenting

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The Chinese-German Journal of Clinical Oncology 2007年第2期6卷 138-141页

作者： U. Wahnschaffe M. Kraft S. Turi M. M. Lerch Department of Gastroenterology Endocrinology and Nutrition Ernst-Moritz-Arndt-University GreifswaldFriedrich-Loeffler-Strasse 23a 17475 Greifswald Germany

Pancreatic cancer remains a common and very lethal malignancy with a median survival of approximately 6 months. Surgical resection offers the only potentially curative approach but many patients (80% or more) are ineligible for this kind of therapy, because of age, comorbidities, or locally advanced or metastatic disease that does not benefit from resection. Thus, for many patients with pancreatic cancer treatment remains palliative and endoscopic therapy to relieve bile duct or gastric outlet obstruction becomes of special importance. Although both surgical and non surgical palliative procedures can relieve biliary and duodenal obstruction particularly endoscopic treatment with plastic prostheses or self expanding metal stents was shown to be not only highly effective but also to be burdened with only few complications. The present article summarizes the palliative endoscopic treatment in patients with non resectable pancreatic cancer.

关键词： pancreatic cancer palliative therapy stenting

Management of stage Ⅳ rectal cancer: palliative options

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World Journal of Gastroenterology 2011年第7期17卷 835-847页

作者： Sean M Ronnekleiv-Kelly Gregory D Kennedy Department of Surgery Section of Colon and Rectal Surgery University of Wisconsin School of Medicine and Public Health 600 HighlandAvenue G4/701A CSC Madison WI 53792 United States

Approximately 30% of patients with rectal cancer present with metastatic disease. Many of these patients have symptoms of bleeding or obstruction. Several treatment options are available to deal with the various complications that may afflict these patients. Endorectal stenting, laser ablation, and operative resection are a few of the options available to the patient with a malignant large bowel obstruction. A thorough understanding of treatment options will ensure the patient is offered the most effective therapy with the least amount of associated morbidity. In this review, we describe various options for palliation of symptoms in patients with metastatic rectal cancer. Additionally, we briefly discuss treatment for asymptomatic patients with metastatic disease.

关键词： palliative therapy Rectal cancer Malignant bleeding Malignant obstruction Endorectal stenting Laser ablation

Recent developments in palliative chemotherapy for locally advanced and metastatic pancreas cancer

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World Journal of Gastroenterology 2010年第6期16卷 673-682页

作者： Soley Bayraktar Ulas Darda Bayraktar Caio Max Rocha-Lima Division of Hematology/Oncology Sylvester Comprehensive Cancer CenterUniversity of Miami

In spite of advances made in the management of the other more common cancers of the gastrointestinal tract,significant progress in the treatment of pancreatic cancer remains *** as many deaths occur from pancreatic cancer as are diagnosed each year reflecting the poor prognosis typically associated with this *** recently,the only treatment with an impact on survival was *** the palliative setting,gemcitabine(Gem) has been a standard treatment for advanced pancreatic cancer since it was shown a decade ago to result in a superior clinical benefit response and survival compared with bolus *** then,clinical trials have explored the pharmacokinetic modulation of Gem by fixed dose administration and the combination of Gem with other cytotoxic or the biologically"targeted"***,promising trial results in small phaseⅡtrials have not translated into survival improvements in larger phaseⅢrandomized trials in the advanced disease *** trials have recently reported modest survival improvements with the use of combination treatment with Gem and capecitabine(United Kingdom National Cancer Research GEMCAP trial) or erlotinib(National Cancer Institute of CanadaClinical Trials Group PA.3 trial) .This review will focus on the use of systemic therapy for advanced and metastatic pancreatic cancer,summarizing the results of several recent clinical trials and discuss their implications for clinical *** will also discuss briefly the second-line chemotherapy options for advanced pancreatic cancer.

关键词： Adjuvant therapy Chemotherapy palliative therapy Pancreas cancer Radiotherapy

palliative surgery for hilar cholangiocarcinoma

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Hepatobiliary & Pancreatic Diseases International 2003年第1期2卷 110-113页

作者： Hai-Min Li Ke-Feng Dou Kai Sun Zhi-Qing Gao Kai-Zong Li You-Chi Fu the Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China Department of Hepatobiliary Surgery Xijing Hospital Fourth Military Medical University Xi'an 710032 China. lihaim@***

OBJECTIVE: To evaluate the results of palliative surgical treatment of hilar cholangiocarcinoma in terms of quality of life, survival period and cholangitis rate. MFTHODS: The clinical data on 232 patients with hilar cholangiocarcinoma in the last 22 years were analyzed retrospectively. palliative operations included extrahepatic or intrahepatie choledochojejunostomy (123 patients), bridge internal drainage (15), endoscopic biliary drainage (49), percutaneous transhepatic biliary drainage or celiotomy biliary drainage (29), and exploratory celiotomy external drainage (16). RESULTS: In this series, the operative mortality rate was 9.1%, and no significant difference was observed between groups. The rate of cholangitis after operation was significantly lower in Roux-en-Y choledochojejunostomy group (16.2%) and bridge internal drainage group (15.4%) than in internal drainage group (35.5%, Ppalliative operation. The use of U-tube is recommended for internal radiation therapy.

关键词： cholangiocarcinoma surgeru palliative therapy percutaneous transheptic biliary drainage endoscopic retrograde biliary drainage Roux-en-Y choledochojejunostomy

Developments in metastatic pancreatic cancer:Is gemcitabine still the standard?

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World Journal of Gastroenterology 2012年第8期18卷 736-745页

作者： Jie-Er Ying Li-Ming Zhu Bi-Xia Liu Department of Medical Ontology Zhejiang Cancer HospitalHangzhou 310022Zhejiang ProvinceChina

In the past 15 years, we have seen few therapeutic advances for patients with pancreatic cancer, which is the fourth leading cause of cancer-related death in the United States. Currently, only about 6% of patients with advanced disease respond to standard gemcitabine therapy, and median survival is only about 6 mo. Moreover, phase Ⅲ trials have shown that adding various cytotoxic and targeted chemotherapeutic agents to gemcitabine has failed to improve overall survival, except in cases in which gemcitabine combined with erlotinib show minimal survival benefi t. Several metaanalyses have shown that the combination of gemcitabine with either a platinum analog or capecitabine may lead to clinically relevant survival prolongation, especially for patients with good performance status. Meanwhile, many studies have focused on the pharmacokinetic modulation of gemcitabine by fi xed-dose administration, and metabolic or transport enzymes related to the response and toxicity of gemcitabine. Strikingly, a phase Ⅲ trial in 2010 showed that, in comparison to gemcitabine alone, the FOLFIRINOX regimen in patients with advanced disease and good performance status, produced better median overall survival, median progression-free survival, and objective response rates. This regimen also resulted in greater, albeit manageable toxicity.

关键词： Chemotherapy palliative therapy Metasta-sis Biomarkers Pancreatic neoplasms

Complete response to radiation therapy of orbital metastasis from hepatocellular carcinoma

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World Journal of Gastroenterology 2009年第47期15卷 6000-6003页

作者： Allison M Quick Mark Bloomston Edward Y Kim Nathan C Hall Nina A Mayr Department of Radiation Medicine Arthur G.James Cancer HospitalThe Ohio State University Medical CenterColumbusOH 43210 United States Department of Surgical Oncology The Ohio State University Medical CenterColumbusOH 43210 United States Department of Radiology The Ohio State University Medical CenterColumbusOH 43210United States

The incidence of hepatocellular carcinoma(HCC)is increasing in the United States,and 50%-75%o patients with HCC will develop metastatic disease Orbital metastases from HCC are extremely *** report the case of a 52-year-old male with known metastatic HCC,who presented with severe proptosis and *** orbital mass was identified on magnetic resonance imaging(MRI)and confirmed to have hypermetabolic activity on positron emission tomography/computed *** received a palliative course of external beam radiation therapy to the right *** modulated radiation therapy (IMRT)was used to allow sparing of critical norma tissues in close proximity to the *** month after completion of IMRT to 58 Gray in 30 fractions delivered over 6 wk,the patient had a complete clinical,radiologic(MRI)and symptomatic response The patient continues to have local control in the orbi 1.7 years after therapy *** critical norma structures were kept below the tolerance dose using IMRT,and no toxicities were observed.

关键词： Hepatocellular carcinoma Eye neoplasms Metastasis Intensity modulated radiation therapy palliative therapy

Endoscopic pancreatic duct stenting for pain palliation in selected pancreatic cancer patients:a systematic review and meta-analysis

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Gastroenterology Report 2021年第2期9卷 105-114,I0001页

作者： Pradeep K.Siddappa Fadi Hawa Larry J.Prokop MHassan Murad Barham K.Abu Dayyeh Vinay Chandrasekhara Mark D.Topazian Fateh Bazerbachi Division of Gastroenterology and Hepatology Stanford University School of MedicineStanfordCAUSA Department of Internal Medicine St.Joseph Mercy Ann Arbor HospitalYpsilantiMIUSA Library Public Services Mayo ClinicRochesterMNUSA Robert D and Patricia E Kern Center for the Science of Health Care Delivery Mayo ClinicRochesterMNUSA Division of Gastroenterology and Hepatology Mayo ClinicRochesterMNUSA Division of Gastroenterology Massachusetts General Hospital and Harvard Medical SchoolBostonMAUSA

Background Abdominal pain is a debilitating symptom affecting-80%of pancreatic cancer(PC)*** duct(PD)decompression has been reported to alleviate this pain,although this practice has not been widely *** aimed to evaluate the role,efficacy,and safety of endoscopic PD decompression for palliation of PC post-prandial obstructive-type *** A systematic review until 7 October 2020 was *** independent reviewers selected studies,extracted data,and assessed the methodological *** We identified 12 publications with a total of 192 patients with PC presenting with abdominal pain,in whom PD decompression was attempted,and was successful in 167 patients(mean age 62.5 years,58.7%males).The use of plastic stents was reported in 159 patients(95.2%).All included studies reported partial or complete improvement in pain levels after PD stenting,with an improvement rate of 93%(95%confidence interval,79%-100%).The mean duration of pain improvement was 94616 *** retrograde cholangiopancreatography(ERCP)-related adverse events(AEs)were postsphincterotomy bleeding(1.8%),post-ERCP pancreatitis(0.6%),and hemosuccus pancreaticus(0.6%).AEs were not reported in two patients who underwent endoscopic ultrasound-guided PD *** the 167 patients with technical success,the stent-migration and stent-occlusion rates were 3.6%and 3.0%,*** AE-related mortality was *** methodological quality assessment showed the majority of the studies having low or unclear *** In this exploratory analysis,endoscopic PD drainage may be an effective and safe option in selected patients for the management of obstructive-type PC ***,a randomized–controlled trial is needed to delineate the role of this invasive practice.

关键词： cancer-associated pain Endoscopic retrograde cholangiopancreatography palliative therapy pancreas cancer systematic review meta-analysis

Cryotherapy in the management of premalignant and malignant conditions of the esophagus

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World Journal of Gastroenterology 2018年第43期24卷 4862-4869页

作者： Pooja Lal Prashanthi N Thota Department of Internal Medicine Cleveland Clinic Department of Gastroenterology Digestive Disease Surgery InstituteCleveland Clinic

Endoscopic cryotherapy is a relatively new thermal ablative modality used for the treatment of neoplastic lesions of the esophagus. It relies on cycles of rapid cooling and thawing to induce tissue destruction with a cryogen(liquid nitrogen or carbon dioxide) leading to intra and extra-cellular damage. Surgical treatment was once considered the standard therapeutic intervention for neoplastic diseases of the esophagus and is associated with considerable rates of morbidity and mortality. Several trials that evaluated cryotherapy in Barrett's esophagus(BE) associated neoplasia showed reasonable efficacy rates and safety profile. Cryotherapy has also found applications in the treatment of esophageal cancer, both for curative and palliative intent. Cryotherapy has also shown promising results as salvage therapy in cases refractory to radiofrequency ablation treatment. Cryoballoon focal ablation using liquid nitrogen is a novel mode of cryogen delivery which has been used for the treatment of BE with dysplasia and squamous cell carcinoma. Most common side effects of cryotherapy reported in the literature include mild chest discomfort, esophageal strictures and bleeding. In conclusion, cryotherapy is an effective and safe method for the treatment of esophageal neoplastic processes, ranging from early stages of low grade dysplasia to esophageal cancer.

关键词： Esophageal cancer Barrett's esophagus palliative therapy Cryotherapy

palliative external-beam radiotherapy for bone metastases from hepatocellular carcinoma

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World Journal of Hepatology 2014年第12期6卷 923-929页

作者： Shinya Hayashi Hidekazu Tanaka Hiroaki Hoshi Department of Radiology Gifu University Hospital Gifu 501-1194 Japan

The incidence of bone metastases(BMs)from hepatocellular carcinoma(HCC)is relatively low compared to those of other cancers,but it has increased recently,especially in Asian ***,BMs from HCC appear radiologically as osteolytic,destructive,and expansive components with large,bulky soft-tissue *** soft-tissue masses are unique to bone metastases from HCC and often replace the normal bone matrix and exhibit expansive *** often compress the peripheral nerves,spinal cord,or cranial nerves,causing not only bone pain but also neuropathic pain and neurological *** patients with spinal BMs,the consequent metastatic spinal cord compression(MSCC)causes *** base metastases(SBMs)with cranial nerve involvement can cause neurological ***,patients with bony lesions often suffer from pain or neurological symptoms that have a severe,adverse effect on the quality of ***-beam radiotherapy(EBRT)can effectively relieve bone pain and neurological symptoms caused by ***,EBRT is not yet widely used for the palliative management of BMs from HCC because of the limited number of relevant ***,the optimal dosing schedule remains unclear,despite clinical evidence to support single-fraction ra-diation schedules for primary *** this review,we outline data describing palliative EBRT for BMs from HCC in the context of(1)bone pain;(2)MSCC;and(3)SBMs.

关键词： Hepatocellular carcinoma Metastasis Radiotherapy palliative therapy Spinal cord compression Skull base metastasis