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| 1 | Neoadjuvant therapy for pancreas cancer: Past lessons and future therapies显示文摘Pancreatic adenocarcinoma remains a most deadly malignancy, with an overall 5-year survival of 5%. A subset of patients will be diagnosed with potentially resectable disease, and while complete surgical resection provides the only chance at cure, data from trials of postoperative chemoradiation and/or chemotherapy demonstrate a modest survival advantage over those patients who undergo resection alone. As such, most practitioners believe that completion of multimodality therapy is the optimal treatment. However, the sequence of surgery, chemotherapy and radiation therapy is frequently debated, as patients may benefit from a neoadjuvant approach by initiating chemotherapy and/or chemoradiation prior to resection. Here we review the rationale for neoadjuvant therapy, which includes a higher rate of completion of multimodality therapy, minimizing the risk of unnecessary surgical resection for patients who develop early metastatic disease, improved surgical outcomes and the potential for longer overall survival. However, there are no prospective, randomized studies of the neoadjuvant approach compared to a surgeryfirst strategy; the established and ongoing investigations of neoadjuvant therapy for pancreatic cancer are discussed in detail. Lastly, as the future of therapeutic regimens is likely to entail patient-specific genetic and molecular analyses, and the treatment that is best applied based on those data, a review of clinically relevant biomarkers in pancreatic cancer is also presented. | Jeffrey M Sutton Daniel E Abbott | 2014 | World Journal of Gastroenterology2014，20，42： | 5 |
| 2 | Neoadjuvant strategies for pancreatic cancer显示文摘Pancreatic cancer(PC)is the fourth cause of cancer death in Western countries,the only chance for long term survival is an R0 surgical resection that is feasible in about 10%-20%of all cases.Five years cumulative survival is less than 5%and rises to 25%for radically resected patients.About 40%has locally advanced in PC either borderline resectable(BRPC)or unresectable locally advanced(LAPC).Since LAPC and BRPC have been recognized as a particular form of PC neoadjuvant therapy(NT)has increasingly became a valid treatment option.The aim of NT is to reach local control of disease but,also,it is recognized to convert about40%of LAPC patients to R0 resectability,thus providing a significant improvement of prognosis for responding patients.Once R0 resection is achieved,survival is comparable to that of early stage PCs treated by upfront surgery.Thus it is crucial to look for a proper patient selection.Neoadjuvant strategies are multiples and include neoadjuvant chemotherapy(nCT),and the association of nCT with radiotherapy(nCRT)given as either a combination of a radio sensitizing drug as gemcitabine or capecitabine or and concomitant irradiation or as upfront nCT followed by nRT associated to a radio sensitizing drug.This latter seem to be most promising as it may select patients who do not go on disease progression during initial treatment and seem to have a better prognosis.The clinical relevance of nCRT may be enhanced by the application of higher active protocols as FOLFIRINOX. | Francesco Polistina Giuseppe Di Natale Giorgio Bonciarelli Giovanni Ambrosino Mauro Frego | 2014 | World Journal of Gastroenterology2014，20，28： | 3 |
| 3 | Pancreatic cancer-improved care achievable显示文摘Pancreatic adenocarcinoma is one of the most aggressive cancers,and the decline in mortality observed in most other cancer diseases,has so far not taken place in pancreatic cancer.Complete tumor resection is a requirement for potential cure,and the reorganization of care in the direction of high patient-volume centers,offering multimodal treatment,has improved survival and Quality of Life.Also the rates and severity grade of complications are improving in high-volume pancreatic centers.One of the major problems worldwide is underutilization of surgery in resectable pancreatic cancer.Suboptimal investigation,follow up and oncological treatment outside specialized centers are additional key problems.New chemotherapeutic regimens like FOLFIRINOX have improved survival in patients with metastatic disease,and different adjuvant treatment options result in well documented survival benefit.Neoadjuvant treatment is highly relevant,but needs further evaluation.Also adjuvant immunotherapy,in the form of vaccination with synthetic K-Ras-peptides,has been shown to produce long term immunological memory in cytotoxic T-cells in long term survivors.Improvement in clinical outcome is already achievable and further progress is expected in the near future for patients treated with curative as well as palliative intention. | Trond A Buanes | 2014 | World Journal of Gastroenterology2014，20，30： | 0 |
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