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Pancreatic Neoplasms: HELP
Articles from Paris area
Based on 482 articles published since 2008
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These are the 482 published articles about Pancreatic Neoplasms that originated from Paris area during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7 · 8 · 9 · 10 · 11 · 12 · 13 · 14 · 15 · 16 · 17 · 18 · 19 · 20
1 Guideline [Radiation therapy of pancreatic cancer]. 2016

Huguet, F / Mornex, F / Orthuon, A. ·Service d'oncologie radiothérapie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France. Electronic address: florence.huguet@aphp.fr. · Département d'oncologie radiothérapie, centre hospitalier Lyon Sud, 69000 Pierre-Bénite, France; EMR 3738, université Claude-Bernard Lyon 1, 69000 Lyon, France. · Unité de radiophysique, service de radiothérapie, hôpital Tenon, AP-HP, 75020 Paris, France. ·Cancer Radiother · Pubmed #27523418.

ABSTRACT: Currently, the use of radiation therapy for patients with pancreatic cancer is subject to discussion. In adjuvant setting, the standard treatment is 6 months of chemotherapy with gemcitabine and capecitabine. Chemoradiation (CRT) may improve the survival of patients with incompletely resected tumors (R1). This should be confirmed by a prospective trial. Neoadjuvant CRT is a promising treatment especially for patients with borderline resectable tumors. For patients with locally advanced tumors, there is no a standard. An induction chemotherapy followed by CRT for non-progressive patients reduces the rate of local relapse. Whereas in the first trials of CRT large fields were used, the treated volumes have been reduced to improve tolerance. Tumor movements induced by breathing should be taken in account. Intensity modulated radiation therapy allows a reduction of doses to the organs at risk. Whereas widely used, this technique is not recommended.

2 Guideline Guidelines for time-to-event end-point definitions in trials for pancreatic cancer. Results of the DATECAN initiative (Definition for the Assessment of Time-to-event End-points in CANcer trials). 2014

Bonnetain, Franck / Bonsing, Bert / Conroy, Thierry / Dousseau, Adelaide / Glimelius, Bengt / Haustermans, Karin / Lacaine, François / Van Laethem, Jean Luc / Aparicio, Thomas / Aust, Daniela / Bassi, Claudio / Berger, Virginie / Chamorey, Emmanuel / Chibaudel, Benoist / Dahan, Laeticia / De Gramont, Aimery / Delpero, Jean Robert / Dervenis, Christos / Ducreux, Michel / Gal, Jocelyn / Gerber, Erich / Ghaneh, Paula / Hammel, Pascal / Hendlisz, Alain / Jooste, Valérie / Labianca, Roberto / Latouche, Aurelien / Lutz, Manfred / Macarulla, Teresa / Malka, David / Mauer, Muriel / Mitry, Emmanuel / Neoptolemos, John / Pessaux, Patrick / Sauvanet, Alain / Tabernero, Josep / Taieb, Julien / van Tienhoven, Geertjan / Gourgou-Bourgade, Sophie / Bellera, Carine / Mathoulin-Pélissier, Simone / Collette, Laurence. ·Methodology and Quality of Life Unit in Cancer, EA 3181, University Hospital of Besançon and CTD-INCa Gercor, UNICNCER GERICO, Besançon, France. Electronic address: franck.bonnetain@univ-fcomte.fr. · Leiden University Medical Center, Leiden, Netherlands. · Department of Medical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-les-Nancy, France. · Bordeaux Segalen University & CHRU, Bordeaux, France. · Department of Radiology, Oncology and Radiation Science, Uppsala University, Uppsala, Sweden. · Department of Radiation Oncology, Leuven, Belgium. · Digestive Surgical Department, Tenon hospital, Paris, France. · Gastro Intestinal Cancer Unit Erasme Hospital Brussels, Belgium. · Gastroenterology Department, Avicenne Hospital, Paris 13, Bobigny, France. · Institute for Pathology, University Hospital Carl-Gustav-Carus, Dresden, Germany. · Surgical and Gastroenterological Department, Endocrine and Pancreatic Unit, Hospital of 'G.B.Rossi', University of Verona, Italy. · Institut de Cancérologie de l'Ouest - Centre Paul Papin Centre de Lutte Contre le Cancer (CLCC), Angers, France. · Biostatistics Unit, Centre Antoine Lacassagne, Nice, France. · Oncology Department, Hôpital Saint-Antoine & CTD-INCa GERCOR, Assistance Publique des Hôpitaux de Paris, UPMC Paris VI, Paris, France. · Gastroenterology Department, Hopital la Timone, Assitance publique des Hopitaux de Marseille, Marseille, France. · Department of Surgery, Institut Paoli Calmettes, Marseille, France. · Department of Surgery, Agia Olga Hospital, Athens, Greece. · Department of Gastroenterology, Institut Gustave Roussy, Villejuif, France. · Biostatistician, Biostatistics Unit, Centre Antoine Lacassagne, Nice, France. · Department of Radiotherapy, Institut fuer Radioonkologie, Vienna, Austria. · Department of Surgical Oncology, Royal Liverpool Hospital, United Kingdom. · Department of Gastroenterology, Beaujon Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France. · Digestive Oncology and Gastro-enterology Department, Jules Bordet Institute, Brussels, Belgium. · Digestive Cancer Registry, INSERM U866, Dijon, France. · Medical Oncology Unit, Ospedali Riuniti di Bergamo, Bergame, Italy. · Inserm, Centre for Research in Epidemiology and Population Health, U1018, Biostatistics Team, Villejuif, France. · Gastroenterology Department, Caritas Hospital, Saarbrücken, Germany. · Department of the Gastrointestinal Tumors and Phase I Unit, Vall d'Hebron University Hospital, Barcelona, Spain. · Statistics Department, EORTC, Brussels, Belgium. · Department of Medical Oncology, Institut Curie, Hôpital René Huguenin, Saint-Cloud, France. · Division of Surgery and Oncology at the University of Liverpool and Royal Liverpool University Hospital, Liverpool, United Kingdom. · Department of Digestive Surgery, Universitu Hospital Strasbourg, France. · Department of Hepato-pancreatic and Biliary Surgery, Beaujon Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France. · Department of Hepato-gastroenterology and Digestive Oncology, Georges Pompidou European hospital, Paris, France. · Department of Radiation Oncology, Academisch Medisch Centrum, Amsterdam, The Netherlands. · Institut Du Cancer de Montpellier, Comprehensive Cancer Centre, and Data Center for Cancer Clinical Trials, CTD-INCa, Montpellier, France. · Clinical and Epidemiological Research Unit, Institut Bergonie, Comprehensive Cancer Centre, Bordeaux, France; Data Center for Cancer Clinical Trials, CTD-INCa, Bordeaux, France; INSERM, Centre d'Investigation Clinique - Épidémiologie Clinique CIC-EC 7, F-33000 Bordeaux, France. ·Eur J Cancer · Pubmed #25256896.

ABSTRACT: BACKGROUND: Using potential surrogate end-points for overall survival (OS) such as Disease-Free- (DFS) or Progression-Free Survival (PFS) is increasingly common in randomised controlled trials (RCTs). However, end-points are too often imprecisely defined which largely contributes to a lack of homogeneity across trials, hampering comparison between them. The aim of the DATECAN (Definition for the Assessment of Time-to-event End-points in CANcer trials)-Pancreas project is to provide guidelines for standardised definition of time-to-event end-points in RCTs for pancreatic cancer. METHODS: Time-to-event end-points currently used were identified from a literature review of pancreatic RCT trials (2006-2009). Academic research groups were contacted for participation in order to select clinicians and methodologists to participate in the pilot and scoring groups (>30 experts). A consensus was built after 2 rounds of the modified Delphi formal consensus approach with the Rand scoring methodology (range: 1-9). RESULTS: For pancreatic cancer, 14 time to event end-points and 25 distinct event types applied to two settings (detectable disease and/or no detectable disease) were considered relevant and included in the questionnaire sent to 52 selected experts. Thirty experts answered both scoring rounds. A total of 204 events distributed over the 14 end-points were scored. After the first round, consensus was reached for 25 items; after the second consensus was reached for 156 items; and after the face-to-face meeting for 203 items. CONCLUSION: The formal consensus approach reached the elaboration of guidelines for standardised definitions of time-to-event end-points allowing cross-comparison of RCTs in pancreatic cancer.

3 Guideline Malignant insulinoma: recommendations for characterisation and treatment. 2013

Baudin, Eric / Caron, Philippe / Lombard-Bohas, Catherine / Tabarin, Antoine / Mitry, Emmanuel / Reznick, Yves / Taieb, David / Pattou, François / Goudet, Pierre / Vezzosi, Delphine / Scoazec, Jean-Yves / Cadiot, Guillaume / Borson-Chazot, Françoise / Do Cao, Christine / Anonymous2960768 / Anonymous2970768. ·Service de médecine nucléaire et d'oncologie endocrinienne, institut Gustave-Roussy, 94800 Villejuif, France. ·Ann Endocrinol (Paris) · Pubmed #23993836.

ABSTRACT: -- No abstract --

4 Guideline Radiotherapy technical considerations in the management of locally advanced pancreatic cancer: American-French consensus recommendations. 2012

Huguet, Florence / Goodman, Karyn A / Azria, David / Racadot, Severine / Abrams, Ross A. ·Department of Radiation Oncology, Tenon Hospital, APHP, University Paris VI, Paris, France. florence.huguet@tnn.aphp.fr ·Int J Radiat Oncol Biol Phys · Pubmed #22768988.

ABSTRACT: Pancreatic carcinoma is a leading cause of cancer-related mortality. Approximately 30% of pancreatic cancer patients present with locally advanced, unresectable nonmetastatic disease. For these patients, two therapeutic options exist: systemic chemotherapy or chemoradiotherapy. Within this context, the optimal technique for pancreatic irradiation is not clearly defined. A search to identify relevant studies was undertaken using the Medline database. All Phase III randomized trials evaluating the modalities of radiotherapy in locally advanced pancreatic cancer were included, as were some noncontrolled Phase II and retrospective studies. An expert panel convened with members of the Radiation Therapy Oncology Group and GERCOR cooperative groups to review identified studies and prepare the guidelines. Each member of the working group independently evaluated five endpoints: total dose, target volume definition, radiotherapy planning technique, dose constraints to organs at risk, and quality assurance. Based on this analysis of the literature, we recommend either three-dimensional conformal radiation therapy or intensity-modulated radiation therapy to a total dose of 50 to 54 Gy at 1.8 to 2 Gy per fraction. We propose gross tumor volume identification to be followed by an expansion of 1.5 to 2 cm anteriorly, posteriorly, and laterally, and 2 to 3 cm craniocaudally to generate the planning target volume. The craniocaudal margins can be reduced with the use of respiratory gating. Organs at risk are liver, kidneys, spinal cord, stomach, and small bowel. Stereotactic body radiation therapy should not be used for pancreatic cancer outside of clinical trials. Radiotherapy quality assurance is mandatory in clinical trials. These consensus recommendations are proposed for use in the development of future trials testing new chemotherapy combinations with radiotherapy. Not all of these recommendations will be appropriate for trials testing radiotherapy dose or dose intensity concepts.

5 Editorial Pancreatic cancer is still waiting for the big leap forward. 2019

Gaujoux, Sébastien / Belghiti, Jacques. ·AP-HP, hôpital Cochin, department of hepato-pancreato-biliary and endocrine surgery, 75014 Paris, France; Université Paris Descartes, 75006 Paris, France. Electronic address: sebastien.gaujoux@aphp.fr. · AP-HP, hôpital Beaujon, department of hepato-pancreato-biliary surgery, pôle des maladies de l'appareil digestif (PMAD), 92110 Clichy, France; Université Paris Diderot, Paris, France. ·Presse Med · Pubmed #30878337.

ABSTRACT: -- No abstract --

6 Review Pancreatic cancer surgical management. 2019

Jeune, Florence / Coriat, Romain / Prat, Frédéric / Dousset, Bertrand / Vaillant, Jean-Christophe / Gaujoux, Sébastien. ·AP-HP, Pierre-and-Marie-Curie university, Paris VI, Pitié-Salpêtrière hospital, department of hepatobiliary surgery, pancreatic surgery and liver transplantation, 75651 Paris cedex, France. Electronic address: florence.jeune@hotmail.fr. · AP-HP, Paris V, Paris Descartes faculty of medecine, Cochin hopsital, department of gastroenterology and oncology, 75014 Paris, France. · AP-HP, Paris V, Paris Descartes faculty of medicine, Cochin hospital, department of digestive, hepatobiliary and pancreatic surgery, 75014 Paris, France. · AP-HP, Pierre-and-Marie-Curie university, Paris VI, Pitié-Salpêtrière hospital, department of hepatobiliary surgery, pancreatic surgery and liver transplantation, 75651 Paris cedex, France. ·Presse Med · Pubmed #30905395.

ABSTRACT: Pancreatic ductal adenocarcinoma (PDAC) remains a dismal prognosis and surgery is the only chance for cure. However, only few of the patients have localized tumor eligible for curative complete resection. Preoperative management and well-staging of the disease are the cornerstone for appropriate surgery and major issues to define the best therapeutic strategy. This review focuses on the surgical and optimal perioperative management of PDAC and summarizes updates data on the subject.

7 Review Systemic treatment of pancreatic cancer revisited. 2019

Ducreux, Michel / Seufferlein, Thomas / Van Laethem, Jean-Luc / Laurent-Puig, Pierre / Smolenschi, Cristina / Malka, David / Boige, Valérie / Hollebecque, Antoine / Conroy, Thierry. ·Département de Médecine Oncologique, Gustave Roussy Cancer Center Grand Paris, Université Paris Saclay, France. Electronic address: michel.ducreux@gustaveroussy.fr. · Department of Internal Medicine I, University of Ulm, Ulm, Germany. · Department of Gastroenterology and Digestive oncology, Erasme University Hospital, Université Libre de Bruxelles, Bruxelles, Belgium. · Assistance Publique-Hôpitaux de Paris, Department of Biology, European Georges Pompidou Hospital, Paris, France. · Département de Médecine Oncologique, Gustave Roussy Cancer Center Grand Paris, France. · Département de Médecine Oncologique, Gustave Roussy Cancer Center Grand Paris, France; Département d'Innovation Thérapeutique, Gustave Roussy Cancer Center Grand Paris, France. · Département d'oncologie médicale, Institut de Cancérologie de Lorraine, Université de Lorraine, Nancy, France. ·Semin Oncol · Pubmed #30638624.

ABSTRACT: Pancreatic cancer is considered to be one of the most aggressive cancers. For unknown reasons, the incidence of pancreatic cancer is slowly rising and so too are mortality rates. Over 75% of patients are diagnosed with locally advanced disease or with metastases; and more than 95% of patients have metastases at diagnosis or will develop metastases during their follow-up. Despite recent improvements in the therapy of pancreatic cancer, initially with demonstration of the activity of the FOLFIRINOX regimen and subsequently the approval of nab-paclitaxel in combination with gemcitabine, prognosis remains poor and the 5-year survival rate is less than 5%. To date, neither personalized medicine nor immunotherapy, the 2 recent revolutions of cancer treatment, have delivered major positive results in the treatment of pancreatic cancer; and it is especially clear that immune checkpoint inhibitors will not become a major tool in the treatment of pancreatic cancer. There are many ongoing studies, including those exploring combinations of chemotherapy with immunotherapy. Vaccines or T cells modified with a chimeric antigen receptor (CAR-T cells) could also play a role in the treatment of cancer in the future. The aim of this review is to discuss recent improvements in standard of care, major obstacles to overcome, recent results of new treatment combinations, and the most interesting innovative approaches.

8 Review Current indications and yield of endoscopic ultrasound and ancillary techniques in pancreatic cystic neoplasms. 2019

Salom, Federico / Prat, Frédéric. ·Departamento de Gastroenterología, Hospital México, San José, 1641-2050, Costa Rica. fedesalom@yahoo.com. · Service de Gastroenterologie, d'endoscopie et de Cancerologie Digestive, APHP-Hopital Cochin, 75014, Paris, France. ·Clin J Gastroenterol · Pubmed #30565189.

ABSTRACT: An increase in the diagnosis of pancreatic cystic neoplasm has been described lately. Surgical treatment or surveillance is advised depending on the type of lesion diagnosed. The most accurate diagnostic approach is needed to make the best therapeutic decision. Endoscopic ultrasound is a very valuable tool in the evaluation of pancreatic cystic neoplasm. It generates high-quality images and allows the possibility of sampling the cystic fluid for cytology, microbiological and molecular evaluation. Even with this evaluation, the sensitivity of this approach is not always adequate. New technological resources have been developed to try to improve the diagnostic accuracy of pancreatic cystic neoplasms. The two most promising techniques are needle-based confocal laser endomicroscopy and contrast-enhanced harmonic endoscopic ultrasound. Needle-based confocal laser endomicroscopy allows a microscopic evaluation of mucosal glands and vascular pattern, to differentiate mucinous from non-mucinous lesions. Contrast-enhanced harmonic endoscopic ultrasound is used for the vascular evaluation of the microcirculation of the cyst wall and mural nodule, mainly to make the difference between malignant nodules and mucus plugs. A combination of these different diagnostic techniques can improve the diagnostic accuracy of pancreatic cystic neoplasms to offer the adequate therapeutic decision.

9 Review Pancreatic cancer: French clinical practice guidelines for diagnosis, treatment and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, ACHBT, AFC). 2018

Neuzillet, Cindy / Gaujoux, Sébastien / Williet, Nicolas / Bachet, Jean-Baptiste / Bauguion, Lucile / Colson Durand, Laurianne / Conroy, Thierry / Dahan, Laetitia / Gilabert, Marine / Huguet, Florence / Marthey, Lysiane / Meilleroux, Julie / de Mestier, Louis / Napoléon, Bertrand / Portales, Fabienne / Sa Cunha, Antonio / Schwarz, Lilian / Taieb, Julien / Chibaudel, Benoist / Bouché, Olivier / Hammel, Pascal / Anonymous2561138 / Anonymous2571138 / Anonymous2581138 / Anonymous2591138 / Anonymous2601138 / Anonymous2611138 / Anonymous2621138 / Anonymous2631138 / Anonymous2641138 / Anonymous2651138. ·Department of Medical Oncology, Curie Institute, Versailles Saint-Quentin University (UVSQ), Saint-Cloud, France. Electronic address: cindy.neuzillet@gmail.com. · Department of Digestive, Hepato-Biliary and Pancreatic Surgery, Cochin Hospital, AP-HP, Paris Descartes Faculty of Medicine, Paris Descartes University, Sorbonne Paris Cité, Paris, France. · Hepato-Gastroenterology Department, University Hospital of Saint-Etienne, Saint Priest en Jarez, France. · Hepato-Gastroenterology Department, Pitié Salpétrière University Hospital, AP-HP, Paris Cedex 13, France. · Hepato-Gastroenterology Department, Departmental Hospital Center, La Roche sur Yon, France. · Department of Radiotherapy, Henri Mondor Hospital, AP-HP, Université Paris Est Creteil, Créteil, France. · Department of Medical Oncology, Lorraine Institute of Oncology and Lorraine University, Vandoeuvre-lès-Nancy Cedex, France. · Digestive Oncology Department, "DACCORD" (Digestif, Anatomie pathologique, Chirurgie, CISIH, Oncologie, Radiothérapie, Dermatologie) pole, CHU Timone, Marseille Cedex 05, France. · Paoli Calmettes Institute, Department of Medical Oncology and Cancer Research Center of Marseille (CRCM), INSERM U1068 Stress Cell, Aix-Marseille University, Marseille, France. · Department of Oncology and Radiotherapy, Tenon Hospital, East Paris University Hospitals, AP-HP, Paris Sorbonne University, Paris, France. · Gastroenterology Department, Béclère Hospital, AP-HP, Clamart, France. · Pathology Department, Toulouse University Hospital, Toulouse, France. · Department of Gastroenterology-Pancreatology, Beaujon Hospital, APHP, Paris 7 University, Clichy, France. · Jean Mermoz Private Hospital, Ramsay Générale de Santé, Lyon, France. · Digestive Oncology Department, Regional Institute of Cancer, Montpellier, France. · INSERM UMR 935, Paul Brousse Hospital, Hepatobiliary Center, AP-HP, Université Paris-Sud, Université Paris-Saclay, Villejuif, France. · Department of Digestive Surgery, Hôpital Charles Nicolle, Rouen University Hospital, Rouen, France and Genomic and Personalized Medicine in Cancer and Neurological Disorders, UMR 1245 INSERM, Rouen University, France. · Hepato-Gastroenterology and Digestive Oncology Department, Georges Pompidou European Hospital, AP-HP, Paris, France. · Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France. · Hepato-Gastroenterology and Digestive Oncology Department, Robert Debré University Hospital, Avenue Général Koenig, 51092 Reims Cedex, France. · Department of Digestive Oncology, Beaujon University Hospital (AP-HP), Paris VII Diderot University, Clichy-la-Garenne, France. Electronic address: pascal.hammel@aphp.fr. ·Dig Liver Dis · Pubmed #30219670.

ABSTRACT: BACKGROUND: This document is a summary of the French intergroup guidelines regarding the management of pancreatic adenocarcinoma (PA), updated in July 2018. DESIGN: This collaborative work was produced under the auspices of all French medical and surgical societies involved in the management of PA. It is based on the previous guidelines, recent literature review and expert opinions. Recommendations were graded in three categories, according to the level of evidence. RESULTS: Over the last seven years, significant changes in PA management have been implemented in clinical practice. Imaging/staging: diffusion magnetic resonance imaging is useful before surgery to rule out small liver metastases. SURGERY: centralization of pancreatic surgery in expert centers is associated with a decreased postoperative mortality. Adjuvant chemotherapy: modified FOLFIRINOX in fit patients, or gemcitabine, or 5-FU, or gemcitabine plus capecitabine, to be discussed on a case-by-case basis. Locally advanced PA: no survival benefit of chemoradiotherapy. Metastatic PA: FOLFIRINOX and gemcitabine plus nab-paclitaxel combination are first-line standards in fit patients; second-line with 5FU/nal-IRI or 5FU/oxaliplatin combination after first-line gemcitabine. CONCLUSION: Guidelines for management of PA are continuously evolving and need to be regularly updated. This constant progress is made possible through clinical and translational research. However, as each individual case is particular, they cannot substitute to multidisciplinary tumor board discussion.

10 Review Prognostic stratification of resected pancreatic ductal adenocarcinoma: Past, present, and future. 2018

Barhli, Aline / Cros, Jérôme / Bartholin, Laurent / Neuzillet, Cindy. ·INSERM UMR1149, Bichat-Beaujon University Hospital, AP-HP - PRES Paris 7 Diderot, Paris, France. · INSERM UMR1149, Bichat-Beaujon University Hospital, AP-HP - PRES Paris 7 Diderot, Paris, France; Department of Pathology, Bichat-Beaujon University Hospital, AP-HP - PRES Paris 7 Diderot, Paris, France. · Cancer Research Center of Lyon, INSERM U1052, CNRS 5286, Léon Bérard Center, Claude Bernard Lyon 1 University, Lyon, France. · INSERM UMR1149, Bichat-Beaujon University Hospital, AP-HP - PRES Paris 7 Diderot, Paris, France; Department of Medical Oncology, Curie Institute, Saint Cloud, France. Electronic address: cindy.neuzillet@gmail.com. ·Dig Liver Dis · Pubmed #30205952.

ABSTRACT: Pancreatic ductal adenocarcinoma (PDAC) is the digestive cancer with the poorest prognosis, with a 5-year overall survival rate of 7%. Complete surgical resection followed by adjuvant chemotherapy is the only treatment with curative intent. However, many patients with an apparently localized disease who may undergo primary tumor resection already have micro-metastatic disease and will promptly develop metastases. Considering the significant rate of morbidity and mortality upon pancreatic surgery, the pre-operative identification of patients with an aggressive disease is therefore a major clinical issue. Although tumor size, differentiation, margins, and lymph node invasion are the main "classical" prognostic factors, they are not sufficient to fully predict early disease recurrence. In the last decade, multi-omics high-throughput analyses have provided a new insight into PDAC biology and have led to the description of multiple molecular subtypes, with a significant prognostic value for most of them, but that have not yet been transposed to routine clinical practice, mainly due to poor availability of tumor tissue material prior to surgical resection. In this review, we provide an overview of the current status of clinico-pathological and molecular biomarkers (tumor and blood) to predict early recurrence, and their implications for clinical practice and future research development.

11 Review [Role of radiation therapy in the management of pancreatic cancer]. 2018

Huguet, F / Rivin Del Campo, E / Antoni, D / Vendrely, V / Hammel, P. ·Service d'oncologie radiothérapie, hôpital Tenon, hôpitaux universitaires Est Parisien, 4, rue de la Chine, 75020 Paris, France; Université Paris Sorbonne, 4, rue de la Chine, 75020 Paris, France. Electronic address: florence.huguet@aphp.fr. · Service d'oncologie radiothérapie, hôpital Tenon, hôpitaux universitaires Est Parisien, 4, rue de la Chine, 75020 Paris, France; Université Paris Sorbonne, 4, rue de la Chine, 75020 Paris, France. · Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France. · Service d'oncologie radiothérapie, hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac, France. · Service d'oncologie digestive et médicale, hôpital Beaujon, AP-HP, 100, boulevard du Géneral-Leclerc, 92110 Clichy, France; Université Paris Diderot, 100, boulevard du Géneral-Leclerc, 92110 Clichy, France. ·Cancer Radiother · Pubmed #30100126.

ABSTRACT: At diagnosis, about 15% of patients with pancreatic cancer present with a resectable tumour, 50% have a metastatic tumour, and 25% a locally advanced tumor (non-metastatic but unresectable due to vascular invasion) or borderline resectable. Despite the technical progress made in the field of radiation therapy and the improvement of the efficacy of chemotherapy, the prognosis of these patients remains very poor. Recently, the role of radiation therapy in the management of pancreatic cancer has been much debated. This review aims to evaluate the role of radiation therapy for these patients.

12 Review The Problem of High-Grade Gastroenteropancreatic Neuroendocrine Neoplasms: Well-Differentiated Neuroendocrine Tumors, Neuroendocrine Carcinomas, and Beyond. 2018

Sorbye, Halfdan / Baudin, Eric / Perren, Aurel. ·Department of Oncology, Haukeland University Hospital, Jonas Lies vei 65, Bergen 5021, Norway; Department of Clinical Science, Haukeland University Hospital, Jonas Lies vei 65, Bergen 5021, Norway. Electronic address: halfdan.sorbye@helse-bergen.no. · Endocrine Oncology, Gustave Roussy, rue Édouard-Vaillant 114, Villejuif 94800, France. · Department of Pathology, University of Bern, Murtenstrasse 31, Bern 3008, Switzerland. ·Endocrinol Metab Clin North Am · Pubmed #30098724.

ABSTRACT: High-grade gastroenteropancreatic neuroendocrine neoplasms are well-differentiated neuroendocrine tumors or poorly differentiated small/large cell neuroendocrine carcinoma. Distinguishing these entities relies on different genetic backgrounds and resulting different biology. The new classification creates several problems. Almost all clinical treatment data on neuroendocrine neoplasms do not stratify between well and poorly differentiated, providing insufficient help in treatment selection. Treatment of gastroenteropancreatic neuroendocrine neoplasms should separate between well-differentiated neuroendocrine tumors and neuroendocrine carcinoma, and depends on primary tumor site, stage, proliferation rate, and clinical course. This article addresses how to diagnose and treat gastroenteropancreatic neuroendocrine neoplasms, focusing on well-differentiated neuroendocrine tumors versus neuroendocrine carcinomas.

13 Review [Venous thromboembolism and pancreatic cancer]. 2018

Frère, C / Bournet, B / Benzidia, I / Jamelot, M / Debourdeau, P / Hij, A / Rafii-Elayoubi, H / Buscail, L / Farge, D / Anonymous2941033. ·Service d'hématologie biologique, hôpital Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, 47-83, boulevard de l'Hôpital, 75013 Paris, France. Electronic address: corinne.frere@aphp.fr. · Pôle digestif, service de gastro-entérologie et de nutrition, hôpital Rangueil, CHU de Toulouse, 31059 Toulouse cedex 9, France. · Service de médecine interne, UF04 maladies auto-immunes et pathologie vasculaire, hôpital Saint-Louis, Assistance publique-Hôpitaux de Paris, 75475 Paris cedex 10, France. · Service d'oncologie médicale, centre Henri-Becquerel, 76038 Rouen, France. · Service oncologie, institut Sainte-Catherine, 84918 Avignon, France. ·J Med Vasc · Pubmed #29981733.

ABSTRACT: Pancreatic cancer (PC) is a devastating malignancy with an overall 5-year survival of 8% for all stages combined. Most of the PC patients diagnosed have an advanced disease (40%) or metastatic stage (40%), which eliminates surgery as a potentially curative treatment. The disease course is often complicated by venous thromboembolism (VTE) events, which per se account for significant morbidity and mortality, with significantly worsen survival. PC is associated with the highest risk of VTE among all cancer patients. We review the literature data to address the incidence and clinical outcomes of VTE in PC patients. VTE incidence varies from 5 to 41% according to epidemiological studies and is as high as 57% in postmortem series. Since 2013, international clinical practice guidelines recommend primary thromboprophylaxis with a grade 1B level of evidence as an adjuvant therapy in advanced PC. A recent meta-analysis of randomized controlled trials investigating the benefit and risk of low-molecular-weight heparins (LMWH) in ambulatory advanced PC patients under chemotherapy showed that the incidence of VTE was 2.1% in patients treated with LMWH and 11.2% in controls (risk ratio, 0.18; 95% CI, 0.083-0.39; P<0.0001). In conclusion, improved earlier diagnosis and effective management of VTE, a frequent and life-threatening complication in PC, is warranted to improve PC patient outcomes.

14 Review Immune therapies in pancreatic ductal adenocarcinoma: Where are we now? 2018

Hilmi, Marc / Bartholin, Laurent / Neuzillet, Cindy. ·Service d'Oncologie Médicale, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil, Créteil 94010, France. · Université de Lyon, Université Claude Bernard Lyon 1, Inserm U1052, CNRS 5286, Centre Léon Bérard, Centre de Recherche en Cancérologie de Lyon, Lyon 69008, France. · Service d'Oncologie Médicale, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris Est Créteil, Créteil 94010, France. cindy.neuzillet@gmail.com. ·World J Gastroenterol · Pubmed #29853732.

ABSTRACT: Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest cancers, mostly due to its resistance to treatment. Of these, checkpoint inhibitors (CPI) are inefficient when used as monotherapy, except in the case of a rare subset of tumors harboring microsatellite instability (< 2%). This inefficacy mainly resides in the low immunogenicity and non-inflamed phenotype of PDAC. The abundant stroma generates a hypoxic microenvironment and drives the recruitment of immunosuppressive cells through cancer-associated-fibroblast activation and transforming growth factor β secretion. Several strategies have recently been developed to overcome this immunosuppressive microenvironment. Combination therapies involving CPI aim at increasing tumor immunogenicity and promoting the recruitment and activation of effector T cells. Ongoing studies are therefore exploring the association of CPI with vaccines, oncolytic viruses, MEK inhibitors, cytokine inhibitors, and hypoxia- and stroma-targeting agents. Adoptive T-cell transfer is also under investigation. Moreover, translational studies on tumor tissue and blood, prior to and during treatment may lead to the identification of biomarkers with predictive value for both clinical outcome and response to immunotherapy.

15 Review Pancreatic Adenocarcinoma Staging in the Era of Preoperative Chemotherapy and Radiation Therapy. 2018

Zins, Marc / Matos, Celso / Cassinotto, Christophe. ·From the Department of Radiology, Groupe Hospitalier Paris Saint-Joseph, 185 rue Raymond Losserand, 75014 Paris, France (M.Z.) · Department of Radiology, Champalimaud Clinical Center, Lisbon, Portugal (C.M.) · and Department of Radiology, Saint-Éloi University Hospital, Montpellier, France (C.C.). ·Radiology · Pubmed #29668413.

ABSTRACT: Pancreatic ductal adenocarcinoma (PDA) remains among the most challenging malignancies to treat. At diagnosis, the tumor often already extends beyond the confines of the pancreas, spreading to an extent such that primary surgery with curative intent is very rarely feasible. Considerable momentum is now being given to a treatment strategy involving neoadjuvant chemotherapy or chemotherapy and radiation therapy in patients with nonmetastatic PDA. The main advantage of this strategy is better selection of patients likely to benefit from curative-intent surgery through the achievement of negative resection margins. Patients with rapidly progressive disease are identified and are spared ineffective surgery with its attendant morbidity. Neoadjuvant therapy can downstage tumors classified as locally advanced at initial imaging studies to resectable tumors. However, the imaging study evaluation of the response to neoadjuvant therapy is extremely complex. Thus, the diagnostic performance of imaging studies is not sufficient to ensure the accurate selection of patients in whom negative-margin resection is likely to be achieved. More specifically, standard criteria for predicting vascular invasion, based on the amount of tumor-vessel contact, are not valid after neoadjuvant therapy.

16 Review [Simple mucinous cyst of the pancreas: Case-report and literature review]. 2018

Hamon, Maxime / Balladur, Pierre / Fléjou, Jean-François. ·Service d'anatomie et cytologie pathologiques, hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75571 Paris cedex 12, France. Electronic address: m-hamon@chu-montpellier.fr. · Service de chirurgie générale et digestive, hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75571 Paris cedex 12, France. Electronic address: pierre.balladur@aphp.fr. · Service d'anatomie et cytologie pathologiques, hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75571 Paris cedex 12, France. Electronic address: jean-francois.flejou@aphp.fr. ·Ann Pathol · Pubmed #29415811.

ABSTRACT: Simple mucinous cyst of the pancreas is an unusual pancreatic cyst, first described by Kosmahl et al. in 2002 with 5 cases. We describe a case of simple mucinous cyst of the pancreas, followed by a literature review. The physiopathology of this cyst is still unclear. It is an epithelial cyst, presenting as unilocular cystic lesion of the pancreatic body or tail, with a clear content, and no communication with the pancreatic duct. Microscopically, the cyst is lined by mucin-producing cells with mild atypia, and contains a fibrous wall without ovarian-like stroma. The prognosis is excellent, as no recurrent disease and progression to malignancy have been described. The non neoplastic origin of this lesion is debated, as cases with KRAS mutation and intra-epithelial neoplastic lesions have been recently reported. It is important to distinguish this lesion from macrocystic serous cystadenoma, mucinous cystic neoplasms and intraductal papillary mucinous neoplasms, by clinical, radiological and pathological features, as the treatment varies from simple surveillance to surgical resection.

17 Review Preoperative imaging and pathologic classification for pancreatic neuroendocrine tumors. 2018

Deguelte, S / de Mestier, L / Hentic, O / Cros, J / Lebtahi, R / Hammel, P / Kianmanesh, R. ·Department of general, digestive and endocrine surgery, Robert-Debré hospital, CHU de Reims, Reims Champagne-Ardenne university, 8, rue du général Koenig, 51100 Reims, France. · Department of gastroenterology, Beaujon hospital, University Paris 7, AP-HP, 100, boulevard du Général-Leclerc, 92110 Clichy, France. · Department of pathology, Beaujon hospital, University Paris 7, AP-HP, 100, boulevard du Général-Leclerc, 92110 Clichy, France. · Department of nuclear medecine, Beaujon hospital, University Paris 7, AP-HP, 100, boulevard du Général-Leclerc, 92110 Clichy, France. · Department of general, digestive and endocrine surgery, Robert-Debré hospital, CHU de Reims, Reims Champagne-Ardenne university, 8, rue du général Koenig, 51100 Reims, France. Electronic address: rkianmanesh@chu-reims.fr. ·J Visc Surg · Pubmed #29397338.

ABSTRACT: The management of patients with pancreatic neuroendocrine tumor (PNET), whether hormonally secretory or not, is multidisciplinary and often multimodal. Surgical treatment plays a central role because complete resection is the only potentially curative treatment. The choice of the therapeutic plan for a PNET requires precise localization of the primary tumor (which may sometimes be multiple in case of genetic predisposition), confirmation of the diagnosis of PNET, a search for metastases (mainly hepatic), and identification of the main histoprognostic factors. This update focuses on the WHO 2017 histological classification and recent innovations in the preoperative assessment of PNET using conventional and isotopic imaging. The aim is to not only allow the mapping of primary and metastatic lesions but also to predict tumor aggressiveness.

18 Review [Molecular characterisation defines several subtypes of pancreatic ductal adenocarcinoma]. 2018

Raffenne, Jérôme / Cros, Jérôme. ·Faculté de médecine Paris-Diderot Paris 7 - site Bichat, centre de recherche sur l'inflammation, Inserm-U1149, 16, rue Henri-Huchard, 75890 Paris cedex 18, France. · Faculté de médecine Paris-Diderot Paris 7 - site Bichat, centre de recherche sur l'inflammation, Inserm-U1149, 16, rue Henri-Huchard, 75890 Paris cedex 18, France; Hôpital Beaujon, service de pathologie, 92110 Clichy, France. Electronic address: jerome.cros@aphp.fr. ·Bull Cancer · Pubmed #29273547.

ABSTRACT: Multi-omics high throughput analyses lead to the description of multiple molecular subtypes of pancreatic adenocarcinoma with major prognostic impact for most of them. There is no consensual multilevel integrative classification yet like in colon or breast cancers. Genomic classifications have identified a tumor subtype (15% of the patients) with deficient homologous DNA repair-system leading to increase sensitivity to platinum-based therapies and possibly to PARP inhibitors and immunotherapies. Transcriptomic classifications are still debated but all have identified an aggressive subtype with a very poor prognosis, presumably unfit for a surgical approach. Finally, approaches based on metabolomic or proteomic profiling have identified subtypes with a particular sensitivity to compounds targeting the hallmarks metabolomics or oncogenic pathways of each subtype. These classifications were mostly based on tumor cell but the micro-environment is also very heterogeneous and several types of stroma will be described soon. Subtype determination in daily practice remains a major challenge as most technologies used to build these classifications are very expensive, requires dedicated bio-informatics analysis pipelines and are not adapted to routine samples that are mostly formal in fixed paraffin embedded biopsies, in which tumor cells are highly contaminated by the cell from the microenvironment and the clot.

19 Review Tumor Heterogeneity in Pancreatic Adenocarcinoma. 2018

Cros, Jerome / Raffenne, Jerome / Couvelard, Anne / Poté, Nicolas. ·Department of Pathology, Beaujon Hospital - Paris Diderot University, Clichy, France. ·Pathobiology · Pubmed #28787741.

ABSTRACT: Pancreatic adenocarcinoma is one of the deadliest malignancies worldwide, mainly due to frequent diagnosis at an advanced stage and its strong chemoresistance. Tumor heterogeneity is evident at the histological level, both between tumors and even within a tumor. Recent high-throughput analyses have confirmed that intertumor heterogeneity is greater than intratumor heterogeneity that is mostly driven by successive catastrophic genetic events in the early stage and by epigenetic modifications in the metastatic stage. While this heterogeneity may complicate the search for a universal cure, these analyses have distinguished several subtypes at the genomic, transcriptomic, and metabolomic levels that offer, for some, new therapeutic opportunities.

20 Review Gastric stump carcinoma as a long-term complication of pancreaticoduodenectomy: report of two cases and review of the English literature. 2017

Bouquot, Morgane / Dokmak, Safi / Barbier, Louise / Cros, Jérôme / Levy, Philippe / Sauvanet, Alain. ·Department of Hepatic and Pancreatic Surgery, Pôle des Maladies de l'Appareil Digestif, Hospital Beaujon, AP-HP, University Paris Diderot, 100 Boulevard du Maréchal Leclerc, 92110, Clichy, France. · Department of Pathology, Hospital Beaujon, AP-HP, University Paris Diderot, 92110, Clichy, France. · Department of Gastroenterology and Pancreatology, Pôle des Maladies de l'Appareil Digestif, Hospital Beaujon, AP-HP, University Paris Diderot, 92110, Clichy, France. · Department of Hepatic and Pancreatic Surgery, Pôle des Maladies de l'Appareil Digestif, Hospital Beaujon, AP-HP, University Paris Diderot, 100 Boulevard du Maréchal Leclerc, 92110, Clichy, France. alain.sauvanet@aphp.fr. ·BMC Gastroenterol · Pubmed #29166862.

ABSTRACT: BACKGROUND: Gastric stump carcinoma is an exceptional and poorly known long-term complication after pancreaticoduodenectomy. CASES PRESENTATION: Two patients developed gastric stump carcinoma 19 and 10 years after pancreaticoduodenectomy for malignant ampulloma and total pancreaticoduodenectomy for pancreatic adenocarcinoma, respectively. Both patients had pT4 signet-ring cell carcinoma involving the gastrojejunostomy site that was revealed by bleeding or obstruction. Patient 1 is alive and remains disease-free 36 months after completion gastrectomy. Patient 2 presented with peritoneal carcinomatosis and died after palliative surgery. We identified only 3 others cases in the English literature. CONCLUSIONS: Prolonged biliary reflux might be the most important risk factor of gastric stump carcinoma following pancreaticoduodenectomy. Its incidence might increase in the future due to prolonged survival observed after pancreaticoduodenectomy for benign and premalignant lesions.

21 Review Revisions of international consensus Fukuoka guidelines for the management of IPMN of the pancreas. 2017

Tanaka, Masao / Fernández-Del Castillo, Carlos / Kamisawa, Terumi / Jang, Jin Young / Levy, Philippe / Ohtsuka, Takao / Salvia, Roberto / Shimizu, Yasuhiro / Tada, Minoru / Wolfgang, Christopher L. ·Department of Surgery, Shimonoseki City Hospital, Shimonoseki, Japan. Electronic address: masaotan@med.kyushu-u.ac.jp. · Pancreas and Biliary Surgery Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. · Department of Gastroenterology, Komagome Metropolitan Hospital, Tokyo, Japan. · Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea. · Pôle des Maladies de l'Appareil Digestif, Service de Gastroentérologie-Pancréatologie, Hopital Beaujon, Clichy Cedex, France. · Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. · Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy. · Dept. of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Japan. · Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. · Cameron Division of Surgical Oncology and The Sol Goldman Pancreatic Cancer Research Center, Department of Surgery, Johns Hopkins University, Baltimore, MD, USA. ·Pancreatology · Pubmed #28735806.

ABSTRACT: The management of intraductal papillary mucinous neoplasm (IPMN) continues to evolve. In particular, the indications for resection of branch duct IPMN have changed from early resection to more deliberate observation as proposed by the international consensus guidelines of 2006 and 2012. Another guideline proposed by the American Gastroenterological Association in 2015 restricted indications for surgery more stringently and recommended physicians to stop surveillance if no significant change had occurred in a pancreatic cyst after five years of surveillance, or if a patient underwent resection and a non-malignant IPMN was found. Whether or not it is safe to do so, as well as the method and interval of surveillance, has generated substantial debate. Based on a consensus symposium held during the meeting of the International Association of Pancreatology in Sendai, Japan, in 2016, the working group has revised the guidelines regarding prediction of invasive carcinoma and high-grade dysplasia, surveillance, and postoperative follow-up of IPMN. As the working group did not recognize the need for major revisions of the guidelines, we made only minor revisions and added most recent articles where appropriate. The present guidelines include updated information and recommendations based on our current understanding, and highlight issues that remain controversial or where further research is required.

22 Review Pancreatic resection in the era of laparoscopy: State of Art. A systematic review. 2017

Cesaretti, Manuela / Bifulco, Lelio / Costi, Renato / Zarzavadjian Le Bian, Alban. ·Service de Chirurgie Hépatique, Pancréatique et Biliaire, Transplantation Hépatique, Hôpital Beaujon, Assistance Publique - Hôpitaux de Paris, Université Paris Diderot-VII, Clichy, 92110, France; Service de Chirurgie Digestive, Hôpital Simone Veil, Eaubonne, 95600, France. · Service de Chirurgie Digestive, Hôpital Simone Veil, Eaubonne, 95600, France. · Service de Chirurgie Digestive, Hôpital Simone Veil, Eaubonne, 95600, France; Dipartimento di Scienze Chirurgiche, Università degli Studi di Parma, Parma, 43100, Italy. · Service de Chirurgie Digestive, Hôpital Simone Veil, Eaubonne, 95600, France; Laboratoire d'Ethique Médicale et de Médecine Légale, Université Paris Descartes - V, Paris, 75006, France. Electronic address: spleen2008@live.fr. ·Int J Surg · Pubmed #28689866.

ABSTRACT: BACKGROUND: Innovation in surgical devices and improvement in laparoscopic skills have gradually led to achieve more challenging surgical procedures. Among these demanding interventions is the pancreatic surgery that is seen as intraoperatively risky and with high postoperative morbi-mortality rate. In order to understand the complexity of laparoscopic pancreatic surgery, we performed a systematic review of literature. DATA SOURCE: A systematic review of literature was performed regarding laparoscopic pancreatic resection. RESULTS: Laparoscopic approach in pancreas resections has been extensively reported as safe and feasible regarding pancreaticoduodenectomy, distal pancreatectomy and pancreatic enucleation. Compared to open approach, no benefit in morbi-mortality has been demonstrated (except for laparoscopic distal pancreatectomy) and no controlled randomized trials have been reported. CONCLUSIONS: Laparoscopic approach is not workable in all patients and patient selection is not standardized. Additionally, most optimistic reports considering laparoscopic approach are produced by tertiary centres. Currently, two tasks should be accomplished 1°) standardization of the laparoscopic pancreatic procedures 2°) comparative trials to assess endpoint benefits of laparoscopic pancreatic resection compared with open procedures.

23 Review Pancreatico-jejunal anastomoses after pancreatoduodenectomy. 2017

Sauvanet, A. ·Pôle des maladies de l'appareil digestif, service de chirurgie hépatobiliaire et pancréatique, hôpital Beaujon, université Paris VII, 100, boulevard Général-Leclerc, 92110 Clichy, France. Electronic address: alain.sauvanet@aphp.fr. ·J Visc Surg · Pubmed #28688776.

ABSTRACT: -- No abstract --

24 Review What treatment in 2017 for inoperable pancreatic cancers? 2017

Taieb, J / Pointet, A-L / Van Laethem, J L / Laquente, B / Pernot, S / Lordick, F / Reni, M. ·Hepatogastroenterology and GI Oncology Department, Sorbonne Paris Cité, Paris Descartes University, Georges Pompidou European Hospital, Paris, France. · Department of Gastroenterology and Digestive Oncology, Erasme University Hospital, ULB, Brussels, Belgium. · Medical Oncology Department, Catalan Institute of Oncology, L'Hospitalet, Barcelona, Spain. · University Cancer Center Leipzig (UCCL), University Medicine Leipzig, Leipzig, Germany. · Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy. ·Ann Oncol · Pubmed #28459988.

ABSTRACT: Pancreatic adenocarcinoma is a frequent and severe disease, either diagnosed as metastatic pancreatic adenocarcinoma (MPA) or as locally advanced pancreatic carcinoma (LAPC). Though no improvement in patients outcome have been made between 1996 and 2011, since 5 years new treatment options have become available to treat our patients. New standard first line regimens, such as FOLFIRINOX and gemcitabine combined with nab-paclitaxel, have improved overall survivals and second line treatments have been tested and validated. Other first-line treatments have failed, but research remains active and trials are ongoing with promising new anti-cancer agents. These new effective regimens used for MPA have yielded promising results in LAPC patients in open cohorts or phase II trials and a recent trial have failed to demonstrate the added value of classical external radiotherapy in this setting. Here, we review current standards of care in LAPC and MPA, consider the latest challenges and strategic questions, and examine what we may hope for in the future.

25 Review Surveillance strategy for small asymptomatic non-functional pancreatic neuroendocrine tumors - a systematic review and meta-analysis. 2017

Sallinen, Ville / Le Large, Tessa Y S / Galeev, Shamil / Kovalenko, Zahar / Tieftrunk, Elke / Araujo, Raphael / Ceyhan, Güralp O / Gaujoux, Sebastien. ·Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. Electronic address: ville.sallinen@helsinki.fi. · Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands. · General Surgery Department, Saint Luke's Clinical Hospital, Saint-Petersburg, Russia. · Federal Medical and Rehabilitation Center, Department of Surgical Oncology, Moscow, Russia. · Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. · Department of Upper Gastrointestinal and Hepato-Pancreato-Biliary Surgery, Barretos Cancer Hospital, Barretos, São Paulo, Brazil. · Department of Digestive and Endocrine Surgery, Cochin Hospital, APHP, Paris, France; Faculté de Médecine Paris Descartes, Université Paris Descartes, Sorbonne Paris Cité, France. Electronic address: sebastien.gaujoux@aphp.fr. ·HPB (Oxford) · Pubmed #28254159.

ABSTRACT: BACKGROUND: Non-functional pancreatic neuroendocrine tumors (NF-PNET) are rare neoplasms being increasingly diagnosed. Surgical treatment or expectant management are both suggested for small NF-PNETs. The aim of this study was to evaluate the outcome of surveillance strategy for small NF-PNETs. METHODS: A systematic search was performed up to March 2016 in MEDLINE, EMBASE and the Cochrane Library according to the PRISMA guidelines. Data was pooled using the random-effects model. RESULTS: Nine articles including 344 patients with sporadic and 64 patients with MEN1 related NF-PNET were selected. Tumor growth was observed in 22% and 52%, development of metastases were reported on 0% and 9%, and rate of secondary surgical resection was 12% and 25% in patients with sporadic or MEN1 related NF-PNETs, respectively. All metastases (1 distant, 4 nodal) were reported by a single study in patients with MEN1. Reason for secondary surgery was tumor growth in half of patients undergoing surgery. DISCUSSION: Expectant management of small asymptomatic, sporadic, NF-PNETs could be a reasonable option in highly selected patients. However, the level of evidence is low and longer follow-up is needed to identify patients could benefit from upfront surgery instead of expectant treatment.

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