Recent Developments in the Treatment of Pancreatic Cancer.

Pancreatic duct adenocarcinoma is currently the sixth-leading cause of cancer death worldwide and the fourth in Europe, with a continuous increase in annual lethality in Portugal during the last two decades. Surgical en-bloc resection of the tumor with microscopic-negative margins and an adequate lymphadenectomy is the only possibility of long-term survival. As this type of cancer is a systemic disease, there is a high rate of recurrence even after curative resection, turning systemic therapy the core of its management, mostly based on chemotherapy. Neoadjuvant strategies for nonmetastatic disease showed significant improvement in overall survival compared with upfront surgery, namely in borderline resectable disease. Moreover, these strategies provided downstaging in several situations allowing R0 resections. Under these new oncologic strategies, several recent surgical issues were introduced, namely more aggressive vascular resections and even tumor resections in oligometastatic disease. This review revisits the state-of-the-art of surgical and oncological interventions in pancreatic duct adenocarcinoma and highlights recent advances in the field aiming to achieve higher survival rates.

Macular Cystoid Edema Induced by Nab-Paclitaxel.

A 61-year old male was referred to the Ophthalmology department because of decreased bilateral visual acuity. The patient had metastatic pancreatic adenocarcinoma and was being treated with gemcitabine+nab-paclitaxel. On examination, the patient presented best corrected visual acuities of 4/20 and 2/20 in the right and left eye, respectively. The optical coherence tomography revealed bilateral severe macular edema. Macular edema was considered secondary to nab-paclitaxel and the drug was discontinued. Three months after drug discontinuation, the patient presented best corrected visual acuities of 20/20 and 16/20 in the right and left eye, respectively, and normal fundoscopy. Macular edema is a very rare side effect of taxanes, and the etiopathology is still unknown. Edema is usually reversible upon discontinuation of the offending agent. Clinicians should be aware of this adverse effect of taxanes, and a high index of clinical suspicion is essential for diagnosis.

Doente do sexo masculino, de 61 anos de idade, foi encaminhado para Oftalmologia por queixas de diminuição da acuidade visual bilateral. Tratava-se de um doente com um adenocarcinoma pancreático metastizado, sob tratamento com gemcitabina+nab-paclitaxel. Ao exame oftalmológico, o doente apresentava melhores acuidades visuais corrigidas de 4/20 e 2/20 do olho direito e esquerdo, respetivamente. A tomografia de coerência ótica revelou a presença de edema macular bilateral grave. O edema macular foi considerado secundário ao uso de nab-paclitaxel, pelo que o fármaco foi suspenso. Três meses após a suspensão do fármaco, o paciente apresentava acuidades visuais de 20/20 e 16/20 do olho direito e esquerdo, respetivamente, e uma fundoscopia normal. O edema macular é um efeito adverso muito raro dos taxanos e a sua etiopatologia ainda não se encontra totalmente esclarecida. O edema é habitualmente reversível após a suspensão do agente causador. Um elevado índice de suspeição é essencial para o diagnóstico desta condição.

Clinical efficacy of three-dimensional conformal radiotherapy combined with thermochemotherapy in the treatment of locally advanced pancreatic cancer / 中国医师杂志

Objective To evaluate the clinical efficacy of three-dimensional conformal radiotherapy (3D-CRT) combined with thermochemotherapy in the treatment of locally advanced pancreatic cancer (LAPC).Methods From June 2008 to June 2011,70 patients with LAPC were divided into radiotherapy group (30 patients) and combination group (40 patients).Radiotherapy used 3D-CRT with a 90％ to 95％ isodose curve,a single dose of 1.8 to 2.OGy,and total radiation dose 50 ～ 70 Gy.The combination group patients received simultaneous thermotherapy at 41.5 ～43.5 ℃ (1 h/fraction,twice a week for 6 times),and hyperthermia given simultaneously injected using arsenic trioxide 20 mg,recombinant mutant human tumor necrosis factor(rmhTNF) intravenous infusion of 10 million U,4 to 6 times,or 3D-CRT at the same time and the treatment given after gemcitabine(0.6 ～ 1.0 g/m2) on Days dl and 8 and cisplatin (DDP) (20 ～ 30 mg/m2) on Days d1-3 intravenous infusion,repeated every 28 days for 3 ～ 6 cycles.Results At 3 months after treatment,the total response (complete remission and partial remission) rate was 70.0％ (49/70),the efficiency of radiotherapy combined with chemotherapy,and radiotherapy combined with thermo-chemotherapy were 56.5％ and 88.2％,and the radiotherapy alone group was 56.7％.There were significant difference in efficiency between radiotherapy combined with thermo-chemotherapy group compared to radiotherapy-chemotherapy group and radiotherapy group (x2 =4.68,4.98,P ＜ 0.05),the last two groups showed no significant difference (P ＞ 0.05).The 1-year and 2-year survival rate was 46.8％ and 20.3％,respectively.The 1-year and 2-year survival rates were 52.4％ and 26.7％ in combination group,and 42.5％ and 16.2％ in radiotherapy group (x2 =14.17,P ＜ 0.05 ; x2 =9.74,P ＜ 0.05).No serious complications such as perforation,bleeding,and high fever were seen during treatment and follow-up.Conclusions 3D-CRT combined with thermochemotherapy is well tolerated and is relatively effective for the LAPC patients.