Retrospective analysis of dual-phase MDCT and follow-up EUS/EUS-FNA in the diagnosis of pancreatic cancer

Background The optimal approach for detecting small pancreatic tumors is uncertain. We compared multidetector CT (MDCT) with follow-up endoscopic ultrasonography (EUS) without or with fine-needle aspiration (EUS-FNA) for diagnosing pancreatic cancer. Methods Patients with suspicion of pancreatic cancer who underwent dual-phase MDCT and follow-up EUS were retrospectively reviewed. This consisted of scoring MDCT scans independently by three radiologists on a 1–5 scale of certainty, determining whether a stent was present, scoring EUS reports regarding presence of a mass and analyzing EUS-FNA results. Results A total of 117 patients underwent MDCT and EUS. ROC values for MDCT were 0.85, 0.87, and 0.91. There was no significant difference in the accuracy of EUS and MDCT. Follow-up EUS (99%) was significantly more sensitive than MDCT (89% and 93%), as interpreted by two radiologists. Follow-up EUS was statistically significantly more sensitive than MDCT (96% vs. 70%) for one radiologist for tumors < 2 cm. Specificity of EUS was 50%, and sensitivity of EUS-FNA was 82%. Negative predictive value of EUS-FNA was significantly less in patients with (21%) than without (70%) biliary stents. Conclusions Follow-up EUS improves lesion detection over MDCT alone. Close follow-up/repeat biopsy should be considered if FNA is negative, but EUS is positive.     

Segmental renal artery embolization in solitary renal carcinoma

Segmental renal artery embolization was performed as an alternative method to treat solitary renal carcinoma in 2 patients who were poor surgical candidates. In the first patient, a recurrent renal carcinoma in a solitary kidney was selectively embolized. Tumor regression was observed eighteen months later. Recanalization of the segmental artery and collateral from the capsular artery required a second embolization. In the second patient with a transitional cell carcinoma involving the lower half of the only functioning kidney, segmental renal artery embolization successfully controlled his persistent gross hematuria.     

Development of biologic markers of response and assessment of antiangiogenic activity in a clinical trial of human recombinant endostatin.

PURPOSE: Angiogenesis is a target for the treatment of cancer and other diseases, and its complex biology suggests that establishing the appropriate dose and schedule for antiangiogenic treatment will require extensive study. We present the initial results of a dose-finding clinical trial of recombinant human endostatin (rh-Endo) that examined potential surrogates for response to antiangiogenic therapy. PATIENTS AND METHODS: Twenty-five patients were treated with escalating doses of rh-Endo. Positron emission tomography (PET) was used to assess tumor blood flow (with [15O]H2O) and metabolism (with [18F]fluorodeoxyglucose) before the start of therapy and then every 4 weeks. To directly assess the effects of rh-Endo on endothelial cells within the tumors, biopsy specimens of tumor tissue were obtained before therapy and again at 8 weeks and evaluated for endothelial cell and tumor cell apoptosis. RESULTS: Tumor blood flow and metabolism as measured by PET scans generally decreased with increasing doses of rh-Endo; however, the effects were complex and in some analyses nonlinear. Tumor biopsy analysis revealed a significant increase in tumor cell apoptosis (P =.027) and endothelial cell apoptosis (P =.027) after 8 weeks of therapy. However, there was no statistically significant relationship between rh-Endo dose and induction of tumor cell or endothelial cell apoptosis. CONCLUSION: These initial data suggest that rh-Endo has measurable effects on tumor blood flow and metabolism and induces endothelial and tumor cell apoptosis even in the absence of demonstrable anticancer effects. Further study and validation of these biomarkers in the context of antiangiogenic therapy will be required.     

Portal thrombosis and steatosis after preoperative chemotherapy with FOLFIRI-bevacizumab for colorectal liver metastases

INTRODUCTIONSurgical resection of colorectal liver metastases is nowadays a standard of care for resectable disease with5-year survival rate approaching60%[1-3].Because of several theoretical benefits,preoperative systemic chemotherapy has been frequently…     

Response of borderline resectable pancreatic cancer to neoadjuvant therapy is not reflected by radiographic indicators

BACKGROUND:

Experience with preoperative therapy for other cancers has led to an assumption that borderline resectable pancreatic cancers can be converted to resectable cancers with preoperative therapy. In this study, the authors sought to determine the rate at which neoadjuvant therapy is associated with a reduction in the size or stage of borderline resectable tumors.

METHODS:

Patients who had borderline resectable pancreatic cancer and received neoadjuvant therapy before potentially undergoing surgery at the authors' institution between 2005 and 2010 were identified. The patients' pretreatment and post‐treatment pancreatic protocol computed tomography images were rereviewed to determine changes in tumor size or stage using modified Response Evaluation Criteria in Solid Tumors (RECIST) (version 1.1) and standardized anatomic criteria.

RESULTS:

The authors identified 129 patients who met inclusion criteria. Of the 122 patients who had their disease restaged after receiving preoperative therapy, 84 patients (69%) had stable disease, 15 patients (12%) had a partial response to therapy, and 23 patients (19%) had progressive disease. Although only 1 patient (0.8%) had their disease downstaged to resectable status after receiving neoadjuvant therapy, 85 patients (66%) underwent pancreatectomy. The median overall survival duration for all 129 patients was 22 months (95% confidence interval, 14‐30 months). The median overall survival duration for the patients who underwent pancreatectomy was 33 months (95% confidence interval, 25‐41 months) and was not associated with RECIST response (P = .78).

CONCLUSIONS:

Radiographic downstaging was rare after neoadjuvant therapy, and RECIST response was not an effective treatment endpoint for patients with borderline resectable pancreatic cancer. The authors concluded that these patients should undergo pancreatectomy after initial therapy in the absence of metastases. Cancer 2012. © 2012 American Cancer Society.