23 results on '"Crane CH"'
Search Results
2. Evaluation of Adjuvant Radiation Therapy for Resected Gallbladder Carcinoma: A Multi-institutional Experience.
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Wang J, Narang AK, Sugar EA, Luber B, Rosati LM, Hsu CC, Fuller CD, Pawlik TM, Miller RC, Czito BG, Tuli R, Crane CH, Ben-Josef E, Thomas CR Jr, and Herman JM
- Subjects
- Adenocarcinoma secondary, Adenocarcinoma surgery, Adult, Aged, Aged, 80 and over, Combined Modality Therapy, Female, Follow-Up Studies, Gallbladder Neoplasms pathology, Gallbladder Neoplasms surgery, Humans, Lymph Node Excision, Male, Middle Aged, Neoplasm Grading, Neoplasm Recurrence, Local drug therapy, Neoplasm Recurrence, Local pathology, Neoplasm Staging, Prognosis, Survival Rate, Adenocarcinoma radiotherapy, Gallbladder Neoplasms radiotherapy, Radiotherapy, Adjuvant
- Abstract
Purpose: The role of adjuvant radiation for gallbladder carcinoma (GBC) is uncertain. We combine the experience of six National Cancer Institute-designated cancer centers to explore the impact of adjuvant radiation following oncologic resection of GBC., Methods: Patients who underwent extended surgery for GBC at Johns Hopkins, Mayo Clinic, Duke University, Oregon Health & Science University, University of Michigan, and University of Texas MD Anderson between 1985 and 2008 were reviewed. Patients with metastatic disease at surgery, gross residual disease, or missing pathologic information were excluded., Results: Of the 112 patients identified, 61 % received adjuvant radiation, 93 % of whom received concurrent chemotherapy. Median follow-up of surviving patients was 47.3 (range 2.2-167.7) months. Patients who received adjuvant radiation had a higher rate of advanced T-stage (57 vs. 16 %, p < 0.01), lymph node involvement (63 vs. 18 %, p < 0.01), and positive microscopic margins (37 vs. 9 %, p < 0.01) compared with patients managed with surgery alone, but overall survival (OS) was comparable between the two cohorts (5-year OS: 49.7 vs. 52.5 %, p = 0.20). Lymph node involvement had the strongest association with poor OS (p < 0.01). Adjuvant radiation was associated with decreased isolated local failure (hazard ratio 0.17, 95 % confidence interval 0.05-0.63, p = 0.01). However, 71 % of recurrences included distant failure., Conclusions: Following oncologic resection for GBC, adjuvant radiation may offer improved local control compared with observation. The benefit of adjuvant radiation beyond chemotherapy alone should therefore be explored. Certainly, the high rate of distant failure highlights the need for more effective systemic therapy.
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- 2015
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3. The Addition of Postoperative Chemotherapy is Associated with Improved Survival in Patients with Pancreatic Cancer Treated with Preoperative Therapy.
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Roland CL, Katz MH, Tzeng CW, Lin H, Varadhachary GR, Shroff R, Javle M, Fogelman D, Wolff RA, Vauthey JN, Crane CH, Lee JE, and Fleming JB
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- Adenocarcinoma drug therapy, Adenocarcinoma pathology, Adenocarcinoma surgery, Adult, Aged, Aged, 80 and over, Carcinoma, Pancreatic Ductal drug therapy, Carcinoma, Pancreatic Ductal pathology, Carcinoma, Pancreatic Ductal surgery, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neoplasm Recurrence, Local drug therapy, Neoplasm Recurrence, Local pathology, Neoplasm Recurrence, Local surgery, Neoplasm Staging, Pancreatic Neoplasms drug therapy, Pancreatic Neoplasms pathology, Pancreatic Neoplasms surgery, Postoperative Care, Preoperative Care, Prognosis, Prospective Studies, Retrospective Studies, Survival Rate, Adenocarcinoma mortality, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Carcinoma, Pancreatic Ductal mortality, Neoplasm Recurrence, Local mortality, Pancreatectomy mortality, Pancreatic Neoplasms mortality
- Abstract
Background: Preoperative/neoadjuvant therapy (NT) is increasingly utilized for the treatment of pancreatic ductal adenocarcinoma (PDAC). However, little data exist regarding information on the use of additional postoperative therapy following NT. The lymph node ratio (LNR) is a prognostic marker of oncologic outcomes after NT and resection. In this study, we evaluated the effectiveness of postoperative therapy following NT, stratified by LNR., Methods: A prospective tumor registry database was queried to identify patients with PDAC who underwent resection following NT from 1990 to 2008. Clinicopathologic factors were compared to identify associations with overall survival (OS) and time to recurrence (TTR) based on postoperative chemotherapy status., Results: Thirty-six (14 %) of the 263 patients received additional postoperative therapy. No differences were observed in the pathologic characteristics between patients who received postoperative chemotherapy and those who did not. The median LNR was 0.12 for patients with N + disease. Following NT, the administration of postoperative therapy was associated with improved median OS (72 vs. 33 months; p = 0.008) for patients with an LNR < 0.15. There was no association between postoperative chemotherapy and OS for patients with LNR ≥ 0.15. Multivariate analysis demonstrated that the administration of postoperative systemic therapy in patients with a low LNR was associated with a reduced risk of death (hazard ratio 0.49; p = 0.02)., Conclusion: Postoperative chemotherapy after NT in patients with low LNR is associated with improved oncologic outcomes.
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- 2015
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4. Interstitial Brachytherapy for the Treatment of Locally Recurrent Anorectal Cancer.
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Bishop AJ, Gupta S, Cunningham MG, Tao R, Berner PA, Korpela SG, Ibbott GS, Lawyer AA, and Crane CH
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- Adult, Aged, Anus Neoplasms pathology, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neoplasm Recurrence, Local pathology, Neoplasm Staging, Palliative Care, Pelvic Neoplasms pathology, Prognosis, Radiotherapy Dosage, Rectal Neoplasms pathology, Retrospective Studies, Survival Rate, Tomography, X-Ray Computed, Anus Neoplasms radiotherapy, Brachytherapy, Neoplasm Recurrence, Local radiotherapy, Pelvic Neoplasms radiotherapy, Radiotherapy, Image-Guided, Rectal Neoplasms radiotherapy
- Abstract
Background: Local tumor control (LC), overall survival (OS), symptom palliation, and late toxicity for patients with locally recurrent anorectal cancer treated with a computed tomography (CT)-guided interstitial brachytherapy implant were examined., Methods: The medical records of 20 consecutive patients who had received interstitial brachytherapy for locally recurrent anorectal cancer from 2000 through 2012 were reviewed. Seventeen patients (85 %) had rectal cancer and three had anal cancer [median follow-up time for living patients, 23 months (range 13-132)]. Brachytherapy was used most commonly at the second pelvic recurrence (n = 13, 65 %). The implant dose was prescribed to 80 Gy to a 1-cm margin or 120 Gy to 100 % of the gross tumor volume. Endpoints were OS, LC, toxicity, and symptom palliation rate, all calculated from the time of implant., Results: The actuarial 1-year rates of LC and OS were 80 and 95 %, respectively. At presentation, 17 patients (85 %) had symptoms related to the treated tumor which were palliated in 13 patients (76 %) at a median time of 3 months (range 1-6); palliation was permanent for seven patients (54 %), and the other six patients lost palliation after a median 8 months (range 5-17). One patient experienced a grade 3 late complication requiring a stent for hydronephrosis; five had grade 2 toxicity, and four had grade 1 toxicity., Conclusions: CT-guided interstitial brachytherapy for locally recurrent anorectal tumors produced durable tumor control and long-term survival, with effective palliation and minimal long-term morbidity.
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- 2015
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5. Neoadjuvant therapy is associated with a reduced lymph node ratio in patients with potentially resectable pancreatic cancer.
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Roland CL, Yang AD, Katz MH, Chatterjee D, Wang H, Lin H, Vauthey JN, Pisters PW, Varadhachary GR, Wolff RA, Crane CH, Lee JE, and Fleming JB
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- Adenocarcinoma mortality, Adenocarcinoma secondary, Adult, Aged, Aged, 80 and over, Carcinoma, Pancreatic Ductal mortality, Carcinoma, Pancreatic Ductal secondary, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Lymphatic Metastasis, Male, Middle Aged, Neoplasm Grading, Neoplasm Invasiveness, Neoplasm Recurrence, Local mortality, Neoplasm Recurrence, Local pathology, Neoplasm Staging, Pancreatectomy, Pancreatic Neoplasms mortality, Pancreatic Neoplasms pathology, Prognosis, Survival Rate, Adenocarcinoma therapy, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Carcinoma, Pancreatic Ductal therapy, Lymph Nodes pathology, Neoadjuvant Therapy, Neoplasm Recurrence, Local therapy, Pancreatic Neoplasms therapy
- Abstract
Background: The use of neoadjuvant therapy (NAC) for the treatment of potentially resectable pancreatic cancer remains controversial. In this study, we sought to evaluate cancer-specific endpoints in patients undergoing a NAC versus a surgery-first (SF) approach with specific emphasis on lymph node metastases., Methods: A total of 222 patients who underwent NAC and 85 patients who underwent SF were identified from 1990 to 2008 and compared for cancer-related endpoints. Peripancreatic lymph nodes from 135 neoadjuvant therapy patients were evaluated for histologic tumor regression., Results: Patients who underwent NAC followed by surgery had improved overall survival and time to local recurrence compared with the SF approach. NAC patients were less likely to have lymph node metastases (p = 0.001), lymphovascular invasion (LVI), and had smaller tumors. On multivariate analysis, lymph node positivity was associated with SF, tumor size, and the presence of LVI. NAC patients with N0 disease had equivalent outcomes to patients with a low-LNR (0.01-0.15), whereas patients with a LNR >0.15 had reduced survival, and time to local and distant recurrence. Ten of 135 (7.4 %) NAC patients had evidence of tumor regression in at least one lymph node., Conclusions: Patients with potentially resectable PDAC selected to undergo NAC had improved survival and longer time to recurrence. Although some of these differences may be related to improvements in multimodality therapy completion rates, tumor regression in lymph node metastases exists and may demonstrate a biologic benefit of NAC compared with a SF approach.
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- 2015
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6. The cost-effectiveness of neoadjuvant chemoradiation is superior to a surgery-first approach in the treatment of pancreatic head adenocarcinoma.
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Abbott DE, Tzeng CW, Merkow RP, Cantor SB, Chang GJ, Katz MH, Bentrem DJ, Bilimoria KY, Crane CH, Varadhachary GR, Abbruzzese JL, Wolff RA, Lee JE, Evans DB, and Fleming JB
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- Adenocarcinoma mortality, Adenocarcinoma therapy, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Chemotherapy, Adjuvant, Combined Modality Therapy, Cost-Benefit Analysis, Follow-Up Studies, Humans, Neoplasm Staging, Pancreatic Neoplasms mortality, Pancreatic Neoplasms therapy, Prognosis, Prospective Studies, Quality-Adjusted Life Years, Radiotherapy, Adjuvant, Survival Rate, Adenocarcinoma economics, Chemoradiotherapy, Decision Support Techniques, Neoadjuvant Therapy, Pancreatectomy, Pancreatic Neoplasms economics
- Abstract
Background: In treating pancreatic cancer, there is no clearly defined optimal sequence of chemotherapy, radiation therapy and surgery. Therefore, cost-effectiveness should be considered. The objective of this study was to compare cost and outcomes between a surgery-first approach versus neoadjuvant chemoradiation followed by surgery for resectable pancreatic head cancer., Methods: A decision analytic model was constructed to compare the 2 approaches. Data from the National Cancer Database, National Surgical Quality Improvement Program, and literature populated the surgery-first arm. Data from our prospectively maintained institutional pancreatic cancer database populated the neoadjuvant arm. Costs were estimated by Medicare payment (2011 U.S. dollars). Survival was reported in quality-adjusted life-months (QALMs)., Results: The neoadjuvant chemoradiation arm consisted of 164 patients who completed preoperative therapy. Of these, 36 (22 %) did not proceed to surgery; 12 (7 %) underwent laparotomy but had unresectable disease; and 116 (71 %) underwent definitive resection. The surgery-first approach cost $46,830 and yielded survival of 8.7 QALMs; the neoadjuvant chemoradiation approach cost $36,583 and yielded survival of 18.8 QALMs. In the neoadjuvant arm, costs and survival times for patients not undergoing surgery, those with unresectable disease at laparotomy, and those completing surgery were $12,401 and 7.7 QALMs, $20,380 and 7.1 QALMs, and $45,673 and 23.4 QALMs, respectively., Conclusions: Neoadjuvant chemoradiation for pancreatic cancer identifies patients with early metastases or poor performance status, who can be spared an ineffective or prohibitively morbid operation, and is associated with improved survival at significantly lower cost than a surgery-first approach. Neoadjuvant chemoradiation followed by surgery is a strategy that provides more cost-effective care than a surgery-first approach.
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- 2013
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7. Is personalization of care coming to pancreatic oncology?
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Crane CH
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- Humans, Pancreatic Neoplasms diagnosis, Biomarkers, Tumor genetics, Pancreatic Neoplasms genetics, Pancreatic Neoplasms therapy, Precision Medicine
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- 2013
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8. A RAND/UCLA appropriateness study of the management of familial gastric cancer.
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Dixon M, Seevaratnam R, Wirtzfeld D, McLeod R, Helyer L, Law C, Swallow C, Paszat L, Bocicariu A, Cardoso R, Mahar A, Bekaii-Saab T, Chau I, Church N, Coit D, Crane CH, Earle C, Mansfield P, Marcon N, Miner T, Noh SH, Porter G, Posner MC, Prachand V, Sano T, Van de Velde CJ, Wong S, and Coburn N
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- Adult, Antigens, CD, Breast Neoplasms pathology, Breast Neoplasms surgery, Carcinoma, Lobular pathology, Carcinoma, Lobular surgery, Disease Management, Family, Female, Gastrectomy, Humans, Male, Middle Aged, Prognosis, Stomach Neoplasms pathology, Stomach Neoplasms surgery, Breast Neoplasms genetics, Cadherins genetics, Carcinoma, Lobular genetics, Genetic Predisposition to Disease, Genetic Testing, Mutation genetics, Stomach Neoplasms genetics
- Abstract
Background: Hereditary diffuse gastric cancer (HDGC) represents a minority of gastric cancer (GC) cases. The goal of this study is to use a RAND/University of California Los Angeles (UCLA) appropriateness methodology to examine indications for genetic referral, CDH1 testing, and consideration of prophylactic total gastrectomy (PTG)., Methods: A multidisciplinary expert panel of 16 physicians from six countries scored 47 scenarios. Appropriateness of scenarios was scored from 1 (highly inappropriate) to 9 (highly appropriate). Median appropriateness scores (AS) of 1-3 were considered inappropriate, 4-6 uncertain, and 7-9 appropriate. Agreement was reached when 12 of 16 panelists scored the statement similarly. Appropriate scenarios agreed upon were subsequently scored for necessity., Results: The panel felt that patients with family history of diffuse gastric cancer (DGC), lobular breast cancer, or multiple family members with GC should be referred for genetic assessment and multidisciplinary decision-making. The panel felt that it is appropriate for patients with DGC to have CDH1 mutation testing in a family with (1) ≥2 cases of GC, with at least one case of DGC diagnosed before age of 50 years; (2) ≥3 cases of GC diagnosed at any age, one or more of which is DGC; (3) a patient diagnosed with DGC and lobular breast carcinoma; or (4) patients diagnosed with DGC under age of 35 years. The panel felt that PTG should be offered to CDH1 mutation carriers 20 years or older., Conclusions: Identification of genetic mutations in patients at risk for hereditary GC is important, and criteria for testing are suggested.
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- 2013
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9. Defined clinical classifications are associated with outcome of patients with anatomically resectable pancreatic adenocarcinoma treated with neoadjuvant therapy.
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Tzeng CW, Fleming JB, Lee JE, Xiao L, Pisters PW, Vauthey JN, Abdalla EK, Wolff RA, Varadhachary GR, Fogelman DR, Crane CH, Balachandran A, and Katz MH
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- Adenocarcinoma mortality, Adenocarcinoma pathology, Adenocarcinoma therapy, Aged, Aged, 80 and over, Carcinoma, Pancreatic Ductal mortality, Carcinoma, Pancreatic Ductal pathology, Carcinoma, Pancreatic Ductal therapy, Cisplatin administration & dosage, Combined Modality Therapy, Deoxycytidine administration & dosage, Deoxycytidine analogs & derivatives, Female, Follow-Up Studies, Humans, Male, Neoplasm Staging, Pancreatic Neoplasms therapy, Prognosis, Retrospective Studies, Survival Rate, Gemcitabine, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Neoadjuvant Therapy mortality, Pancreatectomy mortality, Pancreatic Neoplasms mortality, Pancreatic Neoplasms pathology
- Abstract
Background: We previously introduced a classification system for patients with localized pancreatic adenocarcinoma that integrates assessments of tumor anatomy, cancer biology, and patient physiology. By means of this system, we sought to analyze outcomes of patients with resectable anatomy but heterogeneous biology and physiology who were treated with neoadjuvant therapy., Methods: We evaluated consecutive patients (2002-2007) with anatomically potentially resectable cancers treated with chemotherapy or chemoradiation before potential pancreatectomy. We compared clinical factors and outcomes of patients classified as having disease that was clinically resectable (CR; no extrapancreatic disease, preserved performance status); suspicion for extrapancreatic disease (BR-B); or marginal performance status or significant comorbidity (BR-C). Patients with borderline resectable anatomy (BR-A) were excluded., Results: Resection rates for 138 CR, 41 BR-B, and 38 BR-C patients were 75, 46, and 37%, respectively (P < 0.001). Metastases, detected during treatment in 23% of patients, were the most common contraindication to resection among CR (15%) and BR-B (46%) patients. Performance status rarely precluded surgery except among BR-C (32%) patients. Factors associated with selection against surgery were older age, poor performance status, pain, and therapeutic complications (P < 0.05). The median overall survival of all patients was 21 months. Resected and unresected BR-B and BR-C patients had median overall survival durations similar to those of resected and unresected CR patients, respectively (P > 0.22)., Conclusions: This system describes discrete clinical subgroups of patients with pancreatic cancer who have similar, potentially resectable tumor anatomy but heterogeneous physiology and cancer biology. It may be used with neoadjuvant therapy to predict outcomes, individualize treatment algorithms, and optimize survival.
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- 2012
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10. Survival and quality of life of patients with resected pancreatic adenocarcinoma treated with adjuvant interferon-based chemoradiation: a phase II trial.
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Katz MH, Wolff R, Crane CH, Varadhachary G, Javle M, Lin E, Evans DB, Lee JE, Fleming JB, and Pisters PW
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- Adenocarcinoma pathology, Adenocarcinoma therapy, Adult, Aged, Chemotherapy, Adjuvant, Cisplatin administration & dosage, Combined Modality Therapy, Female, Fluorouracil administration & dosage, Follow-Up Studies, Humans, Interferon alpha-2, Male, Middle Aged, Neoplasm Recurrence, Local mortality, Neoplasm Recurrence, Local pathology, Neoplasm Recurrence, Local therapy, Neoplasm Staging, Pancreatic Neoplasms pathology, Pancreatic Neoplasms therapy, Prognosis, Radiotherapy, Adjuvant, Recombinant Proteins therapeutic use, Survival Rate, Adenocarcinoma mortality, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Interferon-alpha therapeutic use, Pancreatic Neoplasms mortality, Pancreaticoduodenectomy, Quality of Life
- Abstract
Purpose: We conducted a phase II trial to assess the survival duration and quality of life of patients who received adjuvant interferon-based chemoradiation for pancreatic adenocarcinoma after pancreaticoduodenectomy., Methods: Patients with a performance status of 0 or 1 were enrolled to receive interferon-alfa-2b (3 million units MWF), cisplatin (30 mg/m(2), 6 doses) and 5-fluorouracil (5-FU; 175 mg/m(2)/day), concurrent with external-beam radiation (50.4 Gy) and followed by 2 courses of systemic 5-FU. The protocol was modified to include an optional 9 day break in the middle of chemoradiation. Quality of life was assessed by use of validated instruments., Results: Twenty-eight patients were eligible for analysis. The operation of 15 (54%) patients was performed at other institutions. All patients had T3 tumors, 22 (79%) had positive lymph nodes and 4 (14%) had positive (R1) margins. 24 (86%) patients completed therapy. In all, 25 (89%) patients experienced grade 3 toxicity and 3 (11%) patients were hospitalized. The most common grade 3 events were leukopenia (15, 54%) and neutropenia (12, 43%). No grade 4 toxicity occurred. Overall quality of life decreased during chemoradiation but returned to baseline thereafter and was stable throughout surveillance. 19 patients have died; the median follow-up of the 9 survivors is 62 months. The median OS duration of treated patients was 42.3 (95% confidence interval 30.5-54.2) months., Conclusions: Adjuvant interferon-based chemoradiation can be delivered safely and tolerably-though with substantial reversible toxicity-to patients of good performance status at an experienced cancer center. Therapy may be associated with an improvement in overall survival.
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- 2011
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11. Serum CA 19-9 as a marker of resectability and survival in patients with potentially resectable pancreatic cancer treated with neoadjuvant chemoradiation.
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Katz MH, Varadhachary GR, Fleming JB, Wolff RA, Lee JE, Pisters PW, Vauthey JN, Abdalla EK, Sun CC, Wang H, Crane CH, Lee JH, Tamm EP, Abbruzzese JL, and Evans DB
- Subjects
- Adenocarcinoma blood, Adenocarcinoma mortality, Adenocarcinoma therapy, Adult, Aged, Aged, 80 and over, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Combined Modality Therapy, Female, Humans, Male, Middle Aged, Pancreatic Neoplasms therapy, Pancreaticoduodenectomy, Radiotherapy Dosage, Radiotherapy, Adjuvant, Retrospective Studies, Survival Rate, Treatment Outcome, CA-19-9 Antigen blood, Neoadjuvant Therapy, Pancreatic Neoplasms blood, Pancreatic Neoplasms mortality
- Abstract
Purpose: The role of carbohydrate antigen (CA) 19-9 in the evaluation of patients with resectable pancreatic cancer treated with neoadjuvant therapy prior to planned surgical resection is unknown. We evaluated CA 19-9 as a marker of therapeutic response, completion of therapy, and survival in patients enrolled on two recently reported clinical trials., Patients and Methods: We analyzed patients with radiographically resectable adenocarcinoma of the head/uncinate process treated on two phase II trials of neoadjuvant chemoradiation. Patients without evidence of disease progression following chemoradiation underwent pancreaticoduodenectomy (PD). CA 19-9 was evaluated in patients with a normal bilirubin level., Results: We enrolled 174 patients, and 119 (68%) completed all therapy including PD. Pretreatment CA 19-9 <37 U/ml had a positive predictive value (PPV) for completing PD of 86% but a negative predictive value (NPV) of 33%. Among patients without evidence of disease at last follow-up, the highest pretreatment CA 19-9 was 1,125 U/ml. Restaging CA 19-9 <61 U/ml had a PPV of 93% and a NPV of 28% for completing PD among resectable patients. The area under the receiver-operating characteristics curve of pretreatment and restaging CA 19-9 levels for completing PD was 0.59 and 0.74, respectively. We identified no association between change in CA 19-9 and histopathologic response (P = 0.74)., Conclusions: Although the PPV of CA 19-9 for completing neoadjuvant therapy and undergoing PD was high, its clinical utility was compromised by a low NPV. Decision-making for patients with resectable PC should remain based on clinical assessment and radiographic staging.
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- 2010
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12. Challenges in the study of adjuvant chemoradiation after pancreaticoduodenectomy.
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Crane CH, Varadhachary GR, Wolff RA, and Fleming JB
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- Adenocarcinoma surgery, Combined Modality Therapy, Humans, Pancreatic Neoplasms surgery, Treatment Outcome, Adenocarcinoma radiotherapy, Pancreatic Neoplasms radiotherapy, Pancreaticoduodenectomy, Radiotherapy, Adjuvant
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- 2010
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13. Local excision after preoperative chemoradiation results in an equivalent outcome to total mesorectal excision in selected patients with T3 rectal cancer.
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Callender GG, Das P, Rodriguez-Bigas MA, Skibber JM, Crane CH, Krishnan S, Delclos ME, and Feig BW
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- Combined Modality Therapy, Digestive System Surgical Procedures, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neoplasm Staging, Preoperative Care, Rectal Neoplasms pathology, Retrospective Studies, Survival Rate, Treatment Outcome, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Radiotherapy Dosage, Rectal Neoplasms surgery, Rectal Neoplasms therapy
- Abstract
Background: We previously reported 26 patients who underwent preoperative chemoradiotherapy (CXRT) for T3 rectal cancer and were subsequently offered full-thickness local excision (LE) as an alternative to total mesorectal excision (TME). At nearly 4 years' follow-up, no difference in outcome was observed. This study compares outcomes in a larger cohort of patients and reevaluates the original 26 patients after longer follow-up., Methods: Retrospective review was performed of patients who underwent preoperative CXRT (radiation doses of 45, 50.4, or 52.5 Gy with concurrent 5-fluorouracil-based chemotherapy) followed by surgery for T3 rectal cancer. Forty-seven patients underwent LE (Kraske [n = 6] or transanal excision [n = 41]). 473 patients underwent TME (abdominoperineal resection [n = 141] or low anterior resection [n = 332]). Local recurrence, disease-free survival (DFS), disease-specific survival, and overall survival (OS) rates were compared., Results: Median follow-up was 63 months for the LE group and 59 months for the TME group. Twenty-three LE patients (49%) had a complete response to CXRT, 17 (36%) had microscopic residual disease, and 7 (15%) had gross residual disease, compared with 108 (23%), 89 (19%), and 276 (58%) TME patients, respectively. There was no significant difference between the 10-year actuarial local recurrence rate for the LE group versus the TME group (10.6% and 7.6%, respectively; P = .52), and no significant difference in DFS, disease-specific survival, or OS rates between groups., Conclusions: In selected patients who demonstrate an excellent response to preoperative CXRT for T3 rectal cancer, full-thickness LE offers comparable local control, DFS, and OS to that achieved with proctectomy and TME.
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- 2010
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14. Is there a role for intraoperative radiation therapy in patients with resected pancreatic adenocarcinoma?
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Meyer JJ and Crane CH
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- Adenocarcinoma surgery, Humans, Intraoperative Care, Pancreatic Neoplasms surgery, Adenocarcinoma radiotherapy, Pancreatic Neoplasms radiotherapy
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- 2009
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15. Long-term survival after multidisciplinary management of resected pancreatic adenocarcinoma.
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Katz MH, Wang H, Fleming JB, Sun CC, Hwang RF, Wolff RA, Varadhachary G, Abbruzzese JL, Crane CH, Krishnan S, Vauthey JN, Abdalla EK, Lee JE, Pisters PW, and Evans DB
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- Adenocarcinoma mortality, Adenocarcinoma surgery, Adult, Aged, Aged, 80 and over, Antineoplastic Agents administration & dosage, Combined Modality Therapy, Female, Humans, Male, Middle Aged, Neoadjuvant Therapy, Pancreatic Neoplasms mortality, Pancreatic Neoplasms surgery, Patient Care Team, Radiotherapy, Adjuvant, Survival Analysis, Adenocarcinoma therapy, Pancreatic Neoplasms therapy
- Abstract
Introduction: Actual 5-year survival rates of 10-18% have been reported for patients with resected pancreatic adenocarcinoma (PC), but the use of multimodality therapy was uncommon in these series. We evaluated long-term survival and patterns of recurrence in patients treated for PC with contemporary staging and multimodality therapy., Methods: We analyzed 329 consecutive patients with PC evaluated between 1990 and 2002 who underwent resection. Each received a multidisciplinary evaluation and a standard operative approach. Pre- or postoperative chemotherapy and/or chemoradiation were routine. Surgical specimens of 5-year survivors were re-reviewed. A multivariate model of factors associated with long-term survival was constructed., Results: Patients underwent pancreaticoduodenectomy (n = 302; 92%), distal (n = 20; 6%), or total pancreatectomy (n = 7; 2%). A total of 108 patients (33%) underwent vascular reconstruction, 301 patients (91%) received neoadjuvant or adjuvant therapy, 157 specimens (48%) were node positive, and margins were microscopically positive in 52 patients (16%). Median overall survival and disease-specific survival was 23.9 and 26.5 months. Eighty-eight patients (27%) survived a minimum of 5 years and had a median overall survival of 11 years. Of these, 21 (24%) experienced recurrence, 7 (8%) after 5 years. Late recurrences occurred most frequently in the lungs, the latest at 6.7 years. Multivariate analysis identified disease-negative lymph nodes (P = .02) and no prior attempt at resection (P = 0.01) as associated with 5-year survival., Conclusions: Our 27% actual 5-year survival rate for patients with resected PC is superior to that previously reported, and it is influenced by our emphasis on detailed staging and patient selection, a standardized operative approach, and routine use of multimodality therapy.
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- 2009
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16. Extrahepatic bile duct adenocarcinoma: patients at high-risk for local recurrence treated with surgery and adjuvant chemoradiation have an equivalent overall survival to patients with standard-risk treated with surgery alone.
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Borghero Y, Crane CH, Szklaruk J, Oyarzo M, Curley S, Pisters PW, Evans D, Abdalla EK, Thomas MB, Das P, Wistuba II, Krishnan S, and Vauthey JN
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- Adenocarcinoma mortality, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Bile Duct Neoplasms mortality, Combined Modality Therapy, Disease-Free Survival, Female, Humans, Lymphatic Metastasis, Male, Middle Aged, Neoplasm Staging, Prognosis, Retrospective Studies, Risk Factors, Survival Rate, Adenocarcinoma therapy, Bile Duct Neoplasms therapy, Bile Ducts, Extrahepatic, Neoplasm Recurrence, Local diagnosis
- Abstract
Background: Patients with resected extrahepatic bile duct adenocarcinoma who have microscopically positive resection margins and/or pathologic locoregional nodal involvement (R1pN1) have a high-risk of locoregional recurrence, and therefore, we advocate the use of adjuvant chemoradiation. To evaluate the safety and effectiveness of this treatment, we compared survival and side effects outcomes between such patients and patients with negative resection margins and pathologically negative nodes (R0pN0) who did not receive adjuvant treatment., Methods: Between 1984 and 2005, 65 patients were treated with curative-intended resection for extrahepatic bile duct adenocarcinoma. Patients with tumors arising in the gallbladder and periampullary region were excluded. Pathology and diagnostic images were centrally reviewed. Overall survival and locoregional recurrence outcomes for patients with standard-risk R0pN0 (surgery alone, or S group, n = 23) were compared with those of patients with high locoregional recurrence risk, R1 and/or pN1 (R1pN1) status who received adjuvant chemoradiation (S-CRT group, n = 42)., Results: The median follow-up for the entire group was 31 months. Patients in the S-CRT and S groups had a similar 5-year overall survival (36% vs. 42%, P = .6) and locoregional recurrence (5-year rate: 38% vs. 37%, P = .13). In the S-CRT group, three patients (7%) experienced an acute (grade 3 or more) side effect., Conclusions: Our finding of a lack of a survival difference between the S and S-CRT groups suggests that for patients with extrahepatic bile duct adenocarcinoma at high risk for locoregional recurrence (i.e., R1 resection or pN1 disease), adjuvant chemoradiation provides an equivalent overall survival despite of these worse prognostic features.
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- 2008
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17. The added value of multidisciplinary care for patients with pancreatic cancer.
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Evans DB, Crane CH, Charnsangavej C, and Wolff RA
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- Humans, Interdisciplinary Communication, Pancreatic Neoplasms therapy, Patient Care, Patient Care Team
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- 2008
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18. Radiotherapy for hepatocellular carcinoma: an overview.
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Krishnan S, Dawson LA, Seong J, Akine Y, Beddar S, Briere TM, Crane CH, and Mornex F
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- Dose-Response Relationship, Radiation, Humans, Radiotherapy trends, Carcinoma, Hepatocellular radiotherapy, Liver Neoplasms radiotherapy, Radiotherapy methods
- Published
- 2008
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19. Impact of induction chemotherapy and preoperative chemoradiotherapy on operative morbidity and mortality in patients with locoregional adenocarcinoma of the stomach or gastroesophageal junction.
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Fujitani K, Ajani JA, Crane CH, Feig BW, Pisters PW, Janjan N, Walsh GL, Swisher SG, Vaporciyan AA, Rice D, Welch A, Baker J, Faust J, and Mansfield PF
- Subjects
- Adenofibroma mortality, Adenofibroma pathology, Adult, Aged, Aged, 80 and over, Combined Modality Therapy, Female, Humans, Male, Middle Aged, Neoadjuvant Therapy, Neoplasm Staging, Postoperative Complications, Risk Factors, Stomach Neoplasms mortality, Stomach Neoplasms pathology, Stomach Neoplasms therapy, Adenofibroma therapy, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Esophagogastric Junction, Gastrectomy adverse effects, Radiotherapy, Adjuvant
- Abstract
Background: Significant tumor downstaging has been achieved in patients with localized gastric or gastroesophageal adenocarcinoma by induction chemotherapy and preoperative chemoradiotherapy (CTX-CTXRT). However, the influence of CTX-CTXRT on operative morbidity and mortality has not yet been clarified. The aim of the present study was to document the frequency and nature of morbidity and mortality after surgery combined with CTX-CTXRT, and identify factors predictive of postoperative complications in patients with localized gastric or gastroesophageal adenocarcinoma., Methods: A prospectively collected database on 71 consecutive patients who underwent CTX-CTXRT at M.D. Anderson Cancer Center between January 1997 and August 2004 was reviewed. Postoperative morbidity and mortality were investigated, and risk factors for overall complications were identified by multivariate logistic regression analysis., Results: Overall morbidity and mortality rates were 38.0% (27 patients) and 2.8% (2 patients), respectively. Age greater than 60 years [relative risk 11.3 (95% confidence interval 2.50-50.6)] and body mass index (BMI) of 26 kg/m(2) or above [relative risk 4.08 (95% confidence interval 1.08 to 15.4)] were significant risk factors for overall complications., Conclusions: CTX-CTXRT can be performed safely with an acceptable operative morbidity and a low operative mortality rate in patients with gastric or gastroesophageal cancer, with careful consideration of added risk associated with age and obesity.
- Published
- 2007
- Full Text
- View/download PDF
20. Results of surgical salvage after failed chemoradiation therapy for epidermoid carcinoma of the anal canal.
- Author
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Mullen JT, Rodriguez-Bigas MA, Chang GJ, Barcenas CH, Crane CH, Skibber JM, and Feig BW
- Subjects
- Adult, Aged, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Colectomy, Female, Humans, Male, Middle Aged, Radiotherapy, Survival Analysis, Treatment Failure, Treatment Outcome, Anus Neoplasms therapy, Carcinoma, Squamous Cell therapy, Neoplasm Recurrence, Local surgery, Neoplasm, Residual surgery
- Abstract
Background: The standard treatment for epidermoid carcinoma of the anal canal consists of combined radiation and chemotherapy. For patients who present with persistent or locally recurrent disease, salvage abdominoperineal resection is the treatment of choice. The purpose of this study is to review our experience with salvage surgery in this group of patients., Methods: From 1990-2002, 31 patients underwent radical salvage surgery with curative intent after failure of initial sphincter-conserving therapy, and the medical records of these patients were retrospectively reviewed. Clinicopathologic variables were determined and comparisons performed with the Cox proportional hazards model. Survival was calculated by the Kaplan-Meier method., Results: Eleven patients underwent radical salvage surgery for persistent disease and 20 patients for recurrent disease. The median follow-up time was 29 months. The actuarial 5-year overall survival was 64%. Twelve patients developed recurrent disease after radical salvage surgery. Patients who received an initial radiation dose of less than 55 Gy had a significantly worse survival than those who received at least 55 Gy as part of their initial treatment (5-year overall survival 37.5% vs. 75%; age-adjusted hazard ratio 8.2 [95% CI: 1.1-59.8], P = .037). The presence of positive lymph nodes at presentation also adversely affected survival (P < .05). Factors that were not found to have an impact on survival included the presence of persistent versus recurrent disease, tumor (T) stage, and margin status of resection., Conclusions: Long-term survival following salvage surgery for persistent or locally recurrent epidermoid carcinoma of the anal canal can be achieved in the majority of patients. However, patients who initially present with node-positive disease and patients who receive a radiation dose of less than 55 Gy as part of their initial chemoradiation therapy regimen have a worse prognosis after radical salvage surgery.
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- 2007
- Full Text
- View/download PDF
21. Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy.
- Author
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Varadhachary GR, Tamm EP, Abbruzzese JL, Xiong HQ, Crane CH, Wang H, Lee JE, Pisters PW, Evans DB, and Wolff RA
- Subjects
- Adult, Biomarkers, Tumor blood, Combined Modality Therapy, Female, Humans, Liver blood supply, Male, Middle Aged, Neoplasm Invasiveness, Neoplasm Staging, Pancreas blood supply, Pancreatic Neoplasms therapy, Patient Selection, Pancreatic Neoplasms pathology, Pancreatic Neoplasms surgery, Preoperative Care methods
- Abstract
With recent advances in pancreatic imaging and surgical techniques, a distinct subset of pancreatic tumors is emerging that blurs the distinction between resectable and locally advanced disease: tumors of "borderline resectability." In our practice, patients with borderline-resectable pancreatic cancer include those whose tumors exhibit encasement of a short segment of the hepatic artery, without evidence of tumor extension to the celiac axis, that is amenable to resection and reconstruction; tumor abutment of the superior mesenteric artery involving <180 degrees of the circumference of the artery; or short-segment occlusion of the superior mesenteric vein, portal vein, or their confluence with a suitable option available for vascular reconstruction because the veins are normal above and below the area of tumor involvement. With currently available surgical techniques, patients with borderline-resectable pancreatic head cancer are at high risk for a margin-positive resection. Therefore, our approach to these patients is to use preoperative systemic therapy and local-regional chemoradiation to maximize the potential for an R0 resection and to avoid R2 resections. In our experience, patients with favorable responses to preoperative therapy (radiographical evidence of tumor regression and improvement in serum tumor marker levels) are the subset of patients who have the best chance for an R0 resection and a favorable long-term outcome.
- Published
- 2006
- Full Text
- View/download PDF
22. The promises and potential pitfalls of organ preservation for locally advanced rectal cancer.
- Author
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Crane CH
- Subjects
- Humans, Lymphatic Metastasis, Neoadjuvant Therapy, Prognosis, Rectal Neoplasms drug therapy, Rectal Neoplasms radiotherapy, Anal Canal surgery, Rectal Neoplasms surgery, Rectum surgery
- Published
- 2006
- Full Text
- View/download PDF
23. Neoadjuvant chemoradiotherapy for adenocarcinoma of the pancreas: treatment variables and survival duration.
- Author
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Breslin TM, Hess KR, Harbison DB, Jean ME, Cleary KR, Dackiw AP, Wolff RA, Abbruzzese JL, Janjan NA, Crane CH, Vauthey JN, Lee JE, Pisters PW, and Evans DB
- Subjects
- Adenocarcinoma mortality, Adenocarcinoma surgery, Antineoplastic Agents therapeutic use, Chemotherapy, Adjuvant, Combined Modality Therapy methods, Deoxycytidine administration & dosage, Deoxycytidine analogs & derivatives, Female, Fluorouracil administration & dosage, Humans, Male, Middle Aged, Multivariate Analysis, Neoplasm Recurrence, Local epidemiology, Paclitaxel administration & dosage, Pancreatectomy adverse effects, Pancreatic Neoplasms mortality, Pancreatic Neoplasms surgery, Radiotherapy Dosage, Radiotherapy, Adjuvant, Survival Analysis, Treatment Outcome, Gemcitabine, Adenocarcinoma drug therapy, Adenocarcinoma radiotherapy, Pancreatic Neoplasms drug therapy, Pancreatic Neoplasms radiotherapy
- Abstract
Background: For patients with potentially resectable pancreatic cancer, the poor outcome associated with resection alone and the survival advantage demonstrated for combined-modality therapy have stimulated interest in preoperative chemoradiotherapy. The goal of this study was to analyze the effects of different preoperative chemoradiotherapy schedules, intraoperative radiation therapy, patient factors. and histopathologic variables on survival duration and patterns of treatment failure in patients who underwent pancreaticoduodenectomy for adenocarcinoma of the pancreatic head., Methods: Data on 132 consecutive patients who received preoperative chemoradiation followed by pancreaticoduodenectomy for adenocarcinoma of the pancreatic head between June 1990 and June 1999 were retrieved from a prospective pancreatic tumor database. Patients received either 45.0 or 50.4 Gy radiation at 1.8 Gy per fraction in 28 fractions or 30.0 Gy at 3.0 Gy per fraction in 10 fractions with concomitant infusional chemotherapy (5-fluorouracil, paclitaxel, or gemcitabine). If restaging studies demonstrated no evidence of disease progression, patients underwent pancreaticoduodenectomy. All patients were evaluated with serial postoperative computed tomography scans to document first sites of tumor recurrence., Results: The overall median survival from the time of tissue diagnosis was 21 months (range 19-26, 95%CI). At last follow-up, 41 patients (31%) were alive with no clinical or radiographic evidence of disease. The survival duration was superior for women (P = .04) and for patients with no evidence of lymph node metastasis (P = .03). There was no difference in survival duration associated with patient age, dose of preoperative radiation therapy, the delivery of intraoperative radiotherapy, tumor grade, tumor size, retroperitoneal margin status, or the histologic grade of chemoradiation treatment effect., Conclusion: This analysis supports prior studies which suggest that the survival duration of patients with potentially resectable pancreatic cancer is maximized by the combination of chemoradiation and pancreaticoduodenectomy. Furthermore, there was no difference in survival duration between patients who received the less toxic rapid-fractionation chemoradiotherapy schedule (30 Gy, 2 weeks) and those who received standard-fractionation chemoradiotherapy (50.4 Gy, 5.5 weeks). Short-course rapid-fractionation preoperative chemoradiotherapy combined with pancreaticoduodenectomy, when performed on accurately staged patients, maximizes survival duration and is associated with a low incidence of local tumor recurrence.
- Published
- 2001
- Full Text
- View/download PDF
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