Caracterización clinicoepidemiológica de pacientes con cáncer de páncreas en un servicio de cirugía general / Clinical epidemiological characterization of patients with pancreas cancer in a general surgery service

Introducción: El cáncer de páncreas constituye una de las neoplasias de peor pronóstico debido a su diagnóstico tardío. Objetivo: Caracterizar a los pacientes con cáncer de páncreas según variables clinicoepidemiológicas y exámenes complementarios. Métodos: Se realizó un estudio observacional, descriptivo y transversal de 70 pacientes con cáncer de páncreas, egresados del Servicio de Cirugía General del Hospital Provincial Docente Saturnino Lora de Santiago de Cuba durante el periodo 2016-2020. Se estudiaron las variables: edad, sexo, factores de riesgo, enfermedades asociadas, manifestaciones clínicas y exámenes complementarios. Resultados: Predominaron el sexo masculino ( 54,2 %), las edades comprendidas de entre 51- 70 años, la ingestión de comidas grasas y los hábitos tabáquico y alcohólico como factores de riesgo; el alcoholismo crónico, la diabetes mellitus y la hipertensión arterial como enfermedades asociadas más comunes, así como el síndrome general, la ictericia y la coluria entre las manifestaciones clínicas más frecuentes. Por su parte, según los estudios imagenológicos, la mayoría de los afectados se diagnosticaron mediante tomografía computarizada y ecografía abdominal (94,3 y 70,0 %, respectivamente). Conclusiones: La tomografía computarizada multicorte es la técnica de imagen de elección recomendada por las guías de consenso internacional. Si bien el informe radiográfico es clave para la toma de decisiones posteriores, existen circunstancias del paciente que pueden afectarlas, tales como edad, factores de riesgo, manifestaciones clínicas y comorbilidad, entre otras.

Introduction: The pancreas cancer constitutes one of the neoplasms with worse prognosis due to its late diagnosis. Objective: To characterize patients with pancreas cancer according to clinical epidemiological variables and complementary exams. Methods: An observational, descriptive and cross-sectional study of 70 patients with pancreas cancer was carried out, who were discharged from the General Surgery Service of Saturnino Lora Teaching Provincial Hospital in Santiago de Cuba during 2016-2020. The variables studied were: age, sex, risk factors, associated diseases, signs and symptoms and complementary exams. Results: There was a prevalence of the male sex (54.2 %), the 51-70 age group, the ingestion of fatty foods and nicotine addiction and alcoholism as risk factors, the chronic alcoholism, diabetes mellitus and hypertension as more common associated diseases, as well as the general syndrome, jaundice and coluria among the most frequent signs and symptoms. On the other hand, according to the imaging studies, most of those affected were diagnosed by means of computerized axial tomography and abdominal echography (94.3 and 70.0 %, respectively). Conclusions: The multiscan computerized axial tomography is the image technique of election recommended by the guides of international consent. The radiographic report is the key for later decisions making but there are circumstances of the patient that can affect them, such as age, risk factors, signs and symptoms and comorbidity, among others.

Supervivencia a largo plazo luego de pancreatectomía por cáncer de páncreas / Long-term survival after pancreatic cancer surgery

Resumen El adenocarcinoma ductal de páncreas es una enfermedad agresiva asociada con pobres resultados de supervivencia a largo plazo. La resección quirúrgica y los nuevos tratamientos oncológicos pe rioperatorios han logrado mejorar la supervivencia de estos pacientes en la experiencia internacional. En este estudio retrospectivo se analiza la supervivencia global y la libre de enfermedad de todos los pacientes operados por cáncer de páncreas en el Hospital Italiano de Buenos Aires de enero 2010 a enero 2020. Se identificaron 242 pacientes con resecciones pancreáticas por adenocarcinoma de páncreas o carcinoma indiferenciado. La supervivencia global mediana fue de 22.8 meses (IC 95%: 19.5-29) y la tasa de supervivencia global a 1, 3 y 5 años fue de 72%, 32.5% y 20.8% respectivamente. La supervivencia libre de enfermedad mediana fue de 13.8 meses (IC 95%: 12-17.6) y la tasa de supervivencia libre de enfermedad a 1, 3 y 5 años fueron de 56.1%, 21.8% y 19.4% respectivamente. El grupo de pacientes que logró completar el tratamiento adyuvante mostró una mayor supervivencia global (p<0.0001).

Abstract Pancreatic cancer is an aggressive disease associated with poor results regarding long term survival. Surgical treatment along with new onco logic treatments have improved the survival of these patients in international experience reports. The aim of this study was to describe overall survival and disease-free survival after pancreatectomy for pancreatic ductal adenocarcinoma. A retrospective study of consecutive patients undergoing pancreatic resection due to PDAC or undifferentiated carcinoma from January 2010 to January 2020 in a single tertiary center was performed. Overall, 242 patients underwent complete pancreatic resections for pancreatic ductal adenocarcinoma or undifferentiated carcinoma. Median overall survival was 22.8 months (95% CI: 19.5-29) and survival at 1, 3 and 5 years were 72%, 32.5% and 20.8% respectively. The median disease-free survival was 13.8 months (95% CI: 12-17.6) and 1, 3- and 5-years disease-free survival were 56.1%, 21.8% and 19.4% respectively. The groups of patients that completed adjuvant treatment showed a better overall survival (p < 0.0001).

Initial experience with radical antegrade modular pancreatosplenectomy in a single institution

PURPOSE: Radical antegrade modular pancreatosplenectomy (RAMPS) is expected to be favorable for obtaining the negative tangential margin with oncologic feasibility through the horizontal dissection in a right-to-left fashion for radical lymph node dissections. METHODS: From January 2007 to February 2015, a total of 30 RAMPS and 19 conventional distal pancreatectomy (DP) cases were enrolled. The demographics, perioperative and survival outcomes were compared according to the type of surgery. RESULTS: The mean operative time, blood loss and length of hospital stay were similar between 2 groups. Morbidities were reported in 14 cases of RAMPS (46.7%) and 8 cases of DP (42.1%) (P = 0.777). The rate of negative tangential margin (96.2%) and the number of harvested lymph nodes (mean ± standard deviation, 21.5 ± 8.3) were significantly higher in RAMPS group (P = 0.011, P = 0.003, respectively). In terms of survival outcomes, there was no significant difference in regard to the overall 3-year disease-free survival (DFS; 30.4% in RAMPS vs. 35.0% in DP, P = 0.354) or overall survival (OS; 29.9% vs. 29.4%, P = 0.429) between the 2 groups. After exclusion of cases with nodal invasion, however, the RAMPS group had a longer DFS than the DP group (55.6% vs. 27.3%, P = 0.048) although OS was similar without significant difference (42.4% vs. 27.3%, P = 0.197). CONCLUSION: RAMPS is a safe and oncologically feasible procedure in left-sided pancreatic cancer by obtaining a successful negative tangential margin and radical lymph node dissection. The authors suggest it could also be useful for local control, especially for the limited left-sided pancreatic cancer without nodal invasion.

Initial experience with radical antegrade modular pancreatosplenectomy in a single institution

PURPOSE: Radical antegrade modular pancreatosplenectomy (RAMPS) is expected to be favorable for obtaining the negative tangential margin with oncologic feasibility through the horizontal dissection in a right-to-left fashion for radical lymph node dissections. METHODS: From January 2007 to February 2015, a total of 30 RAMPS and 19 conventional distal pancreatectomy (DP) cases were enrolled. The demographics, perioperative and survival outcomes were compared according to the type of surgery. RESULTS: The mean operative time, blood loss and length of hospital stay were similar between 2 groups. Morbidities were reported in 14 cases of RAMPS (46.7%) and 8 cases of DP (42.1%) (P = 0.777). The rate of negative tangential margin (96.2%) and the number of harvested lymph nodes (mean ± standard deviation, 21.5 ± 8.3) were significantly higher in RAMPS group (P = 0.011, P = 0.003, respectively). In terms of survival outcomes, there was no significant difference in regard to the overall 3-year disease-free survival (DFS; 30.4% in RAMPS vs. 35.0% in DP, P = 0.354) or overall survival (OS; 29.9% vs. 29.4%, P = 0.429) between the 2 groups. After exclusion of cases with nodal invasion, however, the RAMPS group had a longer DFS than the DP group (55.6% vs. 27.3%, P = 0.048) although OS was similar without significant difference (42.4% vs. 27.3%, P = 0.197). CONCLUSION: RAMPS is a safe and oncologically feasible procedure in left-sided pancreatic cancer by obtaining a successful negative tangential margin and radical lymph node dissection. The authors suggest it could also be useful for local control, especially for the limited left-sided pancreatic cancer without nodal invasion.

Percutaneous computed tomography‑guided iodine‑125 seeds implantation for unresectable pancreatic cancer.

BACKGROUND: To examine the safety and clinical efficacy of computed tomography (CT)‑guided radioactive iodine‑125 (125I) seeds implantation for patients with unresectable pancreatic cancer. MATERIALS AND METHODS: A group of 26 patients with pathologically confirmed unresectable pancreatic cancer underwent percutaneous CT‑guided 125I seeds implantation. Part of them received transarterial chemotherapy and/or percutaneous transhepatic cholangial drainage before or after seeds implantation. The primary endpoints were the objective response rates, local control rates, and overall survival. RESULTS: CT scan 2 months after treatment revealed complete response (CR) in 8 patients, partial response (PR) in 9 patients. Overall response rate (CR + PR) is 65.38%. Local control rate was 88.46%. Median survival of the whole group was 15.3 months, whereas for Stage III and IV was 17.6 and 9.1 months, respectively. The estimated 1‑year survival was 30.77%. CONCLUSIONS: We consider CT‑guided 125I seeds implantation as a safe, effective, uncomplicated treatment for unresectable pancreatic cancer.

Tumor sólido pseudopapilar del páncreas en la IV región / Solid-pseudopapillary tumor of pancreas

Introduction: The solid-pseudopapillary tumor of pancreas (STP) is a low-grade malignant neoplasm. In Chile, 21 cases have been reported since 2008, most of them treated in Santiago. The present series contributes to the national case-load and has the purpose to describe the experience with this uncommon neoplasm in the IV Region. Patients and Methods: From January 2004 to March 2014, a total of 38 benign and malignant pancreatic neoplasms have been informed in the data-base of our Regional Pathology Service. We selected the biopsies informed as STP and 5 cases (13 percent) were found. The clinical records of these patients were retrospectively reviewed. The results were reported using descriptive statistics with central tendency measures and dispersion. Results: Most patients were women with a mean age of 44.8 years. All patients were studied with either abdominal ultrasound; computed tomography or magnetic resonance. In 2 patients the STP was located in the pancreatic tail, and they were submitted to distal pancreatectomy. The other 3 patients had the STP in the pancreatic head and were resolved by pancreatoduodenectomy. All tumors were confirmed by immunohistochemistry. Late follow-up showed malignant behavior in 1 patient while the other 4 patients are currently free of disease. Conclusions: The general characteristics of STP in the IV Region are similar to what is currently known. They present a high incidence compared with the habitually published incidence.

Introducción: El tumor sólido pseudopapilar del páncreas (TSP) es una neoplasia con bajo potencial maligno. En Chile se han reportado 21 casos desde el año 2008, 18 de ellos tratados en instituciones de Santiago. La presente serie además de contribuir a la casuística nacional, tiene como objetivo la descripción de la experiencia de la IV Región con el manejo de estos tumores. Pacientes y Métodos: Entre enero de 2004 y marzo de 2014 se informaron 38 biopsias de tumores pancreáticos benignos y malignos en la base de datos del Servicio de Patología Regional. Se seleccionaron las biopsias informadas como TSP, las que constituyen 5 casos (13 por ciento) y se revisaron las fichas clínicas en forma retrospectiva. Para el informe de los resultados se utilizó estadística descriptiva con medidas de tendencia central y dispersión. Resultados: El promedio de edad fue 44,8 años, siendo la mayoría mujeres. Los pacientes fueron estudiados con ecografía, tomografía computarizada y resonancia magnética. En 2 pacientes el TSP se localizaba en la cola del páncreas, estos pacientes fueron sometidos a pancreatectomía distal. En los otros 3 casos el TSP se encontraba en la cabeza del páncreas y fueron resueltos mediante pancreatoduodenectomía. Los TSP fueron confirmados por inmunohistoquímica. El comportamiento posterior fue benigno en 4 casos y maligno en 1 caso. Conclusiones: Las características de los TSP en la IV Región son similares a las conocidas y presentan una alta incidencia comparada con la habitualmente reportada.

A Case of Malignant Biliary Stricture Mimicking Benign Stricture coincided with Clonorchis sinensis / 대한췌담도학회지

Accurate and early diagnosis of indeterminate bile duct stricture is difficult. There are numerous cases suggesting similarity between benign tumors and malignancy. Therefore, meticulous evaluation with endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound and computed tomography (CT) is necessary. A 50 year-old male presented with painless jaundice. Abdominal CT scan showed distal biliary stricture without definite pancreatic mass. Repeated brush cytology and endobiliary biopsy during ERCP did not reveal malignancy except for eggs of Clonorchis sinensis. The patient declined surgical resection without definite evidence of malignancy. Abdominal CT scan one month later showed progressive parenchymal atrophy and pancreatic duct dilatation. The patient underwent pylorus preserving pancreatoduodenectomy. Pathology revealed pancreatic adenocarcinoma in the head portion. Since accurate preoperative diagnosis of malignant biliary obstruction can be evasive, patients with biliary stricture should undergo evaluation with high index of suspicion.

Two Cases of Supraclavicular Lymph Node Metastasis in Pancreatic Adenocarcinoma / 대한내과학회지

The supraclavicular lymph node (SCN) is frequently involved in lymphoma and metastatic malignancies of the breast and lung, but is extremely rarely involved in pancreatic cancer. Only 10 such cases have been reported in the medical literature worldwide. We herein report an additional two cases. An 83-year-old male patient had a 7.6 x 5 cm pancreatic tumor from the pancreatic head to tail, and a 71-year-old male patient had a 2.8 x 1.9 cm pancreatic body tumor. PET-CT revealed SCN metastasis, and subsequent excisional biopsy confirmed metastatic adenocarcinoma. With the more popular use of PET-CT in patients with pancreatic cancer, the number of cases of metastasis to the SCN is expected to increase. This suggests that lymphatic spread is the main metastatic route in pancreatic cancer. Further large-scale studies along with increased numbers of case reports are needed to determine whether lymphatic spread is the main metastatic route in pancreatic cancer.

Prevalence of nutritional risk and malnutrition among hospitalized elderly abdominal surgical patients with malignant tumors / 中华临床营养杂志

ObjectiveTo investigate the prevalence of nutritional risk and malnutrition among hospitalized elderly abdominal surgical patients with malignant tumors.MethodsTotally 269 elderly patents ( ≥ 65 years) with malignant tumor who were hospitalized in our department of abdominal surgery from December 2009 to November 2010 were consecutively enrolled.Nutritional Risk Screening 2002 ( NRS 2002 ) was performed on the next morning after admission.Body mass index (BMI) lower than 18.5 kg/m2 was considered as malnutrition.Results The NRS 2002 was completed in all the 269 enrolled patients.The overall prevalence of malnutrition was 30.1％ (81/269) ; more specifically,37.5％ (21/56) among geriatric patients ( ≥80 years) and 17.6％ (43/245) among the other age groups (P =0.001 ).The overall rate of nutrition risk was 38.3％ (103/269) ; more specifically,57.1％ (32/56) among the geriatric patients and 29.3％ (72/245) among the other age groups (P ＜0.001 ).The rate of nutrition risk in patients with pancreas cancer was 58.3％,which was higher than other elderly patients; on the contrary,and the rate of nutrition risk in the patients with colorectal cancer was relatively lower.ConclusionThe rates of nutrition risk and malnutrition in hospitalized elderly abdominal surgical patients ( ≥ 65years) with malignant tumor are relatively higher than other age groups,especially among the geriatric patients.

EUS-Guided Antitumor Therapy for Pancreatic Tumors

Endoscopic ultrasound (EUS) is a very useful modality for the diagnosis and staging of pancreatic masses. With the advent of EUS-guided fine-needle aspiration technology, this modality has made a tremendous leap from imaging modality to histologic diagnosis and therapeutic intervention. EUS offers high-resolution images of and unparalleled access to the pancreas. After locating the tip of the echoendoscope in the duodenum or stomach, several drugs or local treatment modalities can be delivered directly into the pancreas. EUS-guided ethanol lavage with/without paclitaxel injection has been tested for the treatment of cystic tumors of the pancreas, with complete resolution of cystic tumor being observed in up to 70-80% of patients. Ethanol injection is also performed for the management of solid neuroendocrine tumors of the pancreas. Various type of EUS-guided injection have also been investigated for the treatment of pancreatic cancer. An activated allogenic mixed lymphocyte culture (Cytoimplant) was injected in patients with advanced pancreatic cancer. A replication-deficient adenovirus vector carrying the tumor necrosis factor-alpha gene was also delivered intratumorally by EUS. ONYX-015 is an oncolytic attenuated adenovirus that exhibits replication preferentially in malignant cells, causing cell death, and this has also been injected into pancreatic cancers under EUS guidance. EUS-guided local ablation therapies such as radiofrequency ablation, photodynamic therapy, and brachytherapy are also under investigation. EUS-guided fine-needle injection for various solid or cystic lesions is a rapidly expanding field. This article reviews the various applications of EUS for the treatment of pancreatic tumors.

Endoscopic stents drainage in patients with pancreas head carcinoma / 中华消化内镜杂志

Objective To evaluate the clinical value of endoscopic palliative stents drainage in patients with unresectable carcinoma at pancreas head.Methods Endoscopic stents placement was Derformed in 197 patients with unresectable pancreas head carcinoma,from August 2003 to August 2007,and the clinieal data was studied retrospectively.Results Bile duct obstruction was present in all patients.in which 126 were accompanied with dilation of distal pancreatic duct,91 with atrophy of pancrea body and tail. Stent placement in pancreatic duct Was performed in 108 patients with a Success rate of 96.4%,and placement in bile duct was performed in all patients with a success rate of 99.0%.In 195 patients with successful stent placement,jaundice dissolved after the procedure.Of 101 patients who had abdominal pain,complete pain alleviation Was achieved in 98,partially alleviation achieved in 3. Serum amylase level increased after the operation in 24 cases,which resumed tO normal value after corresponding managements.All Datients received a lifelong follow-up at mean duration of 373.57±157.35 days,with a longest survival time of 842 days.Conclusion Endoscopic palliative stents drainage is safe and effective in patients with unresectable Dancre.atie carcer,which miight increase survival rate and improve life quality.

Combined Inferior Vena Cava Resection during Pancreatoduodenectomy

There is no consensus for the surgical indications, as well as the surgical technique, for the treatment of inferior vena cava (IVC) invasion by pancreas head cancer. The authors experienced a case of pancreas head cancer invading the anterior wall of the IVC. We performed en bloc excision of the anterior wall of the IVC combined with pancreatoduodenectomy in this case under the assumption that only a margin-negative surgical resection could offer a chance for cure. Technically, the sequence of dissection and addressing the IVC at the end of dissection are considered to be important to secure the operative field surrounding the IVC and to achieve a margin-negative resection. There has been no recurrence up to now, 8 months after the extensive radical operation.

Combined Inferior Vena Cava Resection during Pancreatoduodenectomy

There is no consensus for the surgical indications, as well as the surgical technique, for the treatment of inferior vena cava (IVC) invasion by pancreas head cancer. The authors experienced a case of pancreas head cancer invading the anterior wall of the IVC. We performed en bloc excision of the anterior wall of the IVC combined with pancreatoduodenectomy in this case under the assumption that only a margin-negative surgical resection could offer a chance for cure. Technically, the sequence of dissection and addressing the IVC at the end of dissection are considered to be important to secure the operative field surrounding the IVC and to achieve a margin-negative resection. There has been no recurrence up to now, 8 months after the extensive radical operation.

The anti-tumor new drug:9-nitrocamptothecin / 国际外科学杂志

9-Nitrocamptothcin(9-NC)is an orally available new type camptothecinanalog with antineoplastic activity that results from inhibition of DNA topoisomerase Ⅰ.In the study we reviewed the feature of the drug,mechanism of action,update studies of preclinical and pancreas cancer clinical trial.

Clinical Characteristics of Uncinate Process Carcinoma of the Pancreas

PURPOSE: The pancreatic uncinate process is defined as the portion of the pancreatic head that lies behind the SMV and SMA. In spite of its peculiar anatomical characteristics, there are few reports addressing the clinicopathologic features of uncinate process carcinoma (UPCa). The purpose of this study was to explore the clinical characteristics of UPCa and to compare them with the characteristics of carcinomas located in other parts of the pancreatic head (non-UPCa). METHODS: We retrospectively reviewed the medical records of 380 patients (127 UPCa and 253 non-UPCa) treated for pancreatic head cancer at Seoul National University Hospital between January 2002 and December 2007. The patient demographics, clinical presentation, radiologic details, surgical data, and long-term survival rates were evaluated. The clinical characteristics were analyzed according to tumor location. RESULTS: Jaundice was less common in UPCa (56/127, 44.1% vs. 150/253, 59.3%; p=0.006). Duodenal obstruction (12/127, 9.4% vs. 11/253, 4.3%; p =0.049) and SMA invasion (56/127, 44.1% vs. 58/253, 23.0%; p<0.001) were more frequent in UPCa. Resectability (38/127, 30.0% vs. 117/253, 46.2%; p=0.002) and curative resection rate (29/127, 22.8% vs. 90/253, 35.6%; p=0.001) were significantly lower in UPCa. The overall 3-year survival rate (7.7% vs. 17.9%; p=0.019) and 3-year survival rate after curative resection (0% vs. 35.9%; p=0.012) were lower in UPCa. CONCLUSION: UPCa less frequently caused jaundice, but more frequently caused duodenal obstruction. Frequent invasion into the SMA led to lower resectability and curative resection rates. Even in cases of R0 resection, long-term survival in the setting of UPCa was lower than that seen in the setting of non-UPCa, which suggests other unknown prognostic factors.

Cáncer en la región de Antofagasta, con especial referencia al cáncer vesical y al cáncer pulmonar / Cancer in the Antofagasta region of Chile, with special reference

Se presenta el perfil oncológico de la Región de Antofagasta. Mediante la comparación de la mortalidad regional por las distintas localizaciones de cáncer con la mortalidad nacional y de otras áreas se deduce que persiste un exceso de mortalidad por cáncer vesical (2002-2004) y broncopulmonar (2001-2004), en hombres y en mujeres; y que hay un exceso de cáncer renal y hepático en varones y un exceso de cáncer pancreático en mujeres. Se descarta el papel del envejecimiento poblacional en lo que respecta a los cánceres de vejiga y de pulmón. Se discuten las características de estos cánceres en Chile y en otros países: mortalidad, incidencia, tendencias, relación con el sexo y con otros factores posibles. Se citan las investigaciones nacionales relativas a la presencia y papel del arsénico en el aire, agua, alimentos y procesos laborales en la región. Las diferencias por sexo sugieren que: el cáncer vesical se relaciona con el ambiente general más que con el ambiente laboral (los excesos son similares en ambos sexos); el cáncer pulmonar, con el ambiente general y con el ambiente laboral (proceso metalúrgico); el cáncer renal y el del hígado, con circunstancias atingentes al género masculino pero probablemente no con el arsénico en el caso del cáncer hepático; y el cáncer de páncreas, posiblemente con el ambiente general. En Antofagasta y regiones vecinas hay menos mortalidad por cánceres digestivos y de próstata y ovario. Esta extensión en el espacio contrasta con la especificidad regional de los excesos. Se recomienda continuar e intensificar la investigación, monitoreo y control multisectorial de aquellos cánceres cuyo exceso persiste desde hace varias décadas en la Región de Antofagasta.

We present the oncological profile of Antofagasta Region, within a general regional approach to the state of health of the population. Through the comparison of regional mortality for the different cancer localizations with mortality in the country and in other regions, we show a persistent excess of bladder and lung cancer in men and women; an excess in kidney and liver cancer in men, and an excess of pancreatic cancer in women. The role of age structure is discarded, at least as far as bladder and lung cancer are concerned. The characteristics of these cancers in Chile and other countries are discussed: mortality, incidence, trends, relationships with gender, and to other possible factors. The previous national investigations related to the presence and the role of arsenic in the air, in drinking water, in food and in occupational processes in the region are cited. Gender associations suggest that: bladder cancer is related to the general environment more than to occupation (the excess is similar for both sexes); lung cancer is related both with the general and the occupational (copper smelting) environment; kidney and liver cancer, with men-related circumstances but probably not with arsenic, in the case of hepatic cancer; and pancreatic cancer, possibly with the general environment. In both Antofagasta and neigh boring regions there is less mortality than in the country as a whole from cancers of the digestive tract and of prostate and ovary. This spatial extension does not apply to the cancers found to be in excess in Antofagasta. We conclude that research, monitoring and multisector control must continue and be intensified regarding the types of cancer for which a regional excess has persisted over several decades.

Tyrosine kinase Src mediates Notch-1 activation in BxPC3 pancreatic cancer cells / 基础医学与临床

Objective To observe the effect of tyrosine kinase Src on activating Notch-1 protein in pancreatic cancer cell line-BxPC3. Methods Notch-1 expression and c-Src expression were inhibited by siRNA interference, and the activation of Src was inhibited by its inhibitor PP2. The growth rate of BxPC3 cells was measured by MTT. The change of Notch-1 NICD level and Src protein level was measured by Western blot. Results The growth of BxPC3 cells decreased after inhibiting Notch-1 expression, as well as the cells were treated with PP2. The level of Notch-1 NICD decreased both after inhibiting c-Src expression and after Src activation was inhibited by PP2. Conclusion In BxPC3 cells, tyrosine kinase Src promotes the level of Notch-1 NICD, which directly influences the cell growth.

Effect of Large-dosage Shenmai Injection on Immune Function of Patients with Chemical Therapy after Pancreas Carcinectomy / 浙江中医药大学学报

[Objective] To observe the effect of large-dosage Shenmai Injection on the immune function of patients with chemical therapy after pancreas carcinectomy.[Method] Randomly divide 35 cases into treatment and control groups,the treatment one takes Shenmai Injection on the basis of control one taking GEM chemical therapy;measure both T lymphocyte sub-group CD3+,CD4+,CD8+ and the percentage of NK with direct immunofluorescence technology.[Result]The NK cell,sub-group percentage of CD3+T cell and CD4+/ CD8+ ratio are much more than that in control one,with statistical meaning(P

Application of Real-Time Tumor-Tracking and Gated Radiotherapy System for Unresectable Pancreatic Cancer

Herein is reported our experience of radiation therapy using a real-time tumor-tracking and gated radiotherapy (RTRT) system for inoperable pancreatic cancer. Three unresectable pancreatic cancer patients were treated with intraoperative electron beam radiation therapy, at the time of open biopsy, and postoperative external beam radiation therapy using an RTRT system with a 2.0 mm diameter gold ball implanted into the pancreas. The total BED's (alpha/beta=10) was intended to be equivalent to that of delivering 60 Gy by 2.0 Gy/fraction, while the actual dose schedules were individualized. The movement of the pancreas was analyzed based on the 3-dimensional marker positions during the RTRT. The side effects and tumor responses were evaluated. During the RTRT course, the average movement of markers in the x (left to right), y (cranial to caudal) and z (dorsal to ventral) directions were 3.0 mm (1.7- 5.2 mm), 5.2 mm (3.5 - 6.8 mm) and 3.5 mm (2.7 - 5.1 mm), respectively. During and after the course of postoperative radiation therapy, no acute side effects of RTOG grade II or higher were detected. The objective tumor responses, as evaluated by CT scans 3 months after the treatment, were 2 partial responses and no response in one patient. Using the RTRT technique the margin of treatment planning and the possible errors in target localization were reduced, and the 3-dimensional movement of the internal marker implanted in the pancreas was able to be analyzed.

Pancreatic Adenocarcinoma: Dual-Phase Helical CT with Surgical and Histopathologic Correlation

PURPOSE: To determine the accuracy of dual-phase helical CT in assessing the resectability of pancreatic ductal adenocarcinoma, and to correlate the CT findings with the surgical and histopathologic findings. MATERIALS AND METHODS: Thirty patients with pathologically proven cancer of the pancreas underwent arterialand portal- phase helical CT scanning, and in two of these, single-level dynamic CT was performed during celiac and superior mesenteric arteriography. In 17 patients who underwent surgery for potentially resectable cancer of the pancreatic head, tumor resectability was assessed. The CT findings were analyzed and correlated with these of surgery and histopathology. RESULTS: In 13 (76%) of the 17 patients who underwent surgery, tumors were resectable. Their average size was 2.76 cm (arterial phase), 2.30 cm (portal phase), and 2.48 cm (pathologically determined) and the overall accuracy of helical CT for assessing resectability was 87%. In all patients, the central portion of the tumors exhibited hypoattenuation at both phases; the peripheral portion showed hypoattenuation at the arterial phase and iso- (n=10) or hyperattenuation (n=3) at the portal phase. Single-level dynamic CT depicted a persistently ypoattenuating central portion and progressive and prolonged enhancement of the periphery. CT-histopathologic correlation showed that central hypoattenuation indicated the presence of tumor cells, necrosis (n=3) and mucin (n=4), while the peripheral iso- or hyperattenuated areas seen at the portal phase represented fibrosis and inflammatory infiltration. Histopathologic examination revealed tumoral infiltration of peripancreatic fat tissue (n=11) and microvascular invasion of major peripancreatic vessels (n=7). CONCLUSION: The dual-phase helical CT is useful in the determination of resectability in pancreas cancer and CT findings represent well the histopathologic features of pancreas cancer.