Adjuvant treatment of pancreatic cancer in 2009: where are we? Highlights from the 45th ASCO annual meeting. Orlando, FL, USA. May 29-June 2, 2009.

JOP. 2009;10(4):373-7

Authors: Saif MW

Despite attempted curative resection of localized pancreatic adenocarcinoma, most patients succumb a recurrence and die of their disease. The Gastrointestinal Tumor Study Group, European Organization for Research and Treatment of Cancer, and European Study Group for Pancreatic Cancer trials have suggested the benefit of adjuvant therapy. However, the relatively few randomized trials available have not established a definite standard of care due to study limitations. Although these trials, and the recently published Charité Onkologie (CONKO)-001 trial, have shown a definite advantage of adjuvant chemotherapy, the most effective chemotherapy and the role of radiation therapy remain unclear. This review will discuss the data available from reported trials of adjuvant therapy in pancreatic cancer, especially the results of the ESPAC-3 study presented at the annual meeting of ASCO 2009, and consider future directions for clinical trials.

PMID: 19581737 [PubMed - in process]

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Pancreatic metastasis from renal carcinoma managed by Whipple resection. A case report and literature review of metastatic pattern, surgical management and outcome.

JOP. 2009;10(4):413-8

Authors: Machado NO, Chopra P

CONTEXT: Metastatic cancer to the pancreas is rare and accounts for less than 2% of all pancreatic malignancies, metastasis from renal cell carcinoma being predominant. While symptomatic patients present with obstructive jaundice, abdominal pain, or GI bleeding, the diagnosis is often made in asymptomatic patients during follow-up for renal cell carcinoma. Hence, a high index of clinical suspicion is required in a patient who presents with a pancreatic tumor following a nephrectomy for renal cell carcinoma.

CASE REPORT: We report the case of a patient in whom a lesion was detected in the head of the pancreas, following a nephrectomy performed 5 years previously for renal cell carcinoma. A magnetic resonance scan revealed a well-defined lesion in the head of the pancreas. The patient underwent a pancreaticoduodenectomy and histopathology confirmed a metastatic renal cell carcinoma. Two years after the surgery, the patient is doing well. The literature is reviewed for pancreatic metastasis from renal cell carcinoma, for metastatic pattern, surgical management and outcome.

CONCLUSION: Pancreatic metastases are usually detected during the follow-up of patients having undergone a previous nephrectomy for renal cell carcinoma. Typically, the interval between a nephrectomy and pancreatic metastasis is long. The literature contained more than 250 cases of pancreatic resection for metastatic renal cell carcinoma. The median duration of presentation was 10.5+/-6.5 years following a nephrectomy. The lesions are multifocal (3.2+/-1.5) in about 39% of patients and resectable in 80%. A high resectability rate is characteristic of metastasis from renal cell carcinoma as compared to primary pancreatic cancer. The five year survival rate is between 43 and 88%.

PMID: 19581746 [PubMed - in process]

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Solitary true cyst of the pancreas in adults. A report of two cases.

JOP. 2009;10(4):429-31

Authors: Carboni F, Mancini P, Lorusso R, Santoro E

CONTEXT: Solitary true cysts of the pancreas in adults are extremely rare and only few cases have been reported in the literature. The etiology and natural history of these lesions remain unknown and treatment is not standardized. We describe two additional resected cases.

CASE REPORTS: The first patient was a young woman with an incidental 3 cm cyst located in the pancreatic head who underwent enucleation. The second patient was a young woman with a large 8 cm symptomatic cyst located in the pancreatic tail who underwent a laparoscopic spleen-preserving distal pancreatectomy. Histological examination revealed fibrous walls lined by a monolayer of cuboidal epithelium in both cases.

CONCLUSIONS: A preoperative work-up alone does not always allow an accurate diagnosis, but it is useful in determining lesion characteristics and guiding therapeutic decision making. When surgery is indicated, a limited resection is warranted in most cases. PMID: 19581750 [PubMed - in process]

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