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| 1 | Optimizing neoadjuvant radiotherapy for resectable and borderline resectable pancreatic cancer using protons显示文摘Approximately 25%of patients diagnosed with pancreatic cancer present with non-metastatic resectable or borderline resectable disease.Unfortunately,the cure rate for these“curable”patients is only in the range of 20%.Local-regional failure rates may exceed 50%after margin-negative,node-negative pancreatectomy,but up to 80%of resections are associated with regional lymph node or margin positivity.While systemic drug therapy and chemotherapy may prevent or delay the appearance of distant metastases,it is unlikely to have a significant impact on local-regional disease control.Preoperative radiotherapy would represent a rational intervention to improve local-regional control.The barrier to preoperative radiotherapy is the concern that it could potentially complicate what is already a long and complicated operation.When the radiotherapy is delivered with X-rays(photons),the entire cylinder of the abdomen is irradiated;therefore,an operating surgeon may be reluctant to accept the associated risk of increased toxicity.When preoperative radiotherapy is delivered with protons,however,significant bowel and gastric tissue-sparing is achieved and clinical outcomes indicate that proton therapy does not increase the risk of operative complications nor extend the length of the procedure. | Romaine Charles Nichols Michael Rutenberg | 2019 | World Journal of Gastrointestinal Surgery2019，11，7： | 2 |
| 2 | Feasibility of pancreatectomy following high-dose proton therapy for unresectable pancreatic cancer显示文摘AIM To review surgical outcomes for patients undergoing pancreatectomy after proton therapy with concomitant capecitabine for initially unresectable pancreatic adenocarcinoma.METHODS From April 2010 to September 2013,15 patients with initially unresectable pancreatic cancer were treated withproton therapy with concomitant capecitabine at 1000 mg orally twice daily. All patients received 59.40 Gy(RBE) to the gross disease and 1 patient received 50.40 Gy(RBE) to high-risk nodal targets. There were no treatment interruptions and no chemotherapy dose reductions. Six patients achieved a radiographic response sufficient to justify surgical exploration,of whom 1 was identified as having intraperitoneal dissemination at the time of surgery and the planned pancreatectomy was aborted. Five patients underwent resection. Procedures included:Laparoscopic standard pancreaticoduodenectomy(n = 3),open pyloris-sparing pancreaticoduodenectomy(n = 1),and open distal pancreatectomy with irreversible electroporation(IRE) of a pancreatic head mass(n = 1). RESULTS The median patient age was 60 years(range,51-67). The median duration of surgery was 419 min(range,290-484),with a median estimated blood loss of 850 cm^3(range,300-2000),median ICU stay of 1 d(range,0-2),and median hospital stay of 10 d(range,5-14). Three patients were re-admitted to a hospital within 30 d after discharge for wound infection(n = 1),delayed gastric emptying(n = 1),and ischemic gastritis(n = 1). Two patients underwent R0 resections and demonstrated minimal residual disease in the final pathology specimen. One patient,after negative pancreatic head biopsies,underwent IRE followed by distal pancreatectomy with no tumor seen in the specimen. Two patients underwent R2 resections. Only 1 patient demonstrated ultimate local progression at the primary site. Median survival for the 5 resected patients was 24 mo(range,10-30).CONCLUSION Pancreatic resection for patients with initially unresectable cancers is feasible after high-dose [59.4 Gy(RBE)] proton radiotherapy with a high rate of local control,acceptable surgical morbidity,and a median survival of 24 mo. | Kathryn E Hitchcock R Charles Nichols Christopher G Morris Debashish Bose Steven J Hughes John A Stauffer Scott A Celinski Elizabeth A Johnson Robert A Zaiden Nancy P Mendenhall Michael S Rutenberg | 2017 | World Journal of Gastrointestinal Surgery2017，9，4： | 1 |
| 3 | Proton therapy for pancreatic cancer显示文摘Radiotherapy is commonly offered to patients with pancreatic malignancies although its ultimate utility is compromised since the pancreas is surrounded by exquisitely radiosensitive normal tissues, such as the duodenum, stomach, jejunum, liver, and kidneys. Proton radiotherapy can be used to create dose distributions that conform to tumor targets with significant normal tissue sparing. Because of this, protons appear to represent a superior modality for radiotherapy delivery to patients with unresectable tumors and those receiving postoperative radiotherapy. A particularly exciting opportunity for protons also exists for patients with resectable and marginally resectable disease. In this paper, we review the current literature on proton therapy for pancreatic cancer and discuss scenarios wherein the improvement in the therapeutic index with protons may have the potential to change the management paradigm for this malignancy. | Romaine C Nichols Soon Huh Zuofeng Li Michael Rutenberg | 2015 | World Journal of Gastrointestinal Oncology2015，7，9： | 1 |
| 4 | Targeting KRAS in pancreatic adenocarcinoma:Progress in demystifying the holy grail显示文摘Pancreatic cancer(PC)remains one of the most challenging diseases,with a very poor 5-year overall survival of around 11.5%.Kirsten rat sarcoma virus(KRAS)mutation is seen in 90%-95%of PC patients and plays an important role in cancer cell proliferation,differentiation,metabolism,and survival,making it an essential mutation for targeted therapy.Despite extensive efforts in studying this oncogene,there has been little success in finding a drug to target this pathway,labelling it for decades as“undruggable”.In this article we summarize some of the efforts made to target the KRAS pathway in PC,discuss the challenges,and shed light on promising clinical trials. | Ahmed Elhariri Ahmed Alhaj Daniel Ahn Mohamad Bassam Sonbol Tanios Bekaii-Saab Christina Wu Michael Scott Rutenberg John Stauffer Jason Starr Umair Majeed Jeremy Jones Mitesh Borad Hani Babiker | 2023 | World Journal of Clinical Oncology2023，14，8： | 0 |
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