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Advances in neoadjuvant therapy for resectable pancreatic cancer over the past two decades
Alvaro Gregorio Morales Taboad,Pablo Lozano Lominchar,Lorena Martin Roman,Pilar Garcia-Alfonso,Andres Jesus Munoz Martin,Jose Antonio Blanco Rodriguez,Jose Manuel Asencio Pascual 한국간담췌외과학회 2021 Annals of hepato-biliary-pancreatic surgery Vol.25 No.2
In the last two decades, pancreatic cancer has been undergoing important changes in its perioperative management due to the great interest in multidisciplinary management and preoperative multimodal therapy, which in numerous studies have shown promising clinical results. Although the standard of treatment for resectable pancreatic ductal adenocarcinoma (PDAC) today is surgery followed by adjuvant therapy, as it is a biologically aggressive disease, even with complete resection, it has high rates of local and distant relapse. Several retrospective and prospective phase I/II studies have opened the window for neoadjuvant therapy with chemotherapy (CT), chemoradiotherapy (CRT), or both, as an alternative treatment for resectable pancreatic cancer, with promising results. Neoadjuvant therapy could has some advantages, including early administration of systemic treatment, in vivo assessment of response to treatment, increase resectability rate in borderline patients, increase resection rate with negative margin and survival benefit. While it seems clear that even potentially resectable disease would benefit from preoperative multimodal therapy, the optimal neoadjuvant therapeutic strategy is still controversial and currently there are only recommendations for neoadjuvant treatment, in clinical guidelines such as the NCCN and ESMO, for borderline and/or locally advanced PDAC. This review provides an overview of recent studies available and how they relate to systemic treatment of resectable PDAC in the neoadjuvant setting.
Neoadjuvant therapy impact in early pancreatic cancer: “bioborderline” vs. “non-bioborderline”
Alvaro Gregorio Morales Taboad,Pablo Lozano Lominchar,Maria Fernandez Martinez,Pilar Garcia-Alfonso,Andres Munoz Martin,Jose Manuel Asencio 한국간담췌외과학회 2022 Annals of hepato-biliary-pancreatic surgery Vol.26 No.4
Submucosal fat accumulation in Crohn’s disease: evaluation with sonography
( Tomás Ripollés ),( María Jesús Martínez-pérez ),( José María Paredes ),( José Vizuete ),( Gregorio Martin ),( Lidia Navarro ) 대한장연구학회 2023 Intestinal Research Vol.21 No.3
Background/Aims: The study objective is to investigate the ultrasound features that allow suspecting the presence of submucosal fat deposition, called the fat halo sign (FHS), in the intestinal wall of patients with Crohn’s disease. Methods: Computed tomography (CT) examinations over a period of 10 years were reviewed for the presence of the FHS in the bowel wall. A measurement of less than -10 Hounsfield units was regarded as indicative of fat. We included only patients who had undergone ultrasound examinations 3 months before or after CT. The study cohort group comprised 68 patients. Wall and submucosal thickness were measured on longitudinal ultrasound sections. A receiver operating characteristic curve was constructed to determine the best cutoff of ultrasound submucosal wall thickness value for predicting FHS in the bowel wall determined on CT. Results: The FHS was present in 22 patients (31%) on CT. There were significant differences between submucosal thickness of patients with FHS and patients without FHS (4.19 mm vs. 2.41 mm). From the receiver operating characteristic curve, a threshold value of 3.1 mm of submucosal thickness had the best sensitivity and specificity to suspect FHS (95.5% and 89.1%, respectively; area under the curve, 0.962), with an odds ratio of 172. All of 16 patients with a submucosal thickness >3.9 mm had FHS. Conclusions: FHS in patients with Crohn’s disease can be suspected on ultrasound in cases with marked thickening of the submucosa layer. In these cases, the activity of the disease should be measured by other parameters such as the color Doppler. (Intest Res 2023;21:385-391)