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CT Measurements Predict Need for Venous Resection in Pancreatic Cancer

The evaluation and diagnosis of pancreatic cancer (ductal adenocarcinoma of the pancreas) is now largely initially accomplished through radiographic means, including CT scanning. This has produced changes in related areas such as the staging of pancreatic cancer, and the evaluation for potential resection.  Depending on tumor extension, as a part of the Whipple, the surgeon may need to surgically resect the superior mesenteric vein – portal vein complex (“SMV-PV”).

Researcher Katz and colleagues at the University of Texas / M.D. Anderson Cancer Center in Houston wondered if the necessity of the likelihood of this vascular aspect of the surgical procedure could be anticipated among resectable and borderline resectable cases using CT scan criteria. Their results were published in the February 2014 issue of the Journal of Gastrointestinal Surgery, the official publication of the Society for Surgery of the Alimentary Tract.

The researchers reviewed all patients who received the pancreaticoduodenectomy (Whipple procedure) at the M.D. Anderson Cancer Center for a seven year period (2004-2011).  This process eventually yielded 254 pancreatic cancer patients who met inclusion standards (39.6% of these patients eventually required SMV-PV resection at surgery).  The authors reexamined the CT images of these patients taken prior to surgery in regard to the extent of the tumor / SMV-PV interface in terms of four categories:  no interface, less than or equal to 180° of interface, more than 180° of interface, or full occlusion.

The authors found that 89.5% of patients with either full occlusion of the vein complex or those with more than 180° of interface had received the SMV-PV resection.  Also, they found that those with less than or equal to 180° of interface tended to have longer pancreatic cancer survival.

They conclude that this method of classification can be of help in pancreatic cancer surgical planning, and in prognosis. This is an interesting study suggesting fairly easy measurements that may that may prove to be very useful.  


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Dale O’Brien, MD

Does Aspirin Prevent Pancreatic Cancer? High dose vs. Low Dose Intake

The possible cancer protective effects (including on pancreatic cancer) of aspirin and related drugs have been actively studied for the past twenty-five years or so. The initial work was noted and especially explored in colon cancer.  There is conflicting research but the chemopreventive outcome of long-term aspirin use on cancer seems reasonably likely in colorectal cancer with probable but a lesser likelihood in other parts of the human GI tract.  Research on long-term aspirin usage and pancreatic cancer (ductal adenocarcinoma of the pancreas) has yielded conflicting results.

The active ingredient in the bark of the willow tree (salicylic acid) was discovered in 1763 by Edward Stone of Oxford University UK. More than one hundred years later, this ingredient was first synthesized by the Bayer company in Germany, the “biotech” high flyer of its day.  In modern times, aspirin is categorized in a class called nonsteroidal anti-inflammatory drugs (NSAIDs) that are each separated by slightly different mechanisms of action.  The mechanisms of action of aspirin are myriad, but distinctively include being an irreversible cyclooxygenase (“COX”) enzyme inhibitor – both of the COX-1 and COX 2 pathways.

Qin and colleagues from Zhengzhou and Xinxiang, China conducted a meta-analysis of the chemopreventive possibility of aspirin intake in the medical literature and published the results in the January 2014 issue of the journal Pancreas. The authors identified ten studies that met their criteria for analysis which totaled 7,252 patients carrying a diagnosis of pancreatic cancer.  They found that the odds ratio of taking a high dosage of aspirin was modestly protective against pancreatic cancer at 0.88. For Americans alone the odds ratio was 0.82. Low dosage intake of aspirin showed no apparent preventive advantage.

The distinction between high dose and low dose of aspirin intake may help explain the previous uneven research results in pancreatic cancer.  An interesting result, we will have to watch for follow-up studies to better substantiate these findings.

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Dale O’Brien, MD

Mistletoe for Pancreatic Cancer

Viscum Album is a kind of mistletoe that is native to many European and Asian countries. Members of the mistletoe family have been used as an “alternative” or complementary treatment for any number of maladies including pancreatic cancer (ductal adenocarcinoma of the pancreas). As we have mentioned before, the Pancreatica Blog appreciates alternative therapies for cancer of the pancreas that have been subjected to the scientific method. We like these studies as so many patients who we encounter seem to be interested in alternative or complementary therapy for their pancreatic cancer. It seems like a service to offer up information on ones in which serious study has been undertaken.

Mistletoe has been studied more scientifically for the past two decades for pancreatic cancer.  One of our Pancreatica Science Board members participated in a research study almost twenty years ago that found no substantive survival advantage of mistletoe in pancreatic cancer (yet interestingly, it appeared to demonstrate improved quality of life).  It seems as if it is mostly German researchers who have been exploring this area.

Troger and colleagues from Germany and Serbia published the results of their Phase III study involving 220 patients in the December 2013 issue of the European Journal of Cancer whereby the authors reviewed the effects of a dose escalating subcutaneously given regimen of Viscum album offered to patients with advanced and locally advanced adenocarcinoma of the pancreas VERSUS no antineoplastic therapy given for an evenly randomized control group.

The median overall survival in the mistletoe treated group was 4.8 months, and 2.7 months for the control group (p<0.0001).  There were no adverse side-effects due to the Viscum album noted.

This is intriguing of course. There are potential problems with the study including the Stages mix and selection bias. One cringes a bit that the control group did not receive standard of care chemotherapy. The survival advantage seems fairly small.  But it is a finding – and likely worthy of further inquiry.

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Dale O’Brien, MD