Pancreas

Question 1

PREOPANC?

Answer 1

• NCRT (Gem + rads periop) versus adjuvant chemo (only Gem)
• Resectable and BR
• Improved OS, DFS

Question 2

Alliance radiation trial?

Answer 2

• Neoadjuvant mFOLFIRINOX w/wo CRT in borderline resectable
• No benefit to CRT
• mFOLFIRINOX better than historical chemo controls
  *

Question 3

TNT for panc adeno- factors predicting improved OS?

Answer 3

• Duration of chemo
• Ca 19-9 response
• Major path response
• (Imaging not useful)

Question 4

ESPAC 5F pancreatic cancer?

Answer 4

• Upfront surgery vs neoadjuvant mFOLFIRINOX vs Cape/Gem vs CRT in Borderline resectable
• OS improved with neoadjuvant
• mFOLFIRINOX&raquo_space; Gem/Cap» CRT
• No reduction in operability

Question 5

Borderline resectable PDAC artery?

Answer 5

< 180 SMA
< 180 CHA, not extending to CA, HA bifurcation
For body/tail < 180 of CA

Question 6

Borderline resectable PDAC vein?

Answer 6

> 180 PV/SMV
< 180 with contour irregularity or short segment occlusion thats reconstructable

Question 7

Resectable PDAC vein?

Answer 7

< 180 PV/SMV without contour irregularity

Question 8

NORPACT 1 pancreatic cancer trial?

Answer 8

• Upfront surgery + adjuvant FOLFIRINOX vs Periop chemo (4 cyc before, 8 after) for RESECTABLE PDAC
• NO benefit to OS

Question 9

Serous cystadenoma

Answer 9

• Older F>M
• Anywhere in pancreas
• High glycogen, glucose
• VHL associated

Question 10

Mucinous cystadenoma

Answer 10

• Only women, usually after 40’s
• Ovarian stroma (unlike IMPN)
• Body and tail
• No PD communication
• Malignant potential

Question 11

Solid pseudopapillary neoplasms

Answer 11

• Women < 35
• Body or tail
• Solid and cystic
• Malignant potential

Question 12

SWOG S1505

Answer 12

• Periop FOLFIRINOX vs Gem-abraxane in resectable PDAC
• No difference between 2 regimens
• Similar to historical controls