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Pancreatic Neoplasms: HELP
Articles by Dr. Joseph Herman
Based on 126 articles published since 2008
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Between 2008 and 2019, Joseph Herman wrote the following 126 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6
1 Guideline Pancreatic Adenocarcinoma, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology. 2017

Tempero, Margaret A / Malafa, Mokenge P / Al-Hawary, Mahmoud / Asbun, Horacio / Bain, Andrew / Behrman, Stephen W / Benson, Al B / Binder, Ellen / Cardin, Dana B / Cha, Charles / Chiorean, E Gabriela / Chung, Vincent / Czito, Brian / Dillhoff, Mary / Dotan, Efrat / Ferrone, Cristina R / Hardacre, Jeffrey / Hawkins, William G / Herman, Joseph / Ko, Andrew H / Komanduri, Srinadh / Koong, Albert / LoConte, Noelle / Lowy, Andrew M / Moravek, Cassadie / Nakakura, Eric K / O'Reilly, Eileen M / Obando, Jorge / Reddy, Sushanth / Scaife, Courtney / Thayer, Sarah / Weekes, Colin D / Wolff, Robert A / Wolpin, Brian M / Burns, Jennifer / Darlow, Susan. · ·J Natl Compr Canc Netw · Pubmed #28784865.

ABSTRACT: Ductal adenocarcinoma and its variants account for most pancreatic malignancies. High-quality multiphase imaging can help to preoperatively distinguish between patients eligible for resection with curative intent and those with unresectable disease. Systemic therapy is used in the neoadjuvant or adjuvant pancreatic cancer setting, as well as in the management of locally advanced unresectable and metastatic disease. Clinical trials are critical for making progress in treatment of pancreatic cancer. The NCCN Guidelines for Pancreatic Adenocarcinoma focus on diagnosis and treatment with systemic therapy, radiation therapy, and surgical resection.

2 Guideline Pancreatic Adenocarcinoma, version 2.2012: featured updates to the NCCN Guidelines. 2012

Tempero, Margaret A / Arnoletti, J Pablo / Behrman, Stephen W / Ben-Josef, Edgar / Benson, Al B / Casper, Ephraim S / Cohen, Steven J / Czito, Brian / Ellenhorn, Joshua D I / Hawkins, William G / Herman, Joseph / Hoffman, John P / Ko, Andrew / Komanduri, Srinadh / Koong, Albert / Ma, Wen Wee / Malafa, Mokenge P / Merchant, Nipun B / Mulvihill, Sean J / Muscarella, Peter / Nakakura, Eric K / Obando, Jorge / Pitman, Martha B / Sasson, Aaron R / Tally, Anitra / Thayer, Sarah P / Whiting, Samuel / Wolff, Robert A / Wolpin, Brian M / Freedman-Cass, Deborah A / Shead, Dorothy A / Anonymous1061005. ·UCSF Helen Diller Family Comprehensive Cancer Center. ·J Natl Compr Canc Netw · Pubmed #22679115.

ABSTRACT: The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Pancreatic Adenocarcinoma discuss the workup and management of tumors of the exocrine pancreas. These NCCN Guidelines Insights provide a summary and explanation of major changes to the 2012 NCCN Guidelines for Pancreatic Adenocarcinoma. The panel made 3 significant updates to the guidelines: 1) more detail was added regarding multiphase CT techniques for diagnosis and staging of pancreatic cancer, and pancreas protocol MRI was added as an emerging alternative to CT; 2) the use of a fluoropyrimidine plus oxaliplatin (e.g., 5-FU/leucovorin/oxaliplatin or capecitabine/oxaliplatin) was added as an acceptable chemotherapy combination for patients with advanced or metastatic disease and good performance status as a category 2B recommendation; and 3) the panel developed new recommendations concerning surgical technique and pathologic analysis and reporting.

3 Editorial The promise of modern radiotherapy in resected pancreatic adenocarcinoma: a response to Bekaii-Saab et al. 2014

Narang, Amol K / Herman, Joseph M. ·Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA. ·Ann Surg Oncol · Pubmed #24522986.

ABSTRACT: -- No abstract --

4 Editorial Adjuvant pancreatic cancer therapy: no one should go it alone or be left behind. 2010

Herman, Joseph M / Regine, William F. · ·Int J Radiat Oncol Biol Phys · Pubmed #20510192.

ABSTRACT: -- No abstract --

5 Review The role of imaging in the clinical practice of radiation oncology for pancreatic cancer. 2018

Koay, Eugene J / Hall, William / Park, Peter C / Erickson, Beth / Herman, Joseph M. ·Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, MS 97, Houston, TX, 77030, USA. EKoay@mdanderson.org. · Department of Radiation Oncology, Medical College of Wisconsin, Madison, WI, USA. · Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, USA. · Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, MS 97, Houston, TX, 77030, USA. ·Abdom Radiol (NY) · Pubmed #29110053.

ABSTRACT: Advances in technology have enabled the delivery of high doses of radiation therapy for pancreatic ductal adenocarcinoma (PDAC) with low rates of toxicity. Although the role of radiation for pancreatic cancer continues to evolve, encouraging results with newer techniques indicate that radiation may benefit selected patient populations. Imaging has been central to the modern successes of radiation therapy for PDAC. Here, we review the role of diagnostic imaging, imaging-based planning, and image guidance in radiation oncology practice for PDAC.

6 Review Integration of Stereotactic Body Radiation Therapy into the Multidisciplinary Management of Pancreatic Cancer. 2017

Rosati, Lauren M / Kumar, Rachit / Herman, Joseph M. ·Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD. · Division of Radiation Oncology, Banner MD Anderson Cancer Center, Gilbert, AZ. · Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: JMHerman@mdanderson.org. ·Semin Radiat Oncol · Pubmed #28577833.

ABSTRACT: Although most patients with pancreatic cancer die of metastatic disease, an autopsy study showed that up to one-third of patients die of predominantly local disease. This patient population stands to benefit the most from radiation, surgery, or both. Unfortunately, however, single-agent chemotherapy has had minimal benefit in pancreatic cancer, and most patients progress distantly before receiving radiation therapy (RT). With the addition of multiagent chemotherapy, patients are living longer, and RT has emerged as an important modality in preventing local progression. Standard chemoradiation delivered over 5-6 weeks has been shown to improve local control, but this approach delays full-dose systemic therapy and increases toxicity when compared to chemotherapy alone. Stereotactic body RT (SBRT) delivered in 3-5 fractions can be used to accurately target the pancreatic tumor with small margins and limited acute treatment-related toxicity. Given the favorable toxicity profile, SBRT can easily be integrated with other therapies in all stages of pancreatic cancer. However, future studies are necessary to determine optimal dose or fractionation regimens and sequencing with targeted therapies and immunotherapy. The purpose of this review is to discuss our current understanding of SBRT in the multidisciplinary management of patients with pancreatic cancer and future implications.

7 Review Role of Stereotactic Body Radiotherapy in the Treatment of Elderly and Poor Performance Status Patients With Pancreatic Cancer. 2017

Rosati, Lauren M / Herman, Joseph M. ·Johns Hopkins University School of Medicine, Baltimore, MD; and University of Texas MD Anderson Cancer Center, Houston, TX. ·J Oncol Pract · Pubmed #28282277.

ABSTRACT: Literature on the management of nonmetastatic pancreatic ductal adenocarcinoma in patients who are elderly or have poor performance status is sparse. The median survival of this unique cohort of patients is < 6 months, and most patients are only offered single-agent gemcitabine or supportive care. Recently, adding nanoparticle albumin-bound paclitaxel to gemcitabine was shown to improve survival of patients with metastatic disease with Eastern Cooperative Group performance status of 2. Although standard chemoradiotherapy provides long-term locoregional control in locally advanced pancreatic cancer, it is difficult for this group of patients to tolerate 6 weeks of therapy. Stereotactic body radiotherapy (SBRT) can be delivered in only 3 to 5 days, does not require concurrent chemotherapy, and has limited toxicity, and tumor control rates appear to be equivalent to or better than those achieved with standard chemoradiotherapy. Additionally, SBRT has been shown to improve cancer-related pain and patient-reported quality of life. Given the favorable toxicity profile, SBRT seems like an obvious choice for patients who are elderly, have multiple comorbidities, or have poor performance status. Herein, we review the literature on SBRT in this unique patient population and discuss future directions.

8 Review ACR Appropriateness Criteria® Resectable Pancreatic Cancer. 2017

Jones, William E / Suh, W Waren / Abdel-Wahab, May / Abrams, Ross A / Azad, Nilofer / Das, Prajnan / Dragovic, Jadranka / Goodman, Karyn A / Jabbour, Salma K / Konski, Andre A / Koong, Albert C / Kumar, Rachit / Lee, Percy / Pawlik, Timothy M / Small, William / Herman, Joseph M / Anonymous5660897. ·*University of Texas Health Science Center at San Antonio, San Antonio ¶University of Texas MD Anderson Cancer Center, Houston, TX †Cancer Center of Santa Barbara, Santa Barbara §§Stanford Cancer Institute, Stanford ¶¶University of California Los Angeles, Los Angeles, CA ‡Cleveland Clinic, Cleveland, OH ***Stritch School of Medicine Loyola University Chicago, Maywood §Rush University Medical Center, Chicago, IL ∥Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, American Society of Clinical Oncology †††Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University ##Johns Hopkins University, Baltimore, MD, American College of Surgeons #Henry Ford Hospital, Detroit, MI **University of Colorado School of Medicine Anschutz Medical Campus, Aurora, CO ††Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ ‡‡University of Pennsylvania, The Chester County Hospital, West Chester, PA ∥∥Banner MD Anderson Cancer Center, Gilbert, AZ. ·Am J Clin Oncol · Pubmed #28230650.

ABSTRACT: Management of resectable pancreatic adenocarcinoma continues to present a challenge due to a paucity of high-quality randomized studies. Administration of adjuvant chemotherapy is widely accepted due to the high risk of systemic spread associated with pancreatic adenocarcinoma, but the role of radiation therapy is less clear. This paper reviews literature associated with resectable pancreatic cancer to include prognostic factors to aid in the selection of patients appropriate for adjuvant therapies. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

9 Review Systematic review on the treatment of isolated local recurrence of pancreatic cancer after surgery; re-resection, chemoradiotherapy and SBRT. 2017

Groot, Vincent P / van Santvoort, Hjalmar C / Rombouts, Steffi J E / Hagendoorn, Jeroen / Borel Rinkes, Inne H M / van Vulpen, Marco / Herman, Joseph M / Wolfgang, Christopher L / Besselink, Marc G / Molenaar, I Quintus. ·Dept. of Surgery, University Medical Center Utrecht Cancer Center, The Netherlands; Dept. of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Dept. of Surgery, St. Antonius Hospital Nieuwegein, The Netherlands; Dept. of Surgery, Academic Medical Center Amsterdam, The Netherlands. · Dept. of Surgery, University Medical Center Utrecht Cancer Center, The Netherlands. · Dept. of Radiation Oncology, University Medical Center Utrecht Cancer Center, The Netherlands. · Dept. of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Dept. of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Dept. of Surgery, Academic Medical Center Amsterdam, The Netherlands. · Dept. of Surgery, University Medical Center Utrecht Cancer Center, The Netherlands. Electronic address: i.q.molenaar@umcutrecht.nl. ·HPB (Oxford) · Pubmed #28065427.

ABSTRACT: BACKGROUND: The majority of patients who have undergone a pancreatic resection for pancreatic cancer develop disease recurrence within two years. In around 30% of these patients, isolated local recurrence (ILR) is found. The aim of this study was to systematically review treatment options for this subgroup of patients. METHODS: A systematic search was performed in PubMed, Embase and the Cochrane Library. Studies reporting on the treatment of ILR after initial curative-intent resection of primary pancreatic cancer were included. Primary endpoints were morbidity, mortality and survival after ILR treatment. RESULTS: After screening 1152 studies, 18 studies reporting on 313 patients undergoing treatment for ILR were included. Treatment options for ILR included surgical re-resection (8 studies, 100 patients), chemoradiotherapy (7 studies, 153 patients) and stereotactic body radiation therapy (SBRT) (4 studies, 60 patients). Morbidity and mortality were reported for re-resection (29% and 1%, respectively), chemoradiotherapy (54% and 0%) and SBRT (3% and 1%). Most patients had a prolonged disease-free interval before recurrence. Median survival after treatment of ILR of up to 32, 19 and 16 months was reported for re-resection, chemoradiotherapy and SBRT, respectively. CONCLUSION: In selected patients, treatment of ILR following pancreatic resection for pancreatic cancer seems safe, feasible and associated with relatively good survival.

10 Review ACR Appropriateness Criteria® Borderline and Unresectable Pancreas Cancer. 2016

Anonymous970875 / Small, William / Hayes, John P / Suh, W Warren / Abdel-Wahab, May / Abrams, Ross A / Azad, Nilofer / Das, Prajnan / Dragovic, Jadranka / Goodman, Karyn A / Jabbour, Salma K / Jones, William E / Konski, Andre A / Koong, Albert C / Kumar, Rachit / Lee, Percy / Pawlik, Timothy M / Herman, Joseph M. · ·Oncology (Williston Park) · Pubmed #27422109.

ABSTRACT: The American College of Radiology Appropriateness Criteria® are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. The panel reviewed the pertinent literature and voted on five variants to establish appropriate recommended treatment of borderline and unresectable pancreatic cancer. The guidelines reviewed the use of radiation, chemotherapy, and surgery. Radiation technique, dose, and targets were evaluated, as was the recommended chemotherapy, administered either alone or concurrently with radiation. This report will aid clinicians in determining guidelines for the optimal treatment of borderline and unresectable pancreatic cancer.

11 Review Localized Pancreatic Cancer: Multidisciplinary Management. 2016

Coveler, Andrew L / Herman, Joseph M / Simeone, Diane M / Chiorean, E Gabriela. ·From the Division of Hematology-Oncology, University of Washington, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD; University of Michigan, Ann Arbor, MI. ·Am Soc Clin Oncol Educ Book · Pubmed #27249726.

ABSTRACT: Pancreatic cancer is an aggressive cancer that continues to have single-digit 5-year mortality rates despite advancements in the field. Surgery remains the only curative treatment; however, most patients present with late-stage disease deemed unresectable, either due to extensive local vascular involvement or the presence of distant metastasis. Resection guidelines that include a borderline resectable group, as well as advancements in neoadjuvant chemotherapy and radiation that improve resectability of locally advanced disease, may improve outcomes for patients with more invasive disease. Multi-agent chemotherapy regimens fluorouracil, leucovorin, irinotecan, and oxaliplatin (FOLFIRINOX) and nab-paclitaxel with gemcitabine improved response rates and survival in metastatic pancreatic cancer and are now being used in earlier stages for patients with localized potentially resectable and unresectable disease, with goals of downstaging tumors to allow margin-negative resection and reducing systemic recurrence. Chemoradiotherapy, although still controversial for both resectable and unresectable pancreatic cancer, is being used in the context of contemporary chemotherapy backbone regimens, and novel radiation techniques such as stereotactic body frame radiation therapy (SBRT) are studied on the premise of maintaining or improving efficacy and reducing treatment duration. Patient selection for optimal treatment designation is currently provided by multidisciplinary tumor boards, but biomarker discovery, in blood, tumors, or through novel imaging, is an area of intense research. Results to date suggest that some patients with unresectable disease at the outset have survival rates as good as those with initially resectable disease if able to undergo surgical resection. Long-term follow-up and improved clinical trials options are needed to determine optimal treatment modalities for patients with localized pancreatic cancer.

12 Review Stereotactic body radiotherapy for pancreatic cancer: recent progress and future directions. 2016

Myrehaug, Sten / Sahgal, Arjun / Russo, Suzanne M / Lo, Simon S / Rosati, Lauren M / Mayr, Nina A / Lock, Michael / Small, William / Dorth, Jennifer A / Ellis, Rodney J / Teh, Bin S / Herman, Joseph M. ·a Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre , University of Toronto , Toronto , ON , Canada. · b Department of Radiation Oncology , University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center , Cleveland , OH , USA. · c Department of Radiation Oncology & Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center , Johns Hopkins University , Baltimore , MD , USA. · d Department of Radiation Oncology , University of Washington , Seattle , WA , USA. · e Department of Radiation Oncology, London Regional Cancer Program , University of Western Ontario , London , ON , Canada. · f Department of Radiation Oncology , Loyola University Medical Center , Maywood , IL , USA. · g Department of Radiation Oncology , Houston Methodist Hospital, Weill Cornell Medical College , Houston , TX , USA. ·Expert Rev Anticancer Ther · Pubmed #26999329.

ABSTRACT: Despite advances in surgical, medical, and radiation therapy for pancreatic cancer, the prognosis remains poor. At this time, the only chance for long-term survival is surgical resection. More challenging is the optimal management of unresectable locally advanced pancreatic cancer, which has historically been treated with concurrent chemoradiation or chemotherapy alone. However, the survival and local control benefit of conventional radiotherapy in addition to chemotherapy was unclear. More recently, stereotactic body radiotherapy (SBRT) is emerging as a viable approach to maximizing local tumor control with a tolerable side effect profile. SBRT achieves sharp dose fall-off facilitating safe delivery of highly focused radiation to the tumor over 1-5 days. Although the optimal regimen of pancreas SBRT has not yet been established, its short treatment course limits the delay of additional. Future directions involve prospective study of pancreas SBRT and exploration of biomarkers and imaging technology in order to adopt a personalized management paradigm.

13 Review Management of the Primary Tumor and Limited Metastases in Patients With Metastatic Pancreatic Cancer. 2015

Herman, Joseph M / Hoffman, John P / Thayer, Sarah P / Wolff, Robert A. · ·J Natl Compr Canc Netw · Pubmed #26158133.

ABSTRACT: New combinations of cytotoxic chemotherapy have been proven to increase response rates and survival times compared with single-agent gemcitabine for patients with metastatic pancreatic cancer. These responses have been dramatic for a subset of patients, therefore raising questions about the management of limited metastatic disease with surgery or other ablative methods. Similarly, for patients having a complete radiographic response to chemotherapy in the metastatic compartment, whether to consider local therapy in the form of radiation or surgery for the primary tumor is now an appropriate question. Therefore, collaboration among experts in surgery, medical oncology, and radiation oncology has led to the development of guiding principles for local therapies to the primary intact pancreatic tumor for patients with limited metastatic disease and those who have had a significant response after systemic therapy.

14 Review The role of radiation therapy in pancreatic ductal adenocarcinoma in the neoadjuvant and adjuvant settings. 2015

Franke, Aaron J / Rosati, Lauren M / Pawlik, Timothy M / Kumar, Rachit / Herman, Joseph M. ·Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD. · Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. · Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: jherma15@jhmi.edu. ·Semin Oncol · Pubmed #25726059.

ABSTRACT: Pancreatic adenocarcinoma (PCA) is associated with high rates of cancer-related morbidity and mortality. Yet despite modern treatment advances, the only curative therapy remains surgical resection. The adjuvant therapeutic standard of care for PCA in the United States includes both chemotherapy and chemoradiation; however, an optimal regimen has not been established. For patients with resectable and borderline resectable PCA, recent investigation has focused efforts on evaluating the feasibility and efficacy of neoadjuvant therapy. Neoadjuvant therapy allows for early initiation of systemic therapy and identification of patients who harbor micrometastatic disease, thus sparing patients the potential morbidities associated with unnecessary radiation or surgery. This article critically reviews the data supporting or refuting the role of radiation therapy in the neoadjuvant and adjuvant settings of PCA management, with a particular focus on determining which patients may be more likely to benefit from radiation therapy.

15 Review Pancreatic cancer and FOLFIRINOX: a new era and new questions. 2015

Marsh, Robert De W / Talamonti, Mark S / Katz, Matthew Harold / Herman, Joseph M. ·Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois, 60201. · Department of Surgery, NorthShore University HealthSystem, Evanston, Illinois, 60201. · Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. · Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, Maryland. ·Cancer Med · Pubmed #25693729.

ABSTRACT: FOLFIRINOX (FFX) was introduced to clinical practice in 2010 following publication of the PRODIGE 4/ACCORD 11 study, which compared this novel regimen to gemcitabine in metastatic pancreatic cancer. Median overall survival, progression-free survival, and objective responses were all superior with FFX and there was improved time to definitive deterioration in quality of life. Despite initial concerns over toxicity, there has been rapid uptake of this regimen, both revolutionizing management and opening the door to innovative research. As experience with FFX has accrued, many questions have arisen including the management of toxicities, the impact of frequent modifications, the optimal number of cycles, integration with other regimens and modalities, interpretation of radiologic and serologic response, utility of molecular signatures, and potential benefit in unique clinical settings such as pre- and postsurgery. This review will closely examine these issues, not only to summarize current knowledge but also to fuel scientific debate.

16 Review CNS involvement in pancreatic adenocarcinoma: a report of eight cases from the Johns Hopkins Hospital and review of literature. 2015

Kumar, Abhijeet / Dagar, Meenakshi / Herman, Joseph / Iacobuzio-Donahue, Christine / Laheru, Dan. ·Department of Hematology/Oncology, University of Arizona Medical Center, 1501, N Campbell Ave, Tucson, AZ, USA, dr.abhijeetkumar@gmail.com. ·J Gastrointest Cancer · Pubmed #25451139.

ABSTRACT: PURPOSE: CNS metastasis of pancreatic cancer is extremely rare, although systemic metastasis is very common. We present eight such cases with various forms of nervous system involvement. METHODS: Data was gathered from chart review of 800 patients with pancreatic cancer treated between 2004 and 2012 of which eight patients are described with CNS metastases. RESULTS: The median age of patients was 61.5 years and the median time to develop CNS metastasis was 29 months. Interestingly, two patients had no other sites of metastasis. The treatment modalities tried included resection followed by radiation, resection alone, or whole brain radiation.

17 Review Stereotactic body radiation therapy in pancreatic cancer: the new frontier. 2014

Moningi, Shalini / Marciscano, Ariel E / Rosati, Lauren M / Ng, Sook Kien / Teboh Forbang, Roland / Jackson, Juan / Chang, Daniel T / Koong, Albert C / Herman, Joseph M. ·Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, 401 N. Broadway, Weinberg Suite 1440, Baltimore, MD 21231, USA. ·Expert Rev Anticancer Ther · Pubmed #25183386.

ABSTRACT: Pancreatic cancer (PCA) remains a disease with a poor prognosis. The majority of PCA patients are unable to undergo surgical resection, which is the only potentially curative option at this time. A combination of chemotherapy and chemoradiation (CRT) are standard options for patients with locally advanced, unresectable disease, however, local control and patient outcomes remains poor. Stereotactic body radiation therapy (SBRT) is an emerging treatment option for PCA. SBRT delivers potentially ablative doses to the pancreatic tumor plus a small margin over a short period of time. Early studies with single-fraction SBRT demonstrated excellent tumor control with high rates of toxicity. The implementation of SBRT (3-5 doses) has demonstrated promising outcomes with favorable tumor control and toxicity rates. Herein we discuss the evolving role of SBRT in PCA treatment.

18 Review The early detection of pancreatic cancer: what will it take to diagnose and treat curable pancreatic neoplasia? 2014

Lennon, Anne Marie / Wolfgang, Christopher L / Canto, Marcia Irene / Klein, Alison P / Herman, Joseph M / Goggins, Michael / Fishman, Elliot K / Kamel, Ihab / Weiss, Matthew J / Diaz, Luis A / Papadopoulos, Nickolas / Kinzler, Kenneth W / Vogelstein, Bert / Hruban, Ralph H. ·Authors' Affiliations: Departments of Medicine; Surgery; · Surgery; Pathology; Oncology; · Authors' Affiliations: Departments of Medicine; · Pathology; Oncology; Department of Epidemiology, the Bloomberg School of Public Health, Baltimore, Maryland. · Oncology; Radiation Oncology; and. · Authors' Affiliations: Departments of Medicine; Pathology; Oncology; · Radiology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine; and. · Surgery; · Oncology; · Pathology; Oncology; · Pathology; Oncology; rhruban@jhmi.edu. ·Cancer Res · Pubmed #24924775.

ABSTRACT: Pancreatic cancer is the deadliest of all solid malignancies. Early detection offers the best hope for a cure, but characteristics of this disease, such as the lack of early clinical symptoms, make the early detection difficult. Recent genetic mapping of the molecular evolution of pancreatic cancer suggests that a large window of opportunity exists for the early detection of pancreatic neoplasia, and developments in cancer genetics offer new, potentially highly specific approaches for screening of curable pancreatic neoplasia. We review the challenges of screening for early pancreatic neoplasia, as well as opportunities presented by incorporating molecular genetics into these efforts.

19 Review Management options in locally advanced pancreatic cancer. 2014

Mian, Omar Y / Ram, Ashwin N / Tuli, Richard / Herman, Joseph M. ·Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, 401 North Broadway, Weinberg Suite, 1440, Baltimore, MD, 21231, USA. ·Curr Oncol Rep · Pubmed #24740136.

ABSTRACT: Pancreatic ductal adenocarcinoma is a highly lethal cancer that is rarely curable at the time of presentation. Unfortunately, most patients are diagnosed with either metastatic or locally advanced disease, which is not amenable to surgery owing to the high likelihood of incomplete resection. Given the generally poor prognosis with propensity for metastatic failure greater than that for local failure, treatment options are variable, and include chemotherapy, radiotherapy, targeted therapies, and combinations thereof. This review summarizes the current evidence for definitive management of locally advanced pancreatic adenocarcinoma, as well as the role of palliative therapies. Future directions, including the development of predictive biomarkers and novel systemic agents, are also discussed.

20 Review Pancreaticobiliary malignancies: past, present, and future. 2014

Herman, Joseph M. ·Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD. ·Semin Radiat Oncol · Pubmed #24635862.

ABSTRACT: -- No abstract --

21 Review Management of borderline and locally advanced pancreatic cancer: where do we stand? 2014

He, Jin / Page, Andrew J / Weiss, Matthew / Wolfgang, Christopher L / Herman, Joseph M / Pawlik, Timothy M. ·Jin He, Andrew J Page, Matthew Weiss, Christopher L Wolfgang, Timothy M Pawlik, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, United States. ·World J Gastroenterol · Pubmed #24605025.

ABSTRACT: Many patients with pancreas cancer present with locally advanced pancreatic cancer (LAPC). The principle tools used for diagnosis and staging of LAPC include endoscopic ultrasound, axial imaging with computed tomography and magnetic resonance imaging, and diagnostic laparoscopy. The definition of resectability has historically been vague, as there is considerable debate and controversy as to the definition of LAPC. For the patient with LAPC, there is some level of involvement of the surrounding vascular structures, which include the superior mesenteric artery, celiac axis, hepatic artery, superior mesenteric vein, or portal vein. When feasible, most surgeons would recommend possible surgical resection for patients with borderline LAPC, with the goal of an R0 resection. For initially unresectable LAPC, neoadjuvant should be strongly considered. Specifically, these patients should be offered neoadjuvant therapy, and the tumor should be assessed for possible response and eventual resection. The efficacy of neoadjuvant therapy with this approach as a bridge to potential curative resection is broad, ranging from 3%-79%. The different modalities of neoadjuvant therapy include single or multi-agent chemotherapy combined with radiation, chemotherapy alone, and chemotherapy followed by chemotherapy with radiation. This review focuses on patients with LAPC and addresses recent advances and controversies in the field.

22 Review Radiosensitizers in pancreatic cancer--preclinical and clinical exploits with molecularly targeted agents. 2013

Walker, Amanda J / Alcorn, Sara R / Narang, Amol K / Nugent, Katriana M / Wild, Aaron T / Herman, Joseph M / Tran, Phuoc T. · ·Curr Probl Cancer · Pubmed #24331186.

ABSTRACT: -- No abstract --

23 Review The diagnosis and surgical treatment of pancreatoblastoma in adults: a case series and review of the literature. 2013

Salman, Bulent / Brat, Gabriel / Yoon, Yoo-Seok / Hruban, Ralph H / Singhi, Aatur D / Fishman, Elliot K / Herman, Joseph M / Wolfgang, Christopher L. ·Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, Baltimore, MD, USA. ·J Gastrointest Surg · Pubmed #24081396.

ABSTRACT: INTRODUCTION: Pancreatoblastoma is an extremely rare pancreatic neoplasm in adults. The aim of this study is to report our experience with adult pancreatoblastoma as well as review the cases reported in the literature in order to provide guidelines for the management of patients with this rare neoplasm. METHODS: We have encountered three cases of pancreatoblastoma in adults at our institution in addition to the 30 cases reported to date in literature. RESULTS: The median age of pancreatoblastoma in adults is 37 years (range, 18-78 years); men and women are similarly affected (male/female = 16/17). The behavior of pancreatoblastoma is clearly that of a malignant neoplasm, with local invasion, recurrence, and metastasis. Among the adult reported cases, at diagnosis or operation, metastasis and/or local invasion was found in 14 of 31 adult patients (46 %) (2 patients had no data) The survival was significantly higher in patients with resected tumor (resection only and resection + adjuvant chemo/radiotherapy) when compared to unresected patients (palliative chemo/radiotherapy and no treatment), (p = 0.008, HR = 0.20). CONCLUSION: When disease is localized, the treatment of choice is a complete surgical resection. The role of adjuvant chemotherapy or radiotherapy is still unclear based on the very small number of patients treated.

24 Review Recent progress in pancreatic cancer. 2013

Wolfgang, Christopher L / Herman, Joseph M / Laheru, Daniel A / Klein, Alison P / Erdek, Michael A / Fishman, Elliot K / Hruban, Ralph H. ·Associate Professor, Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD; Associate Professor, Department of Oncology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD; Associate Professor, Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD. ·CA Cancer J Clin · Pubmed #23856911.

ABSTRACT: Pancreatic cancer is currently one of the deadliest of the solid malignancies. However, surgery to resect neoplasms of the pancreas is safer and less invasive than ever, novel drug combinations have been shown to improve survival, advances in radiation therapy have resulted in less toxicity, and enormous strides have been made in the understanding of the fundamental genetics of pancreatic cancer. These advances provide hope but they also increase the complexity of caring for patients. It is clear that multidisciplinary care that provides comprehensive and coordinated evaluation and treatment is the most effective way to manage patients with pancreatic cancer.

25 Review Multidisciplinary management of pancreatic cancer. 2013

Kumar, Rachit / Herman, Joseph M / Wolfgang, Christopher L / Zheng, Lei. ·Department of Radiation Oncology & Molecular Radiation Sciences, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA. ·Surg Oncol Clin N Am · Pubmed #23453334.

ABSTRACT: Pancreatic cancer (pancreatic adenocarcinoma) remains one of the deadliest malignancies in the western hemisphere despite improved surgical technique, chemotherapy, and radiation therapy. The appropriate management of this malignancy should incorporate multiple treatment modalities for optimal opportunity for cure. Recent trials with a variety of treatment techniques confer improved survival of patients with pancreatic cancer, even in the metastatic setting. In this review, the importance of multidisciplinary management of pancreatic cancer based on disease stage is discussed.

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