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Pancreatic Neoplasms: HELP
Articles by William Small
Based on 11 articles published since 2010
(Why 11 articles?)

Between 2010 and 2020, W. Small wrote the following 11 articles about Pancreatic Neoplasms.
+ Citations + Abstracts
1 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 / Anonymous4490897. ·*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.

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

Anonymous19880874 / 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.

3 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.

4 Review The effects of bevacizumab on postoperative complications in patients undergoing colorectal and pancreatic cancer resection. 2010

Cheon, E C / Small, W / Strouch, M J / Krantz, S B / Rademaker, A / Mulcahy, M F / Benson, A B / Bentrem, D J / Talamonti, M S. ·Department of Surgery, Mount Sinai Hospital, University of Illinois at Chicago, Chicago, Illinois, USA. ·J Surg Oncol · Pubmed #20812264.

ABSTRACT: Bevacizumab (Avastin™; rhuMab VEGF), a monoclonal antibody targeting vascular endothelial growth factor (VEGF), has seen increased use in the perioperative treatment of colorectal and pancreatic cancer. Little is known, however, regarding its impact on surgical outcomes in patients undergoing resection. The objective of this review was to examine if the addition of bevacizumab to existing neoadjuvant regimens increases morbidity after cancer resection.

5 Clinical Trial Addition of algenpantucel-L immunotherapy to standard adjuvant therapy for pancreatic cancer: a phase 2 study. 2013

Hardacre, Jeffrey M / Mulcahy, Mary / Small, William / Talamonti, Mark / Obel, Jennifer / Krishnamurthi, Smitha / Rocha-Lima, Caio S / Safran, Howard / Lenz, Heinz-Joseph / Chiorean, E Gabriela. ·Department of Surgery, University Hospitals Seidman Cancer Center and Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA. jeffrey.hardacre@UHhospitals.org ·J Gastrointest Surg · Pubmed #23229886.

ABSTRACT: BACKGROUND: Despite continued investigation, limited progress has been made in the adjuvant treatment of resected pancreatic cancer. Novel or targeted therapies are needed. METHODS: Multi-institutional, open-label, dose-finding, phase 2 trial evaluating the use of algenpantucel-L (NewLink Genetics Corporation, Ames, IA) immunotherapy in addition to chemotherapy and chemoradiotherapy in the adjuvant setting for resected pancreatic cancer (ClinicalTrials.gov identifier, NCT00569387). The primary outcome was 12-month disease-free survival. Secondary outcomes included overall survival and toxicity. RESULTS: Seventy patients were treated with gemcitabine and 5-fluorouracil-based chemoradiotherapy as well as algenpantucel-L (mean 12 doses, range 1-14). After a median follow-up of 21 months, the 12-month disease-free survival was 62 %, and the 12-month overall survival was 86 %. The most common adverse events were injection site pain and induration. CONCLUSIONS: The addition of algenpantucel-L to standard adjuvant therapy for resected pancreatic cancer may improve survival. A multi-institutional, phase 3 study is ongoing (ClinicalTrials.gov identifier, NCT01072981).

6 Clinical Trial Change in the growth rate of localized pancreatic adenocarcinoma in response to gemcitabine, bevacizumab, and radiation therapy on MDCT. 2011

Rezai, Pedram / Yaghmai, Vahid / Tochetto, Sandra M / Galizia, Mauricio S / Miller, Frank H / Mulcahy, Mary F / Small, William. ·Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA. ·Int J Radiat Oncol Biol Phys · Pubmed #21570199.

ABSTRACT: PURPOSE: To depict treatment response to chemoradiotherapy by comparing tumor growth rate between treated and untreated patients and to compare depicted response with objective response according to the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 guideline. METHODS AND MATERIALS: This Health Insurance Portability and Accountability Act-compliant, retrospective study was approved by the institutional review board. Volume doubling time (DT) of histologically confirmed locally advanced pancreatic adenocarcinoma was calculated in 16 patients treated with chemoradiotherapy and 10 untreated patients by incorporating interscan interval (Δt) and tumor volume at baseline (V0) and follow-up (V1) obtained by semiautomated segmentation into the following equation: DT = Δt · log 2/log (V1/V0). Reciprocal of doubling time (RDT), which is the linear representation of tumor growth rate, was calculated by use of the following equation: RDT = 365/DT. The lowest RDT value of 2.42 in untreated patients was considered as the cutoff value for depiction of treatment response. Depicted response rate was defined as the proportion of patients with an RDT value of less than 2.42. Depicted response was compared with objective response according to the RECIST 1.1 guideline. The significance level was set at p < 0.05. RESULTS: There was a significant difference in mean RDT between treated (range, -7.12 to 3.27; mean, -1.27; median, -1.30) and untreated (range, 2.42 to 10.74; mean, 5.33; median, 4.26) patients (p < 0.05). Reciprocal of doubling time was less than 2.42 in 14 treated patients, which corresponded to a depicted response rate of 87.50% as opposed to the objective response rate of 18.75% according to the RECIST 1.1 guideline (p < 0.05) and carbohydrate antigen 19-9 response rate of 62.50% (p > 0.05). Carbohydrate antigen 19-9 response was concordant with RDT and RECIST response in 12 patients (75.00%) (κ, 0.38) and 9 patients (56.25%) (κ, 0.24), respectively. CONCLUSIONS: There was a significant difference between depicted response according to RDT and objective response according to RECIST. Reciprocal of doubling time might serve as a valuable biomarker for evaluation of treatment response when depiction of small changes in tumor size is concerned.

7 Clinical Trial Phase II trial of full-dose gemcitabine and bevacizumab in combination with attenuated three-dimensional conformal radiotherapy in patients with localized pancreatic cancer. 2011

Small, William / Mulcahy, Mary F / Rademaker, Alfred / Bentrem, David J / Benson, Al B / Weitner, Bing Bing / Talamonti, Mark S. ·Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, Illinois 60611, USA. wsmall@nmff.org ·Int J Radiat Oncol Biol Phys · Pubmed #20598452.

ABSTRACT: PURPOSE: To evaluate response rate, survival, and toxicity in patients with nonmetastatic pancreatic cancer treated with gemcitabine, bevacizumab, and radiotherapy. METHODS AND MATERIALS: Patients received three cycles of therapy over 10 weeks. In total, treatment consisted of intravenous (IV) gemcitabine, 1,000 mg/m(2), every 1 to 2 weeks (7 doses), IV bevacizumab, 10 mg/kg every 2 weeks (5 doses), and 36 Gy of radiotherapy (2.4-Gy fractions during cycle two). Response was assessed by cross-sectional imaging and carbohydrate antigen 19-9 (CA 19-9) levels. Patients with resectable tumors underwent surgery 6 to 8 weeks after the last dose of bevacizumab. Maintenance gemcitabine and bevacizumab doses were delivered to patients who had unresected tumors and no progression. RESULTS: Twenty-eight of the 32 enrolled patients completed all three cycles. The median follow-up was 11.07 months. Most grade 3 or 4 toxicities occurred in the initial treatment phase; the most frequent toxicities were leukopenia (21%), neutropenia (17%), and nausea (17%). At week 10, 1 patient (4%) had a complete response, 2 patients (7%) had partial responses, 21 patients (75%) had stable disease, and 4 patients (14%) had progressive disease. The median pretreatment and posttreatment CA 19-9 levels (25 patients) were 184.3 and 57.9 U/ml, respectively (p = 0.0006). One of 10 patients proceeding to surgery experienced a major complication. Two of 6 patients undergoing resection had complete pathologic responses. The median progression-free and overall survival durations were 9.9 months and 11.8 months, respectively. CONCLUSIONS: The combination of full-dose gemcitabine, bevacizumab, and radiotherapy was active and was not associated with a high rate of major surgical complications.

8 Article Expression of the DNA repair gene MLH1 correlates with survival in patients who have resected pancreatic cancer and have received adjuvant chemoradiation: NRG Oncology RTOG Study 9704. 2018

Lawrence, Yaacov R / Moughan, Jennifer / Magliocco, Anthony M / Klimowicz, Alexander C / Regine, William F / Mowat, Rex B / DiPetrillo, Thomas A / Small, William / Simko, Jeffry P / Golan, Talia / Winter, Kathryn A / Guha, Chandan / Crane, Christopher H / Dicker, Adam P. ·Department of Oncology, Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel HaShomer, Israel. · Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania. · Statistics and Data Management Center, NRG Oncology, Philadelphia, Pennsylvania. · Department of Anatomic Pathology, H. Lee Moffitt Cancer Center, Tampa, Florida. · Boehringer Ingelheim Pharmaceuticals, Ridgefield, Connecticut. · University of Maryland School of Medicine, Baltimore, Maryland. · Toledo Clinic Cancer Centers, Toledo, Ohio. · Department of Radiation Oncology, Rhode Island Hospital/The Warren Alpert Medical School of Brown University, Providence, Rhode, Island. · Department of Radiation Oncology, Loyola University Medical Center, Chicago, Illinois. · Department of Pathology, University of California-San Francisco Medical Center, San Francisco, California. · Department of Radiation Oncology, Montefiore Medical Center, Bronx, New York. · Memorial Sloan Kettering Cancer Center, New York, New York. ·Cancer · Pubmed #29053185.

ABSTRACT: BACKGROUND: The majority of patients with pancreatic cancer who undergo curative resection experience rapid disease recurrence. In previous small studies, high expression of the mismatch-repair protein mutL protein homolog 1 (MLH1) in pancreatic cancers was associated with better outcomes. The objective of this study was to validate the association between MLH1 expression and survival in patients who underwent resection of pancreatic cancer and received adjuvant chemoradiation. METHODS: Samples were obtained from the NRG Oncology Radiation Therapy Oncology Group 9704 prospective, randomized trial (clinicaltrials.gov identifier NCT00003216), which compared 2 adjuvant protocols in patients with pancreatic cancer who underwent resection. Tissue microarrays were prepared from formalin-fixed, paraffin-embedded, resected tumor tissues. MLH1 expression was quantified using fluorescence immunohistochemistry and automated quantitative analysis, and expression was dichotomized above and below the median value. RESULTS: Immunohistochemical staining was successfully performed on 117 patients for MLH1 (60 and 57 patients from the 2 arms). The characteristics of the participants who had tissue samples available were similar to those of the trial population as a whole. At the time of analysis, 84% of participants had died, with a median survival of 17 months. Elevated MLH1 expression levels in tumor nuclei were significantly correlated with longer disease-free and overall survival in each arm individually and in both arms combined. Two-year overall survival was 16% in patients who had low MLH1 expression levels and 53% in those who had high MLH1 expression levels (P < .0001 for both arms combined). This association remained true on a multivariate analysis that allowed for lymph node status (hazard ratio, 0.41; 95% confidence interval, 0.27-0.63; P < .0001). CONCLUSIONS: In the current sample, MLH1 expression was correlated with long-term survival. Further studies should assess whether MLH1 expression predicts which patients with localized pancreatic cancer may benefit most from aggressive, multimodality treatment. Cancer 2018;124:491-8. © 2017 American Cancer Society.

9 Article Hypofractionated Conformal Radiotherapy with Concurrent Full-Dose Gemcitabine Versus Standard Fractionation Radiotherapy with Concurrent Fluorouracil for Unresectable Pancreatic Cancer: a Multi-Institution Experience. 2016

Rakhra, Sunpreet / Strauss, Jonathan B / Robertson, John / McGinn, Cornelius J / Kim, Thomas / Huang, Jiayi / Blake, Andrew / Helenowski, Irene / Hayes, John P / Mulcahy, Mary / Small, William. ·Department of Radiation Oncology, The Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA. · Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, USA. · Department of Radiation Oncology, Maine Medical Center, Portland, ME, USA. · Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA. · Northwestern University Cancer Biostatistics Core, Chicago, IL, USA. · Division of Hematology/Oncology, The Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA. · Department of Radiation Oncology, Cardinal Bernardin Cancer Center, Stritch School of Medicine, Loyola University Chicago, 2160 S 1st Ave Maguire Center, Rm 2932, Maywood, IL, 60153, USA. wmsmall@lumc.edu. ·J Gastrointest Cancer · Pubmed #27112332.

ABSTRACT: PURPOSE/OBJECTIVE(S): The purpose of this study was to compare oncologic outcomes and toxicity profile of hypofractionated conformal radiotherapy (RT) with concurrent full-dose gemcitabine versus standard fractionation RT with concurrent 5-fluorouracil (5-FU) in the treatment of unresectable non-metastatic pancreatic cancer. MATERIALS/METHODS: Patients with unresectable non-metastatic adenocarcinoma of the pancreas treated at three institutions were included. All patients were treated with chemoradiotherapy (CRT) consisting of either hypofractionated RT to the gross disease concurrent with a full-dose gemcitabine-based regimen versus standard fractionation RT to the tumor and elective nodes concurrent with 5-FU. End points included rates of gastrointestinal (GI) toxicities, overall survival (OS), and distant metastasis free survival (DMFS). RESULTS: From January 1999 to December 2009, 170 patients were identified (118 RT/gemcitabine, 52 RT/5-FU). There were no differences in demographic or clinical factors. Acute GI toxicities (grades <3 versus ≥3) were 82.2 and 17.8 %, respectively, for patients treated with RT/gemcitabine and 78.9 and 21.2 % for those treated with RT/5-FU (p = 0.67). Late GI toxicities (grades <3 versus ≥3) were 88.1 and 11.9 %, respectively, for RT/gemcitabine and 80.8 and 19.2 % for RT/5-FU (p = 0.23). OS for RT/gemcitabine and RT/5-FU were 52 versus 36 % at 1 year and 14 versus 6 % at 2 years favoring the RT/gemcitabine group (p = 0.02). DMFS at 1 and 2 years for RT/gemcitabine were 41 and 11 % versus 24 and 4 % for RT/5-FU (p = 0.02). CONCLUSIONS: RT/gemcitabine was equivalent in toxicity to RT/5-FU but was associated with superior OS and DMFS. When RT is used in the treatment of unresectable pancreatic cancer, hypofractionated conformal RT with concurrent full-dose gemcitabine may be the preferred approach.

10 Article Glycogen Synthase Kinase 3 Beta Predicts Survival in Resected Adenocarcinoma of the Pancreas. 2015

Ben-Josef, Edgar / George, Asha / Regine, William F / Abrams, Ross / Morgan, Meredith / Thomas, Dafydd / Schaefer, Paul L / DiPetrillo, Thomas A / Fromm, Mitchel / Small, William / Narayan, Samir / Winter, Kathryn / Griffith, Kent A / Guha, Chandan / Williams, Terence M. ·University of Pennsylvania, Philadelphia, Pennsylvania. edgar.ben-josef@uphs.upenn.edu. · Radiation Therapy Oncology Group-Statistical Center, Philadelphia, Pennsylvania. · University of Maryland Medical Systems, Baltimore, Maryland. · Rush University Medical Center, Chicago, Illinois. · University of Michigan Medical School, Ann Arbor, Michigan. · Toledo Community Hospital Oncology Program CCOP, Toledo, Ohio. · Providence, Rhode Island. · Akron General Medical Center, Akron, Ohio. · Northwestern Memorial Hospital, Chicago, Illinois. · Michigan Cancer Research Consortium CCOP, Ann Arbor, Michigan. · Montefiore Medical Center, Moses Campus, Bronx, New York. · Ohio State University Medical Center, Columbus, Ohio. ·Clin Cancer Res · Pubmed #26240274.

ABSTRACT: PURPOSE: GSK3β is a protein kinase that can suppress a number of key oncoproteins. We have previously shown in preclinical models of pancreatic ductal adenocarcinoma (PDAC) that inhibition of GSK3β causes stabilization and nuclear translocation of β-catenin, poor differentiation, proliferation, and resistance to radiation. The objective of this study was to determine its utility as a biomarker of clinical outcomes. EXPERIMENTAL DESIGN: Automated Quantitative Immunofluorescence Analysis (AQUA) of GSK3β was performed on a tissue microarray with samples from 163 patients treated on RTOG 9704. On the basis of findings in an exploratory cohort, GSK3β was analyzed as a categorical variable using its upper quartile (>Q3) as a cut point. Overall survival (OS) and disease-free survival (DFS) were estimated with the Kaplan-Meier method, and GSK3β groupings were compared using the log-rank test. Univariable and multivariable Cox proportional hazards models were used to determine associations between GSK3β and OS/DFS. RESULTS: The 3-year OS rates for GSK3β≤Q3 versus GSK3β >Q3 were 16% (95% confidence intervals; CI, 10%-23%) and 30% (95% CI, 17%-44%), respectively, P = 0.0082. The 3-year DFS rates were 9% (95% CI, 5%-15%) and 20% (95% CI, 9%-33%) respectively, P value = 0.0081. On multivariable analysis, GSK3β was a significant predictor of OS. Patients with GSK3β >Q3 had a 46% reduced risk of dying of pancreatic cancer (HR, 0.54; 95% CI, 0.31-0.96, P value = 0.034). The HR for DFS was 0.65 (95% CI, 0.39-1.07; P value = 0.092). CONCLUSIONS: GSK3β expression is a strong prognosticator in PDAC, independent of other known factors such as tumor (T) stage, nodal status, surgical margins and CA19-9. Clin Cancer Res; 21(24); 5612-8. ©2015 AACR.

11 Unspecified Intraoperative Radiation "Boost" to the Surgical Resection Bed following Pancreaticoduodenectomy for a Borderline Resectable Pancreatic Carcinoma: A Case Report. 2018

Thomas, Tarita O / Small, William / Fleming, Mark / Kang, Song / Hoefer, Richard A. ·Department of Radiation Oncology, Stritch School of Medicine, Loyola University, Chicago, IL, United States. · Cardinal Bernardin Cancer Center, Maguire Center, Loyola University Medical Center, Maywood, IL, United States. · Virginia Oncology Associates, Hampton, VA, United States. · Division Chief Hematology and Oncology, Eastern Virginia Medical School, Norfolk, VA, United States. · Department of Radiation Oncology, Sentara CarePlex Hospital, Sentara Healthcare, Hampton, VA, United States. · Department of Surgical Oncology, Sentara CarePlex Hospital, Sentara Healthcare, Hampton, VA, United States. · Eastern Virginia Medical School, Norfolk, VA, United States. ·Front Oncol · Pubmed #29629335.

ABSTRACT: Neoadjuvant therapy including chemotherapy alone or concurrent chemotherapy with external bream radiation is a standard treatment strategy for borderline resectable pancreatic adenocarcinoma and is also used routinely for primary operable cancers at some institutions (1). The use of intraoperative radiation therapy (IORT) has been limited largely because of the logistical issues in delivery of radiation during surgery (2). This is the first reported case of a borderline resectable pancreas cancer patient who underwent neoadjuvant chemo-radiation therapy followed by resection with the use of IORT using the mobile IntraBeam device to boost the resection bed and improve local control by dose escalation.