title: When, What, and Why of Perioperative Treatment of Potentially Curable Pancreatic Adenocarcinoma.
abstract: The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A 64-year-old woman with a history of hypertension and type 2 diabetes had been in her usual state of health until she developed symptoms of diarrhea, abdominal bloating, and discomfort in the midepigastrium. Evaluation with a contrast-enhanced abdominopelvic computed tomography (CT) scan demonstrated a mass in the pancreatic body that was approximately 3.1 cm × 2 cm × 2.1 cm in size with abutment of the portal vein-superior mesenteric vein confluence for less than 180°. The confluence was narrowed but without thrombosis. No tumor-vessel interface was noted at the superior mesenteric artery, celiac artery, or common hepatic artery. Several peripancreatic lymph nodes were observed that measured up to 11 mm × 5 mm. No evidence for distant spread of disease was identified. An upper endoscopy with endoscopic ultrasound was performed and fine-needle aspirates of the pancreas mass were positive for malignant cells that were consistent with adenocarcinoma. Chest CT scan without intravenous contrast demonstrated no evidence of metastatic disease. The patient came to the clinic to discuss management of her newly diagnosed malignancy.
authors.affiliation: Kimberly Perez, Thomas E. Clancy, Joseph D. Mancias, Michael H. Rosenthal, and Brian M. Wolpin, Brigham and Women's Hospital, Dana-Farber Cancer Institute, and Harvard Medical School, Boston, MA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Perez
authors.affiliation: Kimberly Perez, Thomas E. Clancy, Joseph D. Mancias, Michael H. Rosenthal, and Brian M. Wolpin, Brigham and Women's Hospital, Dana-Farber Cancer Institute, and Harvard Medical School, Boston, MA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Clancy
authors.affiliation: Kimberly Perez, Thomas E. Clancy, Joseph D. Mancias, Michael H. Rosenthal, and Brian M. Wolpin, Brigham and Women's Hospital, Dana-Farber Cancer Institute, and Harvard Medical School, Boston, MA.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Mancias
authors.affiliation: Kimberly Perez, Thomas E. Clancy, Joseph D. Mancias, Michael H. Rosenthal, and Brian M. Wolpin, Brigham and Women's Hospital, Dana-Farber Cancer Institute, and Harvard Medical School, Boston, MA.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Rosenthal
authors.affiliation: Kimberly Perez, Thomas E. Clancy, Joseph D. Mancias, Michael H. Rosenthal, and Brian M. Wolpin, Brigham and Women's Hospital, Dana-Farber Cancer Institute, and Harvard Medical School, Boston, MA.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Wolpin
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D008875:Middle Aged; D009944:Organoplatinum Compounds / Q000008:administration & dosage; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D017410:Practice Guidelines as Topic; D057234:Preoperative Period; D012196:Review Literature as Topic
chemical_list: D009944:Organoplatinum Compounds; D002955:Leucovorin; D005472:Fluorouracil