JSCO2016: International Session 18 Hepato-Biliary and Pancreas Cancers

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The 54th Annual Meeting of Japan Society of Clinical Oncology (JSCO2016)

"Renovation of Cancer Medicine in the Mature Society"



International Session 1: Lung Cancer
International Session 2: Colorectal Cancer
International Session 3: Gastric Cancer
International Session 4: Urological Cancer (Prostate and Renal Cancer)
International Session 5: Supportive Care for Adverse Events
International Session 6: Gynecological Cancer (Uterine Body Cancer and Ovarian Cancer)
International Session 7: Central Nervous System Tumor
International Session 8: New Development of Particle Beam Therapy for Cancer
International Session 9: International Cooperation in Radiation Medicine
International Session 10: Recent Advances In Cancer Immunotherapy
International Session 11: Breast Cancer
International Session 12: Pharmacology of Antitumor Agents: New Drug Application (NDA)
International Session 13: Malignant Lymphoma
International Session 14: Palliative Care
International Session 15: Radiation Therapy
International Session 16: Head and Neck Cancer
International Session 17: Skin Cancer (Malignant Melanoma)
International Session 18: Hepato-Biliary and Pancreas Cancers
International Session 19: Leukemia
International Session 20: Ethics for Clinical Research
International Session 21: Esophageal Cancer
International Session 22: Bone and Soft Tissue Tumor
FACO/JSCO Joint Symposium

Abstract Archives (in Japanese)


International Session 18: Hepato-Biliary and Pancreas Cancers


Treatment guideline in Japan: Liver cancer
Susumu Eguchi (Depertment of Surgery, Nagasaki University Graduate School)
The current edition of Japanese guideline for HCC treatment algorithm has its characteristics in contrast to Barcelona clinic liver cancer (BCLC) staging classification and treatment schedule. Both algorithms were designed on the basis of three main factors: degree of liver damage (LD) according to the Child-Pugh classification; number of tumors; diameter of tumor. However, in the era of recent development of preoperative diagnostics including the evaluation liver functional capacity (balance between LD and extent of liver resection), establishment of surgical procedures with technical advancement for surgery, these criteria have already been safely expanded. Therefore, current edition should be updated according to the already reported results, especially regarding to the indication for liver transplantation (LT).
For example, it was reported by Kyoto group that results of their proposed criteria for LT which was used since 2007, involving a combination of tumor number ≤ 10, maximal diameter of each tumor ≤ 5 cm, and serum DCP ≤ 400 mAU/mL. The 5 year survival within Kyoto criteria was 82%, and RFS was 95.6%. Tokyo group reported their criteria 5-5 rule - ≤ 5 nodules and achieved 3 year RFS 94% after LDLT. Therefore, the indication criteria for LT can be carefully expanded. According to the contraindication for liver resection if tumor size is more than 4, it is still possible to do the liver resection with/without ablation therapy, if the liver damage is A and tumors are located in one anatomical side of the liver. In addition, although number of donation after brain death is still limited, liver transplantation for LD A patients should be discussed carefully. Also the roles of radiation therapy and carbon ion radiotherapy should be clarified based on clinical trials.


Evidence-based clinical guideline for pancreatic cancer
Hiroki Yamaue (Second Department of Surgery, Wakayama Medical University)
Clinical guideline for diagnosis and treatment of pancreatic cancer has been first published in 2009 according to evidence-based fashion. The guideline was revised in 2013, and now has been proceeding to finalize the next revision in 2016.
The guideline has an algorithm for the diagnosis and treatment of pancreatic cancer and describes the following issues arisen from clinical questions; disease concept including, diagnosis, surgery, postoperative adjuvant therapy, radiotherapy, chemotherapy, stent therapy, and palliative medicine.
Disease concept contains risk factors, familial pancreatic cancer and borderline resectable pancreatic cancer (BRPC) in the newly revised version. One of the risk factors of pancreatic cancer is IPMN that is the origination of the disease. Especially, BRPC is defined as a cancer with high tendency of residual tumor after surgery, abutment of portal vein (BR-PV), and of artery (BR-A). The treatment strategy should be determined according to the criteria of BRPC.
The topic of diagnosis was the clinical significance of endoscopic ultrasonography (EUS) for early detection of the disease, that has a higher sensitivity compared to other modalities such as CT and MRI. Moreover, EUS-FNA is reported as a potent tool for differential diagnosis with other diseases including autoimmune pancreatitis. Regarding the chemotherapy, new version has stated the neoadjuvant chemotherapy for resectable and BR cancer, and superiority of S-1 compared to gemcitabine as an adjuvant chemotherapy. Moreover, newly developed regimen including FOLFIRINOX and Gemcitabine with nab-paclitaxel for unresectable cancer.
In this lecture, the present Japanese status of diagnosis and treatment for pancreatic cancer will discussed by evidence-based fashion.


Year in review from Oceania: Liver cancer
Lorraine A. Chantrill (Medical Oncology, The Kinghorn Cancer Centre, The Garvan Institute of Medical Research, Australia)
Liver cancer is the second most lethal cancer worldwide. Hepatocellular carcinoma (HCC) comprises about 90% of primary liver cancer, with high prevalence in association with hepatitis B and C virus infection or chronic inflammation and cirrhosis attributed to alcohol excess or obesity related non-alcoholic fatty liver disease. New drugs to control hepatitis and effective public health campaigns in Australia have led to a decrease in incidence of HCC. However, most patients do not have disease curable by surgery at diagnosis. For those who do not have disease amenable to locoregional therapies, or who cannot tolerate surgery, the multikinase inhibitor sorafenib has been the standard of care since 2008.
Unfortunately, despite many trials over the last decade, predominantly assessing tyrosine kinase inhibitors and the angiogenesis pathways, none have shown any survival benefit over sorafenib. Thus enrichment trials have been developed to personalize treatment for patients with HCC. Enrichment employs the use of a biomarker for stratification and trials are currently exploring the predictive value of immunohistochemical expression of C-met and glypican-3, as well as serum alpha-fetoprotein to stratify treatment with ramucirumab and circulating RAS mutation to stratify for the MEK inhibitor refametinib.


Year in review from US: Pancreas cancer
Ramesh K. Ramanathan (Hematology/Oncology, Department of Medicine, Mayo Clinic, USA)
The presentation will focus on current practice patterns and new developments in the US regarding the treatment of pancreatic cancer. The role of neoadjuvant therapy for resectable and borderline pancreatic cancer will be discussed. New treatment regimens for metastatic pancreatic cancer and incorporation of new agents with an emphasis on promising new agents will be highlighted. The speaker will discuss the role of molecular sequencing and targeted agents. High priority clinical trials will be reviewed.


Surgical treatment for advanced hepatocellular carcinoma with inferior vena cava tumor thrombus
Hiroaki Nagano (Department of Gastroenterological Surgery, Yamaguchi University Graduate School of Medicine)
Involvement of the inferior vena cava (IVC) has been considered as contraindication for surgical treatment of hepatocellular carcinoma (HCC), because of poor prognosis and high surgical risk. The development of innovative surgical techniques has made a curative surgical approach to tumors involving both liver and IVC possible.
In this symposium, we will present about the operative procedure and the outcome of the liver resection for far advanced HCC with IVC tumor thrombus in our department.
The tumor thrombus is a state in which the floating blood vessel in general, not invading the HV and/or IVC. Therefore, no vascular resection necessarily, removal of tumor thrombus from IVC, should be applied. As a method, it is important to expose sufficiently the blood vessel wall for handling and dissecting IVC. In surgery for patients with tumor thrombus in IVC, the reconstruction is not needed in almost all cases after removal of thrombus. The use of artificial heart-lung is decided after confirming the atrial side tip of the tumor thrombus by trans-esophageal echo during the surgery.
Of the 931 cases HCC who underwent hepatic resection, 37 cases (4.0%) have (Vv1-3) patients with hepatic vein (HV) and/or IVC, including 21 cases with IVC tumor thrombus (Vv3) (2.3%), in our department. Concerning the outcome of the 22 patients with IVC tumor thrombus, it was possible to perform the hepatic resection and the removal of tumor thrombus safely in all cases with no surgery-related death; no use of artificial cardiopulmonary bypass in 20 cases but 2 exception with self-pericardium in IVC reconstruction. The surgical outcome of these cases in 1- and 2- year survival rates were 56.7% and 31.5%, respectively.
Surgical resection for the advanced HCC with IVC tumor thrombus is the possible procedure with considerable oncological results, being careful separation of the liver and IVC important.


Surgical treatment strategy for Pancreatic cancer: Where are we, and where are we going?
XianJun Yu (Department of pancreatic surgery, Fudan University, China)
Pancreatic cancer is a devastating disease and still risking the health of people. Due to late diagnosis, high metastatic potential, and resistance to chemoradiotherapy, there are no effective treatments for refractory pancreatic cancer. Hence, there is an urgent need for searching a surgical treatment stategy for pancreatic cancer. Although, the pancreatic surgery has developed a lot in the last decades, still, we have not improved the prognosis of the pancreatic patients. And after a long period exploration, we have found that it is the unique biological characteristics of pancreatic cancer that caused the poor prognosis of the patients. We have strived for revealing the deeper mechanism of the cancer, and focused on the patient group who would not benefit from surgery. Furthermore, we have tried to identify this kind of patients and explore the molecular mechanism and the control target for these patients and establish a new therapeutic strategy of the comprehensive treatment of pancreatic cancer surgery.


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