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  • 1
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    Pathologic outcomes of systemic therapy followed by stereotactic body radiation therapy (SBRT) for pancreatic cancer (PC) in a novel lateral decubitus treatment position.
    American Society of Clinical Oncology (ASCO) ; 2019
    In:  Journal of Clinical Oncology Vol. 37, No. 4_suppl ( 2019-02-01), p. 415-415
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 37, No. 4_suppl ( 2019-02-01), p. 415-415
    Abstract: 415 Background: Outcomes of multi-fraction stereotactic body radiotherapy (SBRT) for PC report low rates of toxicity and high local control, improving feasibility for combination with more aggressive systemic therapy regimens. However, SBRT in the ablative range poses risk to adjacent normal structures, excluding this option for tumors within 1 cm of a mucosal organ. In this study, we report our initial experience with treatment in the lateral decubitus position. Methods: An IRB retrospective query identified patients with pancreatic body adenocarcinoma treated with systemic chemotherapy followed by SBRT in the lateral decubitis position. SBRT was delivered to the entire gross disease with 30 Gy in 5 fractions with focal dose escalation up to 40 Gy to the tumor/vessel interface (TVI) as long as constraints were met. Patients were explored for resection if no metastasis or progression on restaging scans. The primary endpoints were pathologic response and margin status. Descriptive analysis was performed with SPSS 24. Results: The median age of the cohort was 68.6 (range, 50-83 yrs), with a white (94%) and male (59%) predominance. Initial staging of the 17 patients who met criteria included 10 (59%) patients diagnosed with borderline resectable disease (BRPC) and 7 (41%) with locally advanced disease (LAPC). 7 (41%) patients were treated with FOLFIRINOX, 5 (29%) with gemcitabine/nab-paclitaxel, 4 (24%) with gemcitabine/capecitabine/docetaxel, and 1 (6%) with gemcitabine/paclitaxel preceding SBRT. A median dose of 40 Gy (range, 33-40 Gy) was delivered to the TVI for all patients. 5 BRCP (29%) and 2 LAPC (12%) patients went to surgery, with 6 of these patients undergoing an R0 resection (86%) and 1 BRPC patient with an R1 resection. Pathologic tumor regression grades by the College of American Pathologists guidelines were 14% Grade 1, 71% Grade 2, and 14% Grade 3. Conclusions: Lateral decubitus treatment expands inclusion of pancreatic body patients for SBRT with focal TVI dose escalation leading to margin negative resection and significant partial tumor response, warranting future studies exploring ablative dosing in this position.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/JCO.2019.37.4_suppl.415
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2019
    detail.hit.zdb_id: 2005181-5
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  • 2
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    Targeted Inhibition of Farnesyltransferase in Locally Advanced Breast Cancer: A Phase I and II Trial of Tipifarnib Plus Dose-Dense Doxorubicin and Cyclophosphamide
    American Society of Clinical Oncology (ASCO) ; 2006
    In:  Journal of Clinical Oncology Vol. 24, No. 19 ( 2006-07-01), p. 3013-3018
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 24, No. 19 ( 2006-07-01), p. 3013-3018
    Abstract: To determine the recommended phase II dose (RPTD) of the farnesyltransferase (FTase) inhibitor tipifarnib when combined with doxorubicin and cyclophosphamide (AC) in patients with advanced breast cancer, the pathologic complete response (pCR) rate after preoperative treatment with four cycles of the combination in locally advanced breast cancer (LABC), and the effect of tipifarnib on primary tumor FTase enzyme activity in vivo. Patients and Methods Thirty-two patients with metastatic breast cancer (n = 11) or LABC (n = 21) received AC (doxorubicin 60 mg/m 2 and cyclophosphamide 600 mg/m 2 ) administered intravenously on day 1 plus tipifarnib (100, 200, or 300 mg bid for 6 to 14 days) without (n = 2) or with (n = 30) granulocyte colony-stimulating factor (G-CSF) for up to four cycles. Patients with LABC underwent surgery after up to four cycles of the combination. Results When combined with AC every 2 weeks plus G-CSF, the RPTD of tipifarnib was 200 mg bid administered on days 2 to 7. Seven (33%) of 21 patients (95% CI, 15% to 55%) with LABC treated with up to four cycles of the combination at the RPTD had a pCR in the breast at surgery. The five patients had serial biopsies that demonstrated at least 50% FTase enzyme inhibition in the primary tumor (median, 100%; range, 55% to 100%) after tipifarnib. Conclusion Tipifarnib may be safely combined with dose-dense AC using a dose and schedule that significantly inhibits FTase enzyme activity in human breast cancer in vivo and may enhance the pCR rate after four cycles of preoperative dose-dense AC.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/JCO.2005.04.9114
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2006
    detail.hit.zdb_id: 2005181-5
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  • 3
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    Multimodality therapy for borderline resectable pancreatic cancer: A single-institution experience.
    American Society of Clinical Oncology (ASCO) ; 2012
    In:  Journal of Clinical Oncology Vol. 30, No. 4_suppl ( 2012-02-01), p. 280-280
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 30, No. 4_suppl ( 2012-02-01), p. 280-280
    Abstract: 280 Background: Multimodality therapy has been advocated for borderline resectable pancreatic cancer (BRCP); however, specific regimens vary widely by institution. Outcomes of these interventions need to be examined to inform future investigation of the optimal therapy for these patients. This study represents the experience of multimodality therapy for BRPC at an NCI designated cancer center. Methods: We identified all patients (pts) with operable pancreatic ductal adenocarcinoma (PDA) from 2006 to 2011. Patients were divided into two groups: resectable group and BRPC group as per the NCCN and AHPBA consensus guidelines. Primary outcomes were resection rate, microscopic negative margin (R0) resection rate, overall survival (OS), and disease free survival (DFS). Fisher's exact and chi-square were used for group comparison while Kaplan-Meier estimates was used for survival analysis. Results: 160pts were identified with operable PDA. 100 (63%) pts had resectable tumors, and 60 (37%) pts had borderline resectable tumors. Neoadjuvant therapy (NT) was administered to 0% in the group with resectable tumors, and 100% in the group with borderline resectable tumors. The resection rate was 100% in pts with resectable tumors and 58% in pts with borderline resectable tumors. R0 resection rates were 80% in the resectable tumors and 97% in the borderline resectable tumors following NT. Perioperative mortality was 〈 1% (1/125) for resectable tumors and 0% in borderline resectable tumors. Median OS was 22.6 months (m) for pts that had resectable tumors and 13.9m for all pts with borderline resectable tumors (p=0.017); however, the median OS for resected pts with borderline resectable tumors was 21.5m (p=0.6). Improved DFS was seen in patients with resectable tumors when compared with resected borderline resectable tumors (15 vs. 9.5m; p=0.04). Conclusions: Multimodality therapy leads to high rates of R0 resections in borderline resectable pancreatic cancer; however 42% of patients progressed during NT. The overall survival for patients with resected borderline resectable pancreatic cancer following NT is similar to patients who undergo resection for resectable pancreatic cancer.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2012.30.4_suppl.280
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2012
    detail.hit.zdb_id: 2005181-5
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  • 4
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    Does 18-fluorodeoxyglucose (FDG) uptake by positron emission tomography/computed tomography (PET/CT) predict survival in advanced pancreatic cancer? A single-institution experience.
    American Society of Clinical Oncology (ASCO) ; 2012
    In:  Journal of Clinical Oncology Vol. 30, No. 4_suppl ( 2012-02-01), p. 351-351
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 30, No. 4_suppl ( 2012-02-01), p. 351-351
    Abstract: 351 Background: Pancreatic cancer is associated with a poor prognosis. Histological grade, stage and serum tumor markers are well established prognostic factors for survival. Some studies suggest that 18-fluorodeoxyglucose (FDG) uptake by positron emission tomography/computed tomography (PET/CT) correlates with survival in pancreatic cancer. In this study, we aimed to determine whether standardized uptake value (SUV), a measure of FDG uptake by fusion PET/CT, had prognostic significance in patients with advanced pancreatic cancer. Methods: Using a comprehensive pancreatic cancer database at H. Lee Moffitt Cancer Center, we identified patients who underwent PET/CT scan as initial workup for resection but were found to have advanced disease (stages III and IV) when surgery was attempted. Data from January 2006 to December 2010 was retrospectively analyzed and correlated with the maximum SUV determined by PET/CT. Other prognostic factors including stage, age, gender, serum tumor marker CA 19-9 levels and the use of chemotherapy were also evaluated using multivariate analysis. Results: We identified 41 consecutive patients who were deemed resectable by virtue of staging workup with CT, PET/CT and endoscopic ultrasound (EUS), but found to have locally advanced/metastatic disease intra-operatively. At the time of analysis, there were a total of 30 deaths. Twelve patients had metastatic disease and 29 had stage III pancreatic cancer. SUV uptake ranged from 2.9 to 16.2 with a mean of 6.4. Median overall survival for the 28 patients with SUV less than or equal to the mean (≤ 6.4) was 14 months (95% confidence interval 10 – 25 months) vs. 9.1 months for the 13 patients with SUV 〉 6.4 (95% confidence interval 4-17 months). This difference was not statistically significant (p=0.178). On multivariate analysis, use of chemotherapy was the only independent predictor of survival. Conclusions: Glucose uptake by PET/CT, reflected by SUV, was not found to be a predictor of survival in patients with advanced pancreatic cancer. The retrospective nature and limited sample size are limitations of our study, however further research is warranted.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2012.30.4_suppl.351
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2012
    detail.hit.zdb_id: 2005181-5
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  • 5
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    Using the ALBI grade as a prognostic marker for radioembolization of hepatocellular carcinoma.
    American Society of Clinical Oncology (ASCO) ; 2016
    In:  Journal of Clinical Oncology Vol. 34, No. 4_suppl ( 2016-02-01), p. 366-366
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 34, No. 4_suppl ( 2016-02-01), p. 366-366
    Abstract: 366 Background: The Childs-Pugh class (C-P) is a commonly used scoring system to measure liver function in patients with hepatocellular carcinoma (HCC). While originally developed for patients undergoing esophageal resection for varices in the setting of cirrhosis and portal hypertension, it is now a widely accepted measure of liver function. The Albumin-Bilirubin (ALBI) grading system is a model developed in 2015 to assess liver function that has eliminated the subjective measures present in C-P. We correlate the ALBI grading system and C-P classes to overall survival in our HCC patients receiving radioembolization. Methods: With IRB approval, we retrospectively evaluated patients who received radioembolization for HCC between 2009-2014. We evaluated the albumin and bilirubin levels in our patients prior to receiving their first radioembolization (n = 121). The ALBI grades were calculated from these data with the formula (log10 bilirubin x 0.66) + (albumin x -0.085) and separated into grades based on the thresholds set in the original manuscript. These grades were then correlated to outcomes using Mantel-Cox Log analysis. The statistical comparisons were duplicated with C-P classes. Results: Median survival for C-P class A and B were 13.1 and 8.4 months (p 〈 0.0005), respectively while median survival for ALBI grades 1 and 2 were 20.9 and 11.0 months (p 〈 0.0005), respectively. Our C-P class A patient group was re-stratified using the ALBI formula and found to have two cohorts of patients with statistically significant differences in survival. The median survival between ALBI grades 1 and 2 within this patient group was 20.9 and 11.0 months (p = 0.002), respectively. Too few C-P class C or ALBI grade 3 patients were within our dataset for statistically significant results. Conclusions: We demonstrated that the ALBI grading system is a more sensitive marker of liver function than the C-P classes in the setting of mild to moderate dysfunction. Using the ALBI grade, we identified a subset of patients that have significantly better outcomes from radioembolization for HCC within C-P class A.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2016.34.4_suppl.366
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2016
    detail.hit.zdb_id: 2005181-5
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  • 6
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    Outcomes of a clinical pathway for borderline resectable pancreatic cancer.
    American Society of Clinical Oncology (ASCO) ; 2015
    In:  Journal of Clinical Oncology Vol. 33, No. 3_suppl ( 2015-01-20), p. 374-374
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 33, No. 3_suppl ( 2015-01-20), p. 374-374
    Abstract: 374 Background: While multimodality therapy for borderline resectable pancreatic adenocarcinoma (BPA) is advocated, treatment regimens vary by institution without a standardized approach supported by prospective randomized data. We implemented a multidisciplinary multimodality clinical pathway (CP) for the management of BPA and examined outcomes to investigate optimal therapy. Methods: From January 1, 2006, to December 31, 2013, BPA cases as defined by the NCCN and AHPBA consensus guidelines were managed prospectively along CP. Resection rates, margin status, pathologic response, and overall survival were retrospectively examined. Standard statistical and survival analysis were used. Results: 121 patients were classified as BPA and 101 entered the CP. The neoadjuvant chemoradiation (NT) completion rate was 93.1%. Of those who entered the CP, 55 patients (54.5%) underwent pancreatectomy. R0, R1 and R2 margin rates were 96.3%, 3.7% and 0%, respectively. Of the 55 patients who underwent resection, 22 (40%) required vascular reconstruction, with R0, R1 and R2 margin rates of 95.2%, 4.8%, and 0%, respectively. Pathologic response to treatment was found in 70.8%, with a complete response rate of 15.9%. Median overall survival in the resected group versus the non-resected group was 34.2 months versus 14.7 months, p 〈 0.001. Conclusions: Our series represents one of the largest reports of BPA in the literature and implementation of our CP resulted in a high NT completion rate and pancreatectomy with negative margin rate. Although 41.4% of cases were not resectable after NT, there was a high rate of negative margin resection with 〉 70% pathologic response rate and a favorable median survival.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2015.33.3_suppl.374
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2015
    detail.hit.zdb_id: 2005181-5
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  • 7
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    Surgery and adjuvant therapy in gallbladder cancer: A single-institution experience.
    American Society of Clinical Oncology (ASCO) ; 2015
    In:  Journal of Clinical Oncology Vol. 33, No. 3_suppl ( 2015-01-20), p. 405-405
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 33, No. 3_suppl ( 2015-01-20), p. 405-405
    Abstract: 405 Background: Gallbladder cancer is a highly fatal disease with a high rate of recurrence even when diagnosed at an early stage. Because of its relative rarity, there are currently no established algorithms to guide therapy after cholecystectomy. To explore the value of adjuvant therapy with chemotherapy and radiation, we evaluated patients with resected gallbladder cancer treated at our institution. Methods: Patients diagnosed with gallbladder cancer who underwent cholecystectomy (simple or radical) between 2000 and 2010 were identified using our cancer registry. Retrospective chart review was performed for clinicopathologic data, including age, stage, grade, type of surgery, margin status, and type and duration of adjuvant therapy. The primary endpoint was overall survival (OS). Univariate (UVA) and multivariate (MVA) analysis was performed with Cox logistic regression analyses. Results: We identified 73 patients with a median followup for all patients of 28.2 months. The majority of patients were female (74%) and underwent radical cholecystectomy (64%). Positive margins and adjuvant radiation therapy were documented in 21% and 37%, respectively. The majority of patients did not receive any adjuvant therapy (53.4%). Median OS for all patients was 41.3 months. There was a survival benefit associated with patients undergoing radical cholecystectomy followed by adjuvant radiation (median OS 48.4 months vs. 22.3 months; HR 0.35; 95% CI: 0.13–0.98; p=0.0448) compared to simple cholecystectomy alone. On UVA, increasing age and positive margins were significantly associated with worse OS, while radical cholecystectomy was associated with improved OS. On MVA, increasing age, male gender, poorly differentiated tumor, and positive margins were associated with worse OS, while adjuvant radiation was associated with improved OS (p=0.0113). Conclusions: Our analysis supports the role for adjuvant radiation therapy in resected gallbladder cancer. Multi-institutional prospective studies should be performed to evaluate the optimal treatment strategy. Biomarker analysis might also help determine the subset of patients who would benefit from combined chemoradiation.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2015.33.3_suppl.405
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2015
    detail.hit.zdb_id: 2005181-5
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  • 8
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    Effect of metformin use on the survival outcomes in diabetic patients with resectable pancreatic cancer: A single-institutional experience and meta-analysis.
    American Society of Clinical Oncology (ASCO) ; 2015
    In:  Journal of Clinical Oncology Vol. 33, No. 3_suppl ( 2015-01-20), p. 465-465
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 33, No. 3_suppl ( 2015-01-20), p. 465-465
    Abstract: 465 Background: Observational studies have shown that metformin use in diabetic patients decreases both cancer incidence and mortality. The aim of this study was to determine whether metformin use had a survival benefit in patients with resected pancreatic cancer. Methods: All patients with diabetes who underwent pancreatic resections for adenocarcinoma between 12/1/1986 and 4/30/2013 at our institution were identified. Patients were categorized by metformin use. Survival analysis was done using the Kaplan Meier method, with log rank test, and Cox proportional hazards multivariable regression models. The comprehensive Meta-Analysis version 2.2 was used to perform a meta-analysis using data from our study and the only other published study. Results: The study from our institution was comprised of 19 patients receiving treatment with metformin, and 25 patients not receiving metformin. There were no significant differences in major clinical and demographic characteristics between metformin and non-metformin users. The estimated median survival for metformin users was 35.3 months (95% CI 10.7 - not estimable) vs. 20.2 months (95% CI 14.4-58.6) for nonusers. The estimated 2, 3 and 5 year survival rates for non-metformin users were 42% (95% CI 22-62%), 28% (95% CI 7-55%) and 14% (95% CI 1-43%) respectively. Metformin users fared better with corresponding rates of 68% (95% CI 41-84%), 34% (95% CI 12-59%) and 34% (95% CI 12-59%) respectively. Metformin users had a 46% lower risk of death; hazard ratio 0.54 (95% CI 0.16-1.86) in a multivariate analysis, p = 0.3275. For the meta-analysis, there were a total of 111 patients from both studies. There were 46 metformin users and 65 nonusers. Metformin users had a 33% lower risk of death; the HR 0.668 (95 % CI 0.397-1.125), in a multivariate analysis p= 0.129. Conclusions: Although the findings of the current study suggests that metformin use does not significantly impact survival outcomes in diabetic patients with resected pancreatic cancer, there appears to be a clinically meaningful improvement in survival. The potential benefit of metformin should be investigated in adequately powered prospective studies.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2015.33.3_suppl.465
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2015
    detail.hit.zdb_id: 2005181-5
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  • 9
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    Genomically adjusted radiation dose to predict for survival with adjuvant radiation in resectable pancreatic cancer.
    American Society of Clinical Oncology (ASCO) ; 2016
    In:  Journal of Clinical Oncology Vol. 34, No. 4_suppl ( 2016-02-01), p. 240-240
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 34, No. 4_suppl ( 2016-02-01), p. 240-240
    Abstract: 240 Background: The median survival of patients with resectable pancreatic cancer remains low at approximately 2 years. A major limitation of treating patients with postoperative radiation therapy (RT) is the close proximity of the small bowel, which confines the RT dose. We hypothesized that a subset of patients might exist who would benefit from an escalated RT dose based on their underlying tumor radiosensitivity. Methods: Genomically-profiled patients with pancreatic cancer were identified from an IRB-approved prospective observational protocol. Patients treated with upfront surgery and postoperative RT were included. Briefly, the radiosensitivity index (RSI) is derived from the expression of 10 specific genes and a linear regression algorithm modeled on SF2 of 48 cancer cells. The RSI was combined with the delivered RT dose to derive a genomically adjusted RT dose (GAD). The GAD patient subsets were split at the middle GAD value and rounded up to the nearest integer (27). Our primary endpoint was to assess whether the GAD would predict for survival. Results: Forty patients underwent surgery and postoperative RT with GAD and clinical outcome data available. The median RT dose was 50.4 Gy (range 45-54) and the median follow-up among surviving patients was 68 months (range 42-141). Eighteen patients with a GAD 〉 27 had a median survival of 32.1 months, while 22 patients with a GAD 〈 27 had a median survival of 17.9 months (p = 0.48). On Cox multivariate analysis, both high-risk pancreatic cancer patients (positive margins, positive lymph nodes or a postoperative CA 19-9 〉 90) and patients with a GAD 〈 27 had significantly decreased survival (Hazard ratio [HR] 5.0 [95%CI 1.8,13.6] , p = 0.002 and HR 2.6 [1.1-6.0], p = 0.03, respectively). Among patients with a GAD 〈 27, 3 of 22 (14%) would have exceeded a GAD of 27 with an escalated RT dose of 54 Gy, and 8 of 22 (36%) patients would have exceeded a GAD of 27 with an escalated dose of 56 Gy to the pancreatic bed. Conclusions: GAD is predictive of survival among patients with resectable pancreatic cancer when combined with known prognostic factors. The GAD provides a tool to determine who might benefit from dose-escalated RT based on the underlying tumor radiosensitivity.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/jco.2016.34.4_suppl.240
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2016
    detail.hit.zdb_id: 2005181-5
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  • 10
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    Increased Expression of the Glucose Transporter Type 1 Gene Is Associated With Worse Overall Survival in Resected Pancreatic Adenocarcinoma
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Pancreas Vol. 45, No. 7 ( 2016-08), p. 974-979
    Details
    In: Pancreas, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. 7 ( 2016-08), p. 974-979
    Type of Medium: Online Resource
    ISSN: 0885-3177
    URL: Article
    DOI: 10.1097/MPA.0000000000000580
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 2053902-2
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