Initial systemic chemotherapy ( 6 months ) with a combination regimen is recommended for most patients ( for some patients radiation therapy may be offered up front ) with Eastern Cooperative Oncology Group performance status 0 or 1 and a favorable comorbidity profile .
There is no clear evidence to support one regimen over another .
PURPOSE To provide evidence -based recommendations to oncologists and others for treatment of patients with locally advanced , unresectable pancreatic cancer .
Tissue Factor Expression, Angiogenesis, and Thrombosis in Pancreatic Cancer
Purpose : Hemostatic activation is common in pancreatic cancer and may be linked to angiogenesis and venous thromboembolism . We investigated expression of  tissue factor ( TF ) , the prime initiator of coagulation , in noninvasive and invasive pancreatic neoplasia . We correlated TF expression with vascular endothelial growth factor ( VEGF ) expression , microvessel density , and venous thromboembolism in resected pancreatic cancer . Experimental Design : Tissue cores from a tri-institutional retrospective series of patients were used to build tissue microarrays . TF expression was grade d semiquantitatively using immunohistochemistry in normal pancreas ( n = 10 ) , intraductal papillary mucinous neoplasms ( n = 70 ) , pancreatic intraepithelial neoplasia ( n = 40 ) , and resected or metastatic pancreatic adenocarcinomas ( n = 130 ) . Results : TF expression was observed in a majority of noninvasive and invasive pancreatic neoplasia , including 77 % of pancreatic intraepithelial neoplasias , 91 % of intraductal papillary mucinous neoplasms , and 89 % of pancreatic cancers , but not in normal pancreas . Sixty-six of 122 resected pancreatic cancers ( 54 % ) were found to have high TF expression ( defined as grade ≥2 , the median score ) . Carcinomas with high TF expression were more likely to also express VEGF ( 80 % versus 27 % with low TF expression , P < 0.0001 ) and had a higher median MVD ( 8 versus 5 per tissue core with low TF expression , P = 0.01 ) . Pancreatic cancer patients with high TF expression  had a venous thromboembolism rate of 26.3 % compared with 4.5 % in patients with low TF expression ( P = 0.04 ) . Conclusions : TF expression occurs early in pancreatic neoplastic transformation and is associated with VEGF expression , increased microvessel density , and possibly clinical venous thromboembolism in pancreatic cancer . Prospect i ve studies evaluating the role of TF in pancreatic cancer outcomes are warranted
Initial systemic chemotherapy ( 6 months ) with a combination regimen is recommended for most patients ( for some patients radiation therapy may be offered up front ) with Eastern Cooperative Oncology Group performance status 0 or 1 and a favorable comorbidity profile .
There is no clear evidence to support one regimen over another .
PURPOSE To provide evidence -based recommendations to oncologists and others for treatment of patients with locally advanced , unresectable pancreatic cancer .