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Liver and Pancreas Tumors   

Questions discussed in this category

Would you still offer adjuvant chemo at 24 weeks post Whipple for a pT1c pN2 cM0 neg margins ampullary adenocarcinoma?
Post-operative surgical course was complicated by anastomotic leak, septic shock, candidemia, wound infections, PE & DVT. Now recovering well.
1 Answer available
What systemic therapy and dose adjustments would you implement for patients with pancreas cancer and cirrhosis with pancytopenia?
The patient declined palliative measures only and is motivated to receive treatment
1 Answer available
Would you ever consider using durvalumab/tremelimumab in second line after progression on Atezolizumab and Bevacizumab in advanced HCC?
2 Answers available
What are your first line treatment choices for metastatic combined HCC/Cholangiocarcinoma?
Would you treat as cholangiocarcinoma with a gemcitabine/platinum regimen or would you use a more HCC regimen like atezo/bev or durva/trem?
2 Answers available
In patients with perihilar cholangiocarcinoma eligible for liver transplant, what is the protocol for neoadjuvant chemo-RT, particularly when brachytherapy is not available?
The Mayo Clinic protocol recommends initial fields -1.5 Gy BID initially to 45 Gy followed by a Brachytherapy boost. If HDR /LDR is not available, wha...
3 Answers available
What are your top takeaways from ASCO GI 2023?
What were your “top 3” presentations/studies coming out of the meeting this year and how will it impact your own clinical practice? ...
8 Answers available
How do you sequence hypofractionated radiation and systemic therapy for patients with unresectable cholangiocarcinoma?
When using hypofractionated RT (i.e., 67.5 Gy in 15 fractions), can chemotherapy be delivered concurrently?  Options for systemic therapy in NCC...
3 Answers available
What non-variceal EGD findings, if any, deter you from using atezo/bev in patients with advanced HCC?
Would portal hypertensive gastropathy or colopathy sway you away from using it?
2 Answers available
How do you choose between Atezolizumab/Bevacizumab (IMbrave 150) versus Durvalumab/Tremelimumab (HIMALAYA) in first-line metastatic hepatocellular cancer?
1 Answer available
How long should surgery be delayed in a patient with localized, resectable pancreatic cancer who developed acute pancreatitis following EUS guided biopsy?
And if delayed, should chemotherapy be started?
2 Answers available
Are durva/cis/gem or pembro/cis/gem less efficacious in cholangiocarcinomas with FGFR2 fusions?
And is there any role in utilizing FGFR2 inhibitors in first line setting? The PROOF trial utilizing Infigratinib in first line was stopped after the...
1 Answer available
How would you manage a patient with metastatic HCC on atezolizumab/bevacizumab who requires holding bevacizumab due to persistent proteinuria >2g?
Do you continue atezo alone if responding or switch to an alternative therapy such as dual IO or TKI? What about if the patient were experiencing subt...
2 Answers available
How would you manage a solitary unresectable liver metastasis?
From NCCN (Rectal MS-33): SBRT is a reasonable option for patients who cannot be resected or ablated. What is the role of SBRT versus microwave ablat...
2 Answers available
What dose/fractionation would you choose for resected tail of pancreas adeno with positive margin, node negative?
Plan to give adjuvant chemotherapy.
2 Answers available
When do you offer radioembolization (Y90) in the treatment of unresectable HCC?
Should Y90 be offered before or after TACE (based on the Northwestern phase 2 study) or sorafenib (based on the SARAH trial)? 
1 Answer available
In patients with resected PDAC treated with adjuvant FOLFIRINOX who recur from 1-3 years post completion of adjuvant therapy, do you consider retreatment with FOLFIRINOX or gemcitabine/nab-paclitaxel in the absence of a clinical trial?
3 Answers available
In a patient with recurrent fibrolamellar HCC a year after upfront resection (previously refused adjuvant therapy) with a solitary abdominal mass, would you offer neoadjuvant therapy to assess response?
Or offer resection followed by adjuvant therapy? 
2 Answers available
How would you treat an MSI-H metastatic cholangiocarcinoma found on liquid biopsy?
Would you offer single agent immunotherapy or chemo-immunotherapy with gem/cis durva/pembro?
1 Answer available
What is the preferred palliative treatment regimen for elderly patients with advanced cholangiocarcinoma?
2 Answers available
Would you treat an unresectable MSI-H colon cancer patient with persistent hepatitis C with immunotherapy?
1 Answer available
How do you manage patients with suspected cholangiocarcinoma that presents with biliary obstruction but has repeated negative brushings/biopsies?
Is liquid biopsy helpful? Would you treat if this shows somatic mutation?
2 Answers available
How do you employ focal therapies in localized hepatocellular carcinoma?
Will the results of the recently published randomized comparison of proton beam therapy (PBT) vs. transarterial chemoembolization (TACE) change the wa...
2 Answers available
What are your top takeaways in GI Cancers from ASCO 2023?
6 Answers available
Would you treat a patient with a pancreatic head mass based on common bile duct brushings suggestive of malignancy, with repeated negative EUS biopsy?
1 Answer available
What is your preferred first line therapy for metastatic cholangiocarcinoma, if the patient is cisplatin ineligible or cisplatin is unavailable?
2 Answers available
How do you justify adjuvant radiotherapy in pancreatic cancer?
I can't convince the surgeons to refer their patients for adjuvant RT because the prospective data is messy and doesn’t seem to indicate a benef...
2 Answers available
How do you sequence HER2-therapy in HER2+ biliary tract cancer with the positive results of tucatinib + trastuzumab and zanidatamab in phase 2 studies?
0 Answers available
What are best practices for oncologists during the national platinum shortage?
Please specify how your institution is allocating resources now or will be soon.
13 Answers available
How do you approach relapsed hepatocellular malignant neoplasm NOS after transplant in pediatric or AYA patients?
2 Answers available
When do you consider performing a diagnostic laparoscopy before neoadjuvant chemotherapy in pancreatic adenocarcinoma patients?
1 Answer available
Is there a role for radiation therapy in the management of unresectable solid papillary cystic tumor of the pancreas?
2 Answers available
What group of early pancreatic cancer patients, such as pT1a, can be excluded from adjuvant chemotherapy post resection?
2 Answers available
What is the appropriate management of severe myalgia during atezolizumab infusion?
1 Answer available
What "adjuvant" therapy would you consider in patients with gallbladder cancer with liver metastases that are resected upfront?
Would you use immunotherapy based on the TOPAZ trial?
2 Answers available
How long do you wait after fiducial marker placement to simulate patients undergoing liver SBRT?
1 Answer available
What is your approach to patients with unresectable, node-negative perihilar cholangiocarcinoma who have undergone biliary stenting and have no evidence of distant disease?
If borderline resectable, can the TOPAZ regimen be considered for downstaging effects?
4 Answers available
How does data from the HIMALAYA trial impact your first line treatment selection for advanced HCC?
8 Answers available
What is your treatment approach for a patient with metastatic hepatocellular carcinoma with Child's Pugh B cirrhosis?
How do you sequence systemic treatment options for in patients with Child's Pugh B (or greater) in context of IMbrave150 and HIMALAYA? When do you in...
4 Answers available
Based on the TOPAZ-1 study, do you now routinely include durvalumab in first line treatment of advanced bile duct cancer?
Is data sufficient to adopt this as the new standard of care? Can you comment on the reported regional and race-based variations in outcomes?  ...
3 Answers available
Would you consider adjuvant capecitabine in a patient with resected stage IA cholangiocarcinoma with MSI high status?
1 Answer available
How would you treat a patient with borderline resectable pancreatic cancer with CT showing no change in tumor size after 4 cycles of neoadjuvant FOLFIRINOX?
Would you consider switching to a different regimen?
4 Answers available
How do you approach management of non-resectable periampullary adenocarcinoma in an elderly patient with otherwise good PS?
2 Answers available
What, if any, role does systemic therapy have in the treatment of HCC amenable to definitive locoregional therapy?
1 Answer available
Would you offer first line atezolizumab plus bevacizumab in unresectable/metastatic hepatocellular carcinoma based on the IMbrave 150 data?
6 Answers available
What would be your next line of treatment for disease control in a pediatric patient with metastatic hepatocellular carcinoma in partial response after multiple therapies?
The patient already received PLADO+sorafenib, Y90, and Atezolizumab/Bevacizumab complicated by recurrent episodes of bleeding from esophageal varices....
2 Answers available
Given the updated results of the PREOPANC study, how can gemcitabine-based neoadjuvant chemoradiation be best incorporated into the treatment of resectable or borderline resectable pancreatic cancer?
If multi-agent systemic therapy, i.e. FOLFIRINOX, is also planned, is there a preferred sequence of therapies?
2 Answers available
Would you offer gemcitabine-based chemoradiation for a resected node positive cholangiocarcinoma with negative margins that has tolerated adjuvant capecitabine?
1 Answer available
Would you prioritize TACE or systemic therapy in BCLC B multifocal HCC with tumor bulk higher than "up to 7?"
Would the etiology of HCC affect your decision, e.g. non-viral hepatitis since less benefit was shown for this group in IMbrave150?
1 Answer available
Is there a role for liver transplantation in an initially unresectable HCC with a complete response after bevacizumab-atezolizumab?
1 Answer available
Would you use bevacizumab in a patient with advanced HCC and multiple large esophageal varices that have not been endosopically intervened upon?
The patient was started on a beta blocker, as this is standard in the area.
2 Answers available
How would you approach the treatment of metastatic cholangiocarcinoma after progression on gemcitabine/cisplatin, FOLFOX, and pemigatinib?
Would you consider using infigratinib after progression on pemigatinib?
3 Answers available
How do you approach treatment of metastatic hepatocellular carcinoma in an adolescent?
Would you offer liver transplant in the setting of metastatic disease? 
1 Answer available
What systemic therapy would you offer for a local, unresectable relapse of a mixed acinar neuroendocrine carcinoma of the pancreas?
What therapy would you offer if the patient had a baseline grade 2 neuropathy?
2 Answers available
What clinical parameters determine when you treat a large HCC lesion with ablative radiation vs Y-90?
2 Answers available
Do you offer adjuvant treatment for resected colloid pancreatic carcinoma?
Colloid is a rare histologic subtype and considered to have more favorable outcomes compared with usual ductal adenocarcinoma, but no dedicated prospe...
2 Answers available
What is your first line treatment for progressive well differentiated metastatic (and unresectable) pancreatic neuroendocrine tumors?
1 Answer available
Would you consider using a PARP inhibitor in a patient with metastatic pancreatic cancer with a germline ATM mutation after progression on FOLFIRINOX and gemcitabine based chemotherapy?
2 Answers available
Would you offer systemic therapy for BCLC Stage C HCC (portal vein invasion) following local therapy with Y90?
Has the recent approval of atezolizumab/bevacizumab impacted your decision making? 
1 Answer available
What treatment would you offer a patient who underwent surgery for an extrahepatic cholangiocarcinoma and subsequently developed an isolated malignant biliary stricture?
Would you recommend radiation, systemic therapy alone, or chemoRT? What about if this recurrence occurred during or shortly after completion of adjuva...
2 Answers available
Would you recommend aspirin 600 mg daily for two years to a patient with Lynch syndrome and a history of colon cancer based on the results of the CAPP2 study for cancer prevention?
Would you offer low dose or standard dose aspirin instead?
1 Answer available
What is your preferred first line regimen for a patient with BRCA+ metastatic pancreatic cancer with poor performance status?
2 Answers available
What third line treatment do you consider for a patient with metastatic pancreatic cancer with good functional status and no targetable mutations after progression on FOLFIRINOX and gemcitabine/nab-paclitaxel?
3 Answers available
Do you routinely utilize G-CSF as primary prophylaxis in patients receiving mFOLFIRINOX or FOLFOXIRI?
If so, do you avoid pegfilgrastim given that <12 days will lapse between its administration and the next cycle?
4 Answers available
Do you routinely start anticoagulation for a patient with newly diagnosed hepatocellular carcinoma presenting with a portal venous thrombosis?
3 Answers available
What is your platelet cutoff for atezolizumab + bevacizumab in HCC in the absence of bleeding (variceal or otherwise)?
1 Answer available
What is your preferred second line therapy for an HCC patient who progressed after first line checkpoint inhibitor monotherapy?
Would you try atezolizumab/bevacizumab or switch to a TKI?
2 Answers available
How would you approach a patient with pancreatic adenocarcinoma who completed 6 months of adjuvant chemotherapy without evidence of disease on imaging but an elevated CA 19-9?
i.e. CA 19-9 >100
4 Answers available
Do you consider FOLFIRINOX dose adjustments for elderly patients with a good performance status in the neoadjuvant setting for resectable pancreatic adenocarcinoma?
When would you consider gemcitabine/abraxane as an alternative treatment? 
3 Answers available
For palliation of gastric bleeding due to malignancy, is a G-tube a contraindication for RT?
Would you reduce dose, e.g. from 30 Gy in 10 fractions to 20 Gy in 5 fractions, or hyperfractionate, e.g. 1.5 Gy bid to 20-30 Gy?
1 Answer available
Would you consider using checkpoint inhibitor therapy as an alternative to adjuvant mFOLFIRINOX in a patient with a very high risk resected pancreatic adenocarcinoma (poorly differentiated, N2 disease) and Lynch syndrome?
1 Answer available
What palliative, systemic treatment would you consider for a patient with an extensive Klatskin tumor with associated hyperbilirubinemia (bilirubin >20) not amenable to local intervention?
Specifically, would you consider incorporating immunotherapy in this setting?
2 Answers available
Would you consider using bevacizumab/atezolizumab in HCC patients who received TKI in the first line?
2 Answers available
What is your preferred second line treatment for advanced hepatocellular carcinoma after progression on atezolizumab and bevacizumab?
6 Answers available
Is anticoagulation a relative contraindication to atezolizumab/bevacizumab for advanced HCC?
For example in a patient with a history of PE?
3 Answers available
For patients with HCC receiving atezo/bev, would you advise any other clinical investigations scheduled during treatment other than basic lab monitoring?
i.e. EGD surveillance for varices?
3 Answers available
Would you consider atezolizumab-bevacizumab combination in a patient with metastatic hepatocellular carcinoma who presented with paraneoplastic myasthenia gravis?
1 Answer available
When would you continue atezolizumab/bevacizumab beyond progression in advanced HCC?
What parameters do you use to decide to treat beyond progression? Is there any efficacy data from this specific study subgroup in IMbrave150?
2 Answers available
Are there any biomarkers that might indicate who might be responders to atezolizumab/bevacizumab for HCC?
ex. VEGFR2 expression, inflammatory signature, PDL1, etc.
2 Answers available
How do you manage patients on atezolizumab/bevacizumab with advanced HCC who develop arterial thrombosis?
Do you continue atezolizumab alone? Would you avoid anticoagulation?
6 Answers available
For patients with HCC that have stable disease on immunotherapy alone, would you consider adding bevacizumab at the time of disease progression and continue immunotherapy?
2 Answers available
How do you decide between systemic vs. arterially directed therapies in the first line setting for unresectable HCC?
In light of the SIRveNIB trial results and now IMbrave150, what is the role of intra-arterial therapy now?
2 Answers available
Would you use upfront atezo/bev in a patient with HCC and untreated hepatitis?
3 Answers available
Do you refer all of your patients for EGD prior to initiation of atezolizumab/bevacizumab for advanced HCC?
Do you screen even asymptomatic patients?
4 Answers available
Do you utilize EUS to determine the nodal radiation fields in esophageal adenocarcinoma?
In a patient with a large primary and a negative PET/CT for nodal disease, would you push for EUS for radiation planning? Or would this be an unnecess...
1 Answer available
How would you treat metastatic squamous cell carcinoma of the gall bladder?
1 Answer available
What FGFR inhibitor would you use for a patient with cholangiocarcinoma and a FGFR3 mutation?
1 Answer available
Would you recommend adjuvant therapy for a patient with intraheptic cholangiocarcinoma with an isolated metastasis who has undergone complete surgical resection and is NED?
Patient had a solitary lung metastasis 
6 Answers available
Would you consider using a PARP inhibitor as maintenance therapy after initial platinum chemotherapy in a patient with metastatic pancreatic cancer who has a somatic non-BRCA DNA damage repair gene alteration?
For example, a FANC mutation
1 Answer available
How would you approach the treatment of borderline resectable pancreatic adenocarcinoma in an elderly patient (>80 years old) with a poor performance status who is not a surgical candidate?
1 Answer available
In very rapidly progressive/poorly differentiated hepatocellular cancer, would you use the targeted options (sorafenib/lenvatinib) or would you try a traditional cytotoxic regimen?
1 Answer available
Would you offer adjuvant chemotherapy for a patient with a high grade IPMN who was found to have a small focus of invasive adenocarcinoma pT1aN0 after Whipple?
Would age influence your decision?
0 Answers available
How would you treat a metastatic pancreatic cancer patient who develops symptomatic leptomeningeal disease on first line FOLFIRINOX?
1 Answer available
How do you manage patients with pancreatic adenocarcinoma who progress during neoadjuvant FOLFIRINOX, such that borderline resectable disease is now unresectable but still localized?
Is there evidence for radiation therapy in this setting? 
3 Answers available
What adjuvant therapy would you recommend for pT2, pN1 cholangiocarcinoma?
1 Answer available
How do you choose first or second-line systemic therapy for fibrolamellar hepatocellular carcinoma?
What are there most evidence-based options?
1 Answer available
What is your treatment algorithm for solitary hepatocellular carcinoma, 3-5 cm, non-operative candidate but Child-Turcotte Pugh A/B?
Do you recommend TACE, RFA, radioembolization, systemic therapy or SBRT?  What if the size is >5 cm?
1 Answer available
Should we be utilizing prophylactic G-CSF in our patients with intermediate risk of febrile neutropenia due to the COVID-19 pandemic?
Are you placing more weight on patient risk factors such as age >65 or co-morbidities?
2 Answers available
What would be your first-line approach to a patient with metastatic HCC with significant bleeding risk?
Patients oftentimes have cardiac co-morbidities with requirement for anti-coagulation making TKIs, including Bevacizumab, difficult to dose. Would the...
2 Answers available
How do you treat de novo metastatic hepatocellular carcinoma in a non-cirrhotic patient with a prior orthotopic liver transplant for hepatitis B now on chronic immunosuppression?
0 Answers available
What are the first line treatment options in HCC patients with significant baseline proteinuria?
Would you consider single agent IO such as Nivolumab, given data are not strong (Checkmate 459)?
1 Answer available
What adjuvant chemotherapy would you offer for completely resected carcinosarcoma of the pancreas?
1 Answer available
What would you recommend for an elderly patient (> 80 year old) with resectable pancreatic cancer?
Upfront surgery vs neoadjuvant therapy? And if neoadjuvant therapy, which regimen? Patient has a good PS.
1 Answer available
What is your preferred neoadjuvant chemotherapy (FOLFIRINOX vs gemcitabine/nab-paclitaxel) and duration for a resectable T2N1 pancreatic adenocarcinoma in a fit patient whose surgery has been cancelled due to COVID-19 risk in the hospital?
1 Answer available
What is your bilirubin threshold to treat a metastatic pancreaticobiliary tumor with FOLFOX?
Quite often we encounter cholestatic hyperbilirubinemia, wherein GI and IR do not believe ERCP with stents or PTC will alleviate jaundice. If the pati...
1 Answer available
Should cisplatin, gemcitabine, and veliparib be the standard of care in treating metastatic/unresectable pancreatic cancer with BRCA or PALB2 mutation?
Does this also apply to somatic mutations?
4 Answers available
What scenarios, if any, are you delaying adjuvant chemotherapy in light of the COVID-19 outbreak?
1 Answer available
Do you recommend chemoradiation following neoadjuvant FOLFIRINOX for resectable pancreatic cancer?
4 Answers available
Would you consider the use of PARP inhibitors in patients with BARD 1 mutation and refractory pancreatic cancer?
With extensive use of NGS testing, it is commonplace to identify mutations that have no validated therapeutic intervention, but strong biologic signal...
1 Answer available
What neoadjuvant strategies do you utilize for initially unresectable biliary tract cancer?
In your experience, what approach has been successful to bridge to surgery?
2 Answers available
When would you consider gemcitabine/cisplatin with Y90 for patients with unresectable intrahepatic cholangiocarcinoma ?
1 Answer available
What is your approach to localized pancreatic cancer that would otherwise be resectable, except for poor patient characteristics?
ex. age, surgical risk, and/or performance status
1 Answer available
For unresectable/metastatic cholangiocarcinoma, would you continue gemcitabine/cisplatin beyond 24 weeks if the patient continues to have a response to therapy?
Up to six cycles of treatment were given in the ABC02 trial.  Do you offer other treatments if you don't continue gem/cis beyond 24 weeks?
1 Answer available
Are you routinely using thrombopoietin agonists in patients with hep C and HCC?
If so, for what platelet count threshold and do you have a preference as to which agent?
1 Answer available
What would be your preferred adjuvant regimen for ampullary carcinoma (pancreatic histology) in patient with pre-existing neuropathy?
2 Answers available
Do you offer somatostatin analogues (eg lanreotide, octreotide) to asymptomatic patients with metastatic, nonfunctioning, well-differentiated enteropancreatic neuroendrocrine tumors?
Given the variable and sometimes indolent disease course of these patients, as well as the absence of a clear overall survival benefit in the PROMID&n...
1 Answer available
How do you sequence antiviral therapy and cancer-directed therapy in a newly diagnosed patient with hepatocellular carcinoma and incidentally found hepatitis C?
Is there a "best" way to approach treatment of the viral infection i.e concurrently with therapy, prior to therapy, delayed or post therapy? Does this...
1 Answer available
When would you consider metastastectomy of liver lesions in metastatic pancreatic cancer who achieve a favorable response to mFOLFIRINOX?
If you do employ this strategy, are there a number of liver lesions (eg <4) or duration of response that guide your decision making?
0 Answers available
How would you approach potential SBRT to liver metastases in a patient on a VEGF inhibitor?
Would you alter your SBRT dose? How long would you hold the VEGF inhibitor before and after? Does the primary matter (e.g. NSCLC vs. colorectal)?
1 Answer available
Would you consider using nab-paclitaxel/gemcitabine/cisplatin in first line setting for metastatic pancreatic adenocarcinoma?
A pilot study has shown activity of this combination in a small patient group. 
1 Answer available
Would you consider using immunotherapy off-label in metastatic pancreatic cancer with high PD-L1 expression?
1 Answer available
What is your preferred second-line of treatment for metastatic gallbladder carcinoma after progression on gemcitabine/cisplatin in a young, fit patient?
1 Answer available
What is your preferred second line of treatment after progression on cisplatin/gemcitabine for advanced or metastatic cholangiocarcinoma?
A number of phase 2 trials support various combinations (e.g. gem/ox, cape/cis, cape/ox, 5-FU based) -- how do you decide either between these regimen...
1 Answer available
When, if ever, do you use gemcitabine + erlotinib in patients with metastatic pancreatic cancer?
1 Answer available
Would you consider off label use of olaparib maintenance in patients with somatic BRCA1 mutated pancreatic adenocarcinoma?
3 Answers available
Do you check baseline or surveillance audiometry (if not overtly symptomatic) to screen for hearing loss in all patients getting cisplatin?
3 Answers available
How would you approach a metastatic ERBB2 amplified gallbladder carcinoma?
Would you consider adding trastuzumab to cis/gem in the first line? If not, would you consider adding Her2 directed therapy to FOLFIRI or FOLFOX in th...
1 Answer available
At what time do you switch to olaparib after FOLFIRINOX in BRCA mutated metastatic pancreatic adenocarcinoma patients?
Do you continue with FOLFIRI for a period and then switch to olaparib (and if so, when do you make that switch) or do you switch directly after FOLFIR...
3 Answers available
For a solitary liver met of pancreatobiliary origin with neoadjuvant chemotherapy required for preoperative downstaging, would you recommend mFOLFIRINOX or Gem-Cis?
1 Answer available
How do you treat unresectable, combined hepatocellular/cholangiocarcinoma?
1 Answer available
For metastatic pancreatic cancer, is there a role for maintenance chemotherapy if patient has stable disease at the end of 12 cycles of dose reduced modified FOLFIRINOX?
How would you approach this situation in the absence of BRCA mutation data?
1 Answer available
Is there a role for pre-operative RT (+/-chemo) for a borderline resectable Klatskin tumor as an attempt to try to get them to surgery?
1 Answer available
How long do you give neoadjuvant therapy in resectable/borderline resectable pancreatic cancer, when you are considering chemoradiotherapy as part of your neoadjuvant strategy?
I have seen anywhere from 4-6 months utilized.  Is there any data to guide your strategy?
1 Answer available
Do you use modified FOLFIRINOX preferentially over gem/nab-paclitaxel for first line metastatic pancreatic cancer patients?
Patient characteristics would unarguably be a deciding factor, but outside of these how would you approach the situation?
3 Answers available
In a patient with gastric adenocarcinoma with +peritoneal cytology status post an R1 resection, would you consider post operative chemoradiation?
2 Answers available
In patients witih locally advanced pancreatic cancer, how long would you wait after 1st line induction chemotherapy with FOLFIRINOX before you image for assessment of response and deciding about 2nd-line therapy?
1 Answer available
What is your general approach to treating bleeding gastric masses with palliative RT?
Do you have any preferred dose fractionation schedules? What kind of margins do you use?
3 Answers available
Would you offer adjuvant chemoRT to a patient with pancreatic adenocarcinoma who underwent neoadjuvant therapy with FOLFIRINOX and SBRT but had a positive (neck) margin on resection and is now s/p adjuvant chemotherapy?
1 Answer available
How do you manage venous thromboembolic events or bleeding events in RCC or HCC patients on anti-angiogenic TKIs?
Arterial events have clear instructions to permanently discontinue on the FDA label.  Especially in HCC without many other treatment options, giv...
1 Answer available
How would you approach oligometastatic (solitary) recurrence with previously resected pancreatic adenocarcinoma and adjuvant chemotherapy with a prolonged disease-free interval?
Is there a role for SBRT with or without the addition of systemic therapy?
3 Answers available
Are you categorically using lenvatinib over sorafenib for unresectable HCC in the absence of contraindications?
3 Answers available
In a patient with borderline resectable pancreatic adenocarcinoma who received neoadjuvant FOLFIRINOX followed by resection that demonstrated residual disease, how do you proceed in the adjuvant setting?
The patient had minimal to no response to neoadjuvant therapy. 
4 Answers available
Would you recommend adjuvant chemoradiation for a resected ampullary adenocarcinoma?
What features would make you more likely to recommend radiation therapy with chemotherapy?
1 Answer available
Is there an age cutoff for when to avoid FOLFIRINOX in older patients with pancreatic cancer?
1 Answer available
Is there an age cutoff for when to avoid Gem/Nab-Paclitaxel in older patients with pancreatic cancer?
2 Answers available
Do you recommend starting sorafenib at a reduced dose and titrating up in patients with advanced hepatocellular carcinoma?
2 Answers available
Do you routinely offer adjuvant chemotherapy to patients with extrahepatic cholangiocarcinoma after R0 resection?
If so, which agent(s) do you prefer?
0 Answers available
Are there any situations where you would you add docetaxel to gemcitabine + capecitabine for locally advanced unresectable pancreatic cancer?
The GTX (gemcitabine, docetaxel, capecitabine) regimen is listed as a category 2B recommendation in the NCCN guidelines- when would this be ...
0 Answers available
What would be your frontline therapeutic choice for a patient with Stage IV pancreatic adenocarcinoma with good PS but elevated bilirubin (4-5) due to tumor volume?
Stenting is not possible/not able to bring down the bilirubin level.
1 Answer available
In the absence of an available clinical trial, would you favor regorafenib immediately post-sorafenib or nivolumab in patients with HCC?
Regorafenib has been approved for patients with advanced HCC post-sorafenib, but the benefits are slight and toxicity substantial.  Nivolumab has...
1 Answer available
How do you approach subsequent treatment in patients with unresectable hepatocellular carcinoma who have progressed on first line sorafenib?
0 Answers available
What dose constraint, if any, do you use for the diaphragm when treating liver or lung tumors with SBRT?
Have you ever seen toxicity related to diaphragm dose with conventional fractionation?  
4 Answers available
Do you recommend neoadjuvant chemotherapy or induction chemo + chemoRT for borderline resectable pancreatic cancer?
How would the new data presented at ASCO GI 2021 from from Alliance A021501 influence your answer?
3 Answers available
Would you recommend sorafenib as an adjunct to liver targeted therapy in patients with hepatocellular carcinoma who are awaiting liver transplant?
1 Answer available
Could a non-cirrhotic patient with a single HCC lesion measuring >5cm who is ineligible for liver transplant by Milan size criteria alone become a candidate if the tumor shrinks after TACE?
1 Answer available
When do you perform HER2 testing in patients with colorectal cancer?
1 Answer available
When do you perform BRAF testing in colon cancer?
1 Answer available
How do you use a 4D CT to account for hepatocellular carcinoma tumor motion?
When planning SBRT cases for primary liver cancers, it is very difficult to see the tumor on the non-contrast 4D scan. How do you use information from...
2 Answers available
When is SBRT or hypofractionated radiation appropriate as adjuvant treatment for pancreatic cancer?
What are the targets (tumor bed, positive margin, nodes etc.)?
3 Answers available
When treating pancreatic cancer with adjuvant chemoradiation, do you treat the initial field to 50 Gy, as per RTOG 0848, or to 45 Gy?
For cases with positive margins, do you boost to 54 Gy? If so, do you boost the entire tumor bed or only the area of the positive margin? 
2 Answers available
Is there a role for PET/CT in pancreatic cancer staging or treatment planning?
I recently had a patient with unresectable disease ask for a PET before starting RT but I’m not sure there is a benefit. 
1 Answer available
How do you control for organ motion when treating pancreatic cancer?
What techniques work best?
2 Answers available


Papers discussed in this category

Cancer, 2007-11-15
Radiation therapy is associated with improved survival in patients with pancreatic adenocarcinoma: results of a study from the Surveillance, Epidemiology, and End Results (SEER) registry data.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2008-07-20
Analysis of fluorouracil-based adjuvant chemotherapy and radiation after pancreaticoduodenectomy for ductal adenocarcinoma of the pancreas: results of a large, prospectively collected database at the Johns Hopkins Hospital.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2008-07-20
Adjuvant radiotherapy and chemotherapy for pancreatic carcinoma: the Mayo Clinic experience (1975-2005).
Cancer, 1987 Jun 15
Further evidence of effective adjuvant combined radiation and chemotherapy following curative resection of pancreatic cancer. Gastrointestinal Tumor Study Group.
Ann Surg, 2007 Nov
Long-term survival and metastatic pattern of pancreatic and periampullary cancer after adjuvant chemoradiation or observation: long-term results of EORTC trial 40891.
Cancer, 2015-04-01
Phase 2 multi-institutional trial evaluating gemcitabine and stereotactic body radiotherapy for patients with locally advanced unresectable pancreatic adenocarcinoma.
JAMA, 2012 Jul 11
Effect of adjuvant chemotherapy with fluorouracil plus folinic acid or gemcitabine vs observation on survival in patients with resected periampullary adenocarcinoma: the ESPAC-3 periampullary cancer randomized trial.
JAMA, 2008-03-05
Fluorouracil vs gemcitabine chemotherapy before and after fluorouracil-based chemoradiation following resection of pancreatic adenocarcinoma: a randomized controlled trial.
Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2011-08-01
Phase II trial of cetuximab, gemcitabine, and oxaliplatin followed by chemoradiation with cetuximab for locally advanced (T4) pancreatic adenocarcinoma: correlation of Smad4(Dpc4) immunostaining with pattern of disease progression.
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