Pancreatic cancer in the era of COVID-19 pandemic:Which one is the lesser of two evils?

Pancreatic adenocarcinoma remains one of the deadliest malignancies affecting the older population.We are experiencing a paradigm shift in the treatment of pancreatic cancer in the era of coronavirus disease 2019(COVID-19)pandemic.Utilizing neoadjuvant treatment and further conducting a safe surgery while protecting patients in a controlled environment can improve oncological outcomes.On the other hand,an optimal oncologic procedure performed in a hazardous setting could shorten patient survival if recovery is complicated by COVID-19 infection.We believe that oncological treatment protocols must adapt to this new health threat,and pancreatic cancer is not unique in this regard.Although survival may not be as optimistic as most other malignancies,as caregivers and researchers,we are committed to innovating and reshaping the treatment algorithms to minimize morbidity and maximize survival as caregivers and researchers.

Trends with neoadjuvant radiotherapy and clinical staging for those with rectal malignancies

AIM To see how patterns of care changed over time,and how institution type effected these decisions.METHODS A retrospective analysis was performed using the National Cancer Database,looking at all patients that were diagnosed with rectal cancer from 1998 to 2011. We tested differences in rates of treatment and stage migration using χ~2 tests and logistic regression models. RESULTS A review of ninety thousand five hundred and ninety four subjects underwent multimodality therapy for cancer of the rectum. Staging and response to treatment varied greatly between centers. Forty-six percent of the time staging was missing in academic practices,vs fiftyfour percent of the time in community centers(P < 0.001). As a result,twenty-percent were down-staged and eight percent up-staged in academia,whereas only fifteen percent were down-staged and 8% up-staged in community practices(P < 0.001). Forty-two percent of individuals underwent radiation before surgery in 1998.Within two years this increased to fifty-three percent. This increased to eighty-six percent by 2011(P < 0.001). Institution specific treatment varied greatly. Fifty-one percent received therapy before surgery in academic centers in 1998. Thirty-nine percent followed this pattern in the same year in the community(P < 0.001). By 2011,ninety-one percent received radiation before their procedure in academic centers,vs eighty-four percent in the community(P < 0.001). Rates of adoption were better in academia,although an increase was seen in both center types. CONCLUSION From the study dates of 1998 to 2011,preoperative treatment with radiation has been on the rise. There is certainly an increased rate of use of radiation in academia,however,this trend is also seen in the community. Practice patterns have evolved over time,although rates of assigning clinical stage are grossly underreported prior to initiation of preoperative therapy.