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Abstract: Pancreatic cancer is considered one of the most lethal malignances. It has been

observed that the five year survival rate is less than 5%. Early diagnosis, understanding the risk
factors and investigation of the molecular pathways with targeted therapy are the keys for
efficient treatment. Moreover; there are several local treatments for patients with unresectable

pancreatic cancer. There are several combined therapies with chemotherapy and radiotherapy,

however; a local therapy approach for many patients with poor performance status are in need.
For those patients with good performance status new polychemotherapy regimens are used
with success and increased survival improvement. Polychemotherapy has been observed to

increase the rate of radical resections in some cases. Second line therapy is used for patients
with good performance status and metastatic disease. Oxaliplatin-based regimens are mostly

used, however; there are several other drugs that are being developed. Unfortunately, targeted
therapy has not presented the expected efficiency. Moreover; immunotherapy; another

treatment approach for several cancers types has again failed to present positive results for
pancreatic cancer. In the current mini review, we will present information from the diagnosis to

molecular pathways and targeted treatment.

38. Chrysa Karapantzou, Ilias Karapantzos, Paul Zarogoulidis, Michail Karanikas, Vasilis
Thomaidis, Charalampos Charalampidis. Botulinum neurotoxin for sialorrhea: a first choice

therapy. Ann Res Hosp 2017;1:17 doi: 10.21037/arh.2017.04.20

Abstract: This article emphasizes the therapeutic potential of botulinum neurotoxin (BoNT) in
the autonomous nerve system disorder of sialorrhea, a pathologic situation found mainly in

patients with neurologic deficits. Major applications that are well known to be treated with
botulinum toxin in the head and neck area, include undesirable muscular dysfunctions and

spasms, based on the toxins blocking effect on the neuromuscular junction transmitter
acetylcholine. In the 90’s it became clear that BoNT could block the release of acetylcholine in

gland tissues, too. A new era in the management of autonomic dysfunctions began. There
have been numerous of treatments such as Frey’s syndrome, sialorrhea, facial and cranial

hyperhidrosis reviewed. Ultrasound guided intraglandular injections of botulinum toxin type A
into both the submandibular and parotid glands, have been noted to be effective at controlling

sialorrhea in practice. The doses and injection techniques are described and further discussed
in this article. The option of the minimal invasive, well tolerated BoNT injections into the major
salivary glands is crucial for the best management of sialorrhea patients, avoiding the side-

effects of anticholinergic medications. The indications of BoNT in the head and neck region

are still expanding as physicians are finding out the therapeutic valuability of the toxin in
otorhinolaryngology.

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