Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “multimodal integration”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 289 records · Page 16Linked to original sources
PubMed2002

The anterior frontomedian cortex and evaluative judgment: an fMRI study.

This study investigated the neuronal basis of evaluative judgment. Judgments can be defined as the assessment of an external or internal stimulus on an internal scale and they are fundamental for decision-making and other cognitive processes. Evaluative judgments (I like George W. Bush: yes/no) are a special type of judgment, in which the internal scale is related to the person's value system (preferences, norms, aesthetic values, etc.). We used functional magnetic resonance imaging to examine brain activation during the performance of evaluative judgments as opposed to episodic and semantic memory retrieval. Evaluative judgment produced significant activation in the anterior frontomedian cortex (BA 10/9), the inferior precuneus (BA 23/31), and the left inferior prefrontal cortex (BA 45/47). The results show a functional dissociation between the activations in the anterior frontomedian cortex and in the inferior precuneus. The latter was mainly activated by episodic retrieval processes, supporting its function as a multimodal association area that integrates the different aspects of retrieved and newly presented information. In contrast, the anterior frontomedian cortex was mainly involved in evaluative judgments, supporting its role in self-referential processes and in the self-initiation of cognitive processes.

Adult↗
PubMed2006

A reexamination of the size-weight illusion induced by visual size cues.

The size-weight illusion induced by visually perceived sizes was reexamined to investigate whether this illusion is a sensory based or cognitive-based phenomenon. A computer-augmented environment was utilized to manipulate visual size information of target objects independently of their haptic information. Two physical cubes of equal mass (30.0 g) and size (3.0 x 3.0 x 3.0 cm) were suspended in parallel by wires attached to small graspable rings, in order to keep haptically obtained information constant between lifts. Instead of directly seeing each physical cube, subjects viewed 3D graphics of a cube with a wire and a ring that were precisely superimposed onto each physical cube. Seventeen subjects vertically lifted these augmented cubes, one after the other, by grasping the attached rings, and then reported their perception of cube heaviness. The graphical size of a comparison cube pseudo randomly varied for every comparison from 1.0 x 1.0 x 1.0 to 9.0 x 9.0 x 9.0 cm, while that of a standard cube remained constant (5.0 x 5.0 x 5.0 cm). Results indicated that the size-weight illusion frequently and systematically occurred for all the subjects such that when the comparison cube was relatively smaller than the standard cube, it was perceived to be heavier, and vice versa. As the size difference increased between the standard cube and the comparison cube, more subjects experienced the illusion, and vice versa. Follow-up tests showed occurrence of the size-weight illusion was significantly correlated with subject's sensitivity to discriminate weight, but not with sensitivity to discriminate visual size. Results suggest that the size-weight illusion induced by only visual size cues in an augmented environment is sensory based, and depends on an individual's integrated perception based on multimodal sensory information.

Adult↗
PubMed2006

Clinical analysis of the effect of intraarterial cytoreductive chemotherapy in the treatment of lacrimal gland adenoid cystic carcinoma.

PURPOSE: To determine the effect of intraarterial cytoreductive chemotherapy (IACC) as an adjunct to conventional surgery and radiation therapy for lacrimal gland adenoid cystic carcinoma (ACC). DESIGN: A retrospective, comparative, interventional case series. METHODS: setting: Institutional. patient population: Nine consecutive patients with lacrimal gland ACC were treated with IACC, followed by orbital exenteration and chemoradiotherapy. This case series was compared with a series of seven patients treated by conventional local therapies in the same institution. intervention procedure: Clinical records, imaging studies, histologic sections, and archival specimens from all 16 patients were reviewed. Information analyzed included site of disease, histologic characteristics, extent of disease, incidence of locoregional recurrence or distant metastases, and disease-free survival and overall survival time. main outcome measure: The effect of IACC was assessed by the radiographic and histologic response and survival outcome in comparison to a historical cohort of patients managed by conventional local therapies. RESULTS: The difference between the carcinoma cause-specific death rate of the study group versus conventional treatment was significant (P = .029, log rank test). The cumulative 5-year carcinoma cause-specific death rate in the IACC treated group was 16.7% compared with 57.1% in the conventional treatment group. The cumulative 5-year recurrence rate in the IACC treated group was 23.8% compared with 71.4% in the conventional treatment group. CONCLUSIONS: The preliminary data suggest that IACC as an integral component of a multimodal treatment strategy is potentially effective in improving local disease control and overall disease-free survival in lacrimal gland adenoid cystic carcinoma.

Adult↗
PubMed2005

The neural basis of smooth-pursuit eye movements.

Smooth-pursuit eye movements are used to stabilize the image of a moving object of interest on the fovea, thus guaranteeing its high-acuity scrutiny. Such movements are based on a phylogenetically recent cerebro-ponto-cerebellar pathway that has evolved in parallel with foveal vision. Recent work has shown that a network of several cerebrocortical areas directs attention to objects of interest moving in three dimensions and reconstructs the trajectory of the target in extrapersonal space, thereby integrating various sources of multimodal sensory and efference copy information, as well as cognitive influences such as prediction. This cortical network is the starting point of a set of parallel cerebrofugal projections that use different parts of the dorsal pontine nuclei and the neighboring rostral nucleus reticularis tegmenti pontis as intermediate stations to feed two areas of the cerebellum, the flocculus-paraflocculus and the posterior vermis, which make mainly complementary contributions to the control of smooth pursuit.

Animals↗
PubMed2005

Sensory convergence solves a motion ambiguity problem.

Our inner ear is equipped with a set of linear accelerometers, the otolith organs, that sense the inertial accelerations experienced during self-motion. However, as Einstein pointed out nearly a century ago, this signal would by itself be insufficient to detect our real movement, because gravity, another form of linear acceleration, and self-motion are sensed identically by otolith afferents. To deal with this ambiguity, it was proposed that neural populations in the pons and midline cerebellum compute an independent, internal estimate of gravity using signals arising from the vestibular rotation sensors, the semicircular canals. This hypothesis, regarding a causal relationship between firing rates and postulated sensory contributions to inertial motion estimation, has been directly tested here by recording neural activities before and after inactivation of the semicircular canals. We show that, unlike cells in normal animals, the gravity component of neural responses was nearly absent in canal-inactivated animals. We conclude that, through integration of temporally matched, multimodal information, neurons derive the mathematical signals predicted by the equations describing the physics of the outside world.

Animals↗
PubMed2006

Simultaneous microsurgical and endovascular management of multiple cerebral aneurysms in acute subarachnoid haemorrhage.

Most aneurysms can be effectively managed using endovascular coiling or microsurgical clipping, but in an acute subarachnoid haemorrhage where there are multiple aneurysms identified, a sequential multimodal approach may prove more beneficial. This report involves a 31-year-old man who presented with sudden onset of severe headache and photophobia. A computed tomography brain scan revealed a diffuse grade II subarachnoid haemorrhagic pattern, and four-vessel angiography revealed two aneurysms: a right middle cerebral artery bifurcation aneurysm measuring 12 x 8 mm and a 4-mm basilar artery aneurysm associated with a fenestration at the confluence of the vertebral arteries. It was not possible to determine which aneurysm or aneurysms were responsible for the haemorrhage using the customary criteria. The patient underwent sequential endovascular coiling of the vertebrobasilar aneurysm without delay, followed immediately by microsurgical clipping of the right middle cerebral artery aneurysm, under a single anaesthetic. The postoperative course was uneventful. This method is a treatment option for acute subarachnoid haemorrhage where there are multiple aneurysms. It is a logical progression of management that could be employed at any experienced neurovascular centre; the employment of a sequential multimodal approach from the integration of these techniques is beneficial to the patient because it decreases morbidity and mortality.

Adult↗
PubMed2005

The plasticity of gravitational reference frame and the subjective vertical: peripheral visual information affects the oblique effect.

The experiment examined the human visual perception of orientations and the nature of reference frame in which the oblique effect (lower performance in oblique orientations than in vertical or horizontal ones) was defined. Previous research [M. Luyat, E. Gentaz, Body tilt effect on the reproduction of orientations: studies on the visual oblique effect and subjective orientations, J. Exp. Psychol. Hum. Percept. Perform. 28 (2002) 1002-1011. M. Luyat, E. Gentaz, T.R. Corte, M. Guerraz, Reference frames and haptic perception of orientation: body and head tilt effects on the oblique effect, Percept. Psychophys. 63 (2001) 541-554], using head tilt paradigm to uncouple the gravitational, egocentric and subjective reference frames, showed that the oblique effect was mapped in a subjective gravitational reference frame with the subjective vertical as a cardinal orientation. However, the subjective vertical is not only affected by the tilt of head but also by the tilt of visual context. Then, the tilt of visual oriented cues is another paradigm permitting to evidence the role of the subjective gravitational reference frame. Sixteen participants were asked to reproduce five different orientations of a luminous line: horizontal (0 degrees ), 45 degrees (oblique), 90 degrees (vertical), 135 degrees (oblique) and the subjective vertical. These orientations were reproduced with no visual contextual cues and with tilted visual contextual cues tilted 15 degrees either to the left or to the right. The results showed that the oblique effect decreased with tilted visual contexts but was not completely suppressed. These results proved that this oblique effect is defined in a multimodal reference frame which integrates not only vestibular and proprioceptive cues but also peripheral visual information.

Adult↗
PubMed2006

The multi-component model of working memory: explorations in experimental cognitive psychology.

There are a number of ways one can hope to describe and explain cognitive abilities, each of them contributing a unique and valuable perspective. Cognitive psychology tries to develop and test functional accounts of cognitive systems that explain the capacities and properties of cognitive abilities as revealed by empirical data gathered by a range of behavioral experimental paradigms. Much of the research in the cognitive psychology of working memory has been strongly influenced by the multi-component model of working memory [Baddeley AD, Hitch GJ (1974) Working memory. In: Recent advances in learning and motivation, Vol. 8 (Bower GA, ed), pp 47-90. New York: Academic Press; Baddeley AD (1986) Working memory. Oxford, UK: Clarendon Press; Baddeley A. Working memory: Thought and action. Oxford: Oxford University Press, in press]. By expanding the notion of a passive short-term memory to an active system that provides the basis for complex cognitive abilities, the model has opened up numerous questions and new lines of research. In this paper we present the current revision of the multi-component model that encompasses a central executive, two unimodal storage systems: a phonological loop and a visuospatial sketchpad, and a further component, a multimodal store capable of integrating information into unitary episodic representations, termed episodic buffer. We review recent empirical data within experimental cognitive psychology that has shaped the development of the multicomponent model and the understanding of the capacities and properties of working memory. Research based largely on dual-task experimental designs and on neuropsychological evidence has yielded valuable information about the fractionation of working memory into independent stores and processes, the nature of representations in individual stores, the mechanisms of their maintenance and manipulation, the way the components of working memory relate to each other, and the role they play in other cognitive abilities. With many questions still open and new issues emerging, we believe that the multicomponent model will continue to stimulate research while providing a comprehensive functional description of working memory.

Brain↗
PubMed2006

Image-guided brachytherapy for prostate cancer.

Prostate brachytherapy offers and effective treatment for organ-confined prostate carcinoma. It is rapidly delivered compared with external beam radiation therapy or surgery and well tolerated by patients. Volumetric imaging and image guidance play critical roles in patient selection, treatment planning, treatment delivery, and postimplant assessment. Costs, availability and ease of use often dictate the local and regional differences in imaging approach, whether ultrasound, CT, or MR. Future volumetric image developments may permit multimodality image fusion to integrate tumor-specific imaging such as MR spectroscopy or positron emission tomography/CT into real-time ultrasound, CT, or MR.

Brachytherapy↗
PubMed2003

Surgery in metastatic testicular cancer.

Surgery in advanced testicular tumors is an integral part of the multimodality treatment. However, the indications for surgery in testis cancer have changed over the last 10 years. Patients with advanced seminoma only rarely will need surgery after chemotherapy whereas patients with advanced non-seminoma need to undergo the resection of residual disease in most of the cases. Surgery in metastatic disease may even be beneficial for patients with recurrent tumors, patients with persisting marker elevations during chemotherapy, or patients with late relapse of the disease. In view of late relapse, the extent and completeness of the primary resection is an important issue and, therefore, surgery should be performed in specialized centers. Most of the procedures are technically demanding and, therefore, individualized perioperative precautions are necessary to reduce morbidity of surgery. Nevertheless, in individual cases nerve-sparing techniques and laparoscopic approaches may be applicable to reduce surgery-related morbidity. This review will update the current indications and recommendations for post-chemotherapy surgery in advanced testis cancer.

Antineoplastic Protocols↗
PubMed1999

Enhancement of local control in locally advanced node-positive nasopharyngeal carcinoma by adjunctive chemotherapy.

PURPOSE: To determine the efficacy of chemotherapy adjunctive to radical radiotherapy (neoadjuvant +/- adjuvant) in patients with node-positive nasopharyngeal carcinoma (NPC). METHODS AND MATERIALS: All the node-positive patients given adjunctive chemotherapy between 1984-1989 (n = 209, CHEMO) were compared with all the node-positive patients treated by radical radiotherapy alone during the same period (n = 409, NCHEMO). The CHEMO group had significantly more bulky nodes, lower cervical/supraclavicular nodes, and more advanced overall stages than the NCHEMO group because nodal size (> or =24 cm) was used as a selection criterion for chemotherapy (1984-1988 departmental protocol and 1988-1989 prospective randomized trial). The chemotherapy consisted of two courses of neoadjuvant cisplatin (100 mg/m2 D1) and 5-fluorouracil (5-FU) (1 gm/m2 D1-D3) in 191 patients. In addition to the two courses of neoadjuvant, four courses of adjuvant chemotherapy, of the same combination, were given after radical radiotherapy in a further 18 patients. Radical radiotherapy delivered a nasopharyngeal dose of 60-62.5 Gy. In addition, parapharyngeal booster external radiotherapy (20 Gy) was given in the presence of parapharyngeal involvement, and intracavitary brachytherapy (24 Gy) was used to treat any local residual tumor diagnosed at 4-6 weeks after external radiotherapy. Both crude and actuarial rates were compared (survival, distant metastases, and local failures) between CHEMO and NCHEMO for all patients, for individual Ho's overall stage, for patients with nodes of different sizes (< or =3 cm, >3-< or =6 cm, >6 cm), for individual T-stage and individual N-stage, and for patients belonging to different gender and different age groups (<40 years, > or =40 years). Multivariate analyses using the Cox Regression Model were performed to identify significant prognostic factors. RESULTS: With a median follow-up of 5.5 years (range 0.7 to 10 years), CHEMO had significantly less local failures overall than NCHEMO; this was especially true for patients with advanced stages (III + IV). Additionally, in all nodal-size subgroups, in all node-positive T3, and in node-positive T3-Stage IV, there was a significant reduction in local failures after chemotherapy. There was a trend toward fewer local failures in favor of chemotherapy in Stage III, Stage IV, and T3-Stage III (0.05<p< or =0.1). There was no difference in local failures between CHEMO and NCHEMO in Stage II or in T1 and T2. The multivariate analyses identified the administration of adjunctive chemotherapy to be of independent significance in determining the local failure rate for all patients, the T3 (node-positive), and the advanced overall stages (III and IV combined). There was no difference in overall survival, relapse-free survival, and distant metastasis rates between CHEMO and NCHEMO among patients belonging to Stages III and IV despite the presence of more advanced nodal diseases in CHEMO. There were very few late local relapses in patients given adjunctive chemotherapy, in contradistinction to the well-known predisposition of NPC to late local relapses after radical radiotherapy. CONCLUSION: Adjunctive chemotherapy enhanced local control in node-positive NPC in general, and node positive-T3 and -T3-Stage IV in particular with reduction of late local relapses. The enhancement in local control of the locally advanced NPC could be explained by the significant shrinkage of the primary tumor by the neoadjuvant chemotherapy, leading to an increased safety margin between the tumor volume and the radiation volume. We recommend that adjunctive chemotherapy (neoadjuvant +/- adjuvant) should become an integral part of the multimodality curative treatment for patients with node-positive T3 NPC.

Adolescent↗
PubMed1998

Intraoperative adjuncts of spinal cord protection.

Immediate neurological deficits as a complication of aortic surgery occur as the direct result of hypoxia, related to the acute deprivation of spinal cord blood supply inflicted by prolonged aortic cross-clamping (AXC). The etiology of spinal cord ischemia constitutes a series of progressive interdependent events which include proximal hypertension, increase in cerebrospinal fluid pressure, perioperative hypotension, inadequate perfusion to critical intercostal or lumbar vessels, extent of aortic pathology and duration of AXC. Several intraoperative interventions and strategies, which address the multifactorial nature of cord injury, are presented by the authors. Of critical importance is the role of adequate distal aortic perfusion, with either left atrium-femoral artery (LA-FA) bypass or arterial-arterial passive shunts, to control both central hypertension, through proximal unloading, and hypotension distal to AXC. Equally crucial is the increase in CSF pressure, secondary to proximal hypertension, which acts antagonistically to distal aortic pressure in regulating spinal cord perfusion pressure (SCPP). Cerebrospinal fluid drainage (CSFD) reduces CSF pressure to offset SCPP to favor cord perfusion. Pharmacological agents, such as papaverine and steroids in combination with CSFD, produce a synergistic benefit of extending the time interval of safe AXC. Encouraging results have also been realized with circulatory arrest and profound hypothermia which reduce oxygen demand of neural tissues and extend the safe duration of AXC interval. The use of distal bypass is most effective with CSFD as an integral component of a multimodality approach, which also incorporates the intraoperative monitoring of somatosensory evoked potentials (SSEP), to detect the onset of spinal cord ischemia and assess the adequacy of distal aortic perfusion and disposition of critical segmental vessels.

Aortic Aneurysm, Abdominal↗
PubMedDate not supplied

Distribution and origin of the catecholaminergic innervation in the amphibian mesencephalic tectum.

The mesencephalic tectum plays a prominent role in integrating both visual and multimodal sensory information essential for normal behavior in amphibians. Activity in the mesencephalic tectum is thought to be modulated by the influence of distinct neurochemical inputs, including the catecholaminergic and the cholinergic systems. In the present study, we have investigated the distribution and the origin of the catecholaminergic innervation of the mesencephalic tectum in two amphibian species, the anuran Rana perezi and the urodele Pleurodeles waltl. Immunohistochemistry for dopamine and two enzymes required for the synthesis of catecholamines, tyrosine hydroxylase (TH) and dopamine beta-hydroxylase (DBH), revealed a complex pattern of catecholaminergic (CA) innervation in the anuran and urodele mesencephalic tectum. Dopaminergic fibers were primarily present in deep tectal layers, whereas noradrenergic (DBH immunoreactive) fibers predominated in superficial layers. Catecholaminergic cell bodies were never observed within the tectum. To determine the origin of this innervation, applications of retrograde tracers into the optic tectum were combined with immunohistochemistry for TH. Results from these experiments demonstrate that dopaminergic neurons in the suprachiasmatic and juxtacommissural nuclei (in Rana) or in the nucleus pretectalis (in Pleurodeles), together with noradrenergic cells of the locus coeruleus, are the sources of CA input to the amphibian mesencephalic tectum. The present results suggest that similar CA modulatory inputs are present in the mesecencephalic tectum of both anurans and urodeles.

Afferent Pathways↗
PubMed2003

Liver resection for colorectal metastases: the third hepatectomy.

OBJECTIVE: To determine the risk, the benefit, and the main factors of prognosis of third liver resections for recurrent colorectal metastases. SUMMARY BACKGROUND DATA: Recurrence following liver resection is frequent after a first as after a second hepatectomy. Second liver resections yield a similar survival to that obtained with first liver resection, but little is known about third hepatectomy. METHODS: This study reports a retrospective analysis of 60 patients who underwent a third liver resection for colorectal metastases in a 16-year experience (1984-2000). Patients were identified from a prospective database that collected 615 consecutive patients who cumulated 883 hepatectomies (615 first, 199 second, 60 thirds, and 9 fourths). Third hepatic resections were compared with first and second procedures, in terms of risk and benefit for the patient. Prognostic factors of survival after third hepatic resection were determined by univariate and multivariate analysis. RESULTS: A third hepatic resection was attempted in 68 of 115 of liver recurrences following a second hepatectomy (59%) and achieved in 88% of the cases (60 of 68). There was no intraoperative mortality or postoperative deaths within the 2 months. Fifteen patients developed postoperative complications (25%), a rate similar to that of first and second hepatectomies. Overall 5-year survival was 32% and disease-free survival was 17% after the third resection. Survival compared favorably to that of patients with recurrence following a second hepatectomy who could not be operated (5% at 3 years) or who failed to be resected (15% at 2 years, P = 0.0001). It also compared favorably to that of patients who underwent only two hepatectomies (5-year survival, 27%). When estimated from the time of first hepatectomy, survival was 65% at 5 years for the 60 patients who underwent three hepatic resections. Concomitant extrahepatic tumor was treated in 16 patients (27%) by 11 abdominal procedures and 5 pulmonary resections. By multivariate analysis, tumor size > 30 mm for first liver metastases, presence of extrahepatic tumor at second hepatectomy, and noncurative pattern of third liver resection were independent prognostic factors of reduced survival. CONCLUSIONS: Third hepatectomy is safe and provides an additional benefit of survival similar to that of first and second liver resections. It is worthwhile when curative and integrated into an intended multimodal strategy of tumoral eradication.

Adult↗
PubMed2006

Neural basis subserving the detection of postural instability: an fMRI study.

Human upright posture is a product of a complex dynamic system that relies on integration of input from multimodal sensory sources. Extensive research has explored the role of visual, vestibular, and somatosensory systems in the control of upright posture. However, the role of higher cognitive function in a participant's assessment of postural stability has been less studied. In previous research, we showed specific neural activation patterns in EEG associated with recognition of unstable postures in young healthy participants. Similar EEG patterns have been recently observed in regulation of posture equilibrium in dynamic stances. This article evaluates participants' postural stability in dynamic stances and neural activation patterns underlying visual recognition of unstable postures using event-related functional MRI (fMRI). Our results show that the "stable" participants were successful in recognition of unstable postures of a computer-animated body model and experienced egocentric motion. Successful recognition of unstable postures in these participants induces activation of distinct areas of the brain including bilateral parietal cortex, anterior cingulate cortex, and bilateral cerebellum. In addition, significant activation is observed in basal ganglia (caudate nucleus and putamen) but only during perception of animated postures. Our findings suggest the existence of modality-specific distributed activation of brain areas responsible for detection of postural instability.

Adult↗
PubMedDate not supplied

Pharmacological approaches to the management of alcohol addiction.

Alcohol abuse and alcoholism represent a world-wide problem, both from a medical and a social point of view. In the past the therapy for patients affected by alcoholism was based mainly on the psychological approach. In recent years the use of pharmacotherapy together with psychosocial interventions have enhanced the percentage of success in maintaining alcoholic patients in remission. The present review discusses the main drugs experimented both in preclinical and clinical studies. Pharmacotherapy of alcohol dependence seems to be effective in both alcohol-related emergencies and prevention relapse. However, pharmacotherapy should not be considered as the only form of treatment but as an integrated part of a multimodal approach including psychological and social support.

Alcohol Deterrents↗
PubMed2004

Radiotherapy for cutaneous malignant melanoma: rationale and indications.

The use of radiation as adjuvant therapy for patients with cutaneous malignant melanoma has been hindered by the unsubstantiated belief that melanoma cells are radioresistant. An abundance of literature has now demonstrated that locoregional relapse of melanoma is common after surgery alone when certain clinicopathologic features are present. Features associated with a high risk of primary tumor recurrence include desmoplastic subtype, positive microscopic margins, recurrent disease, and thick primary lesions with ulceration or statellitosis. Features associated with a high risk of nodal relapse include extracapsular extension, involvement of four or more lymph nodes, lymph nodes measuring at least 3 cm, cervical lymph node location, and recurrent disease. Numerous studies support the efficacy of adjuvant irradiation in these clinical situations. Although data in the literature remain sparse, evidence also indicates that elective irradiation is effective in eradicating subclinical nodal metastases after removal of the primary melanoma. Consequently, there may be an opportunity to integrate radiotherapy into the multimodality treatment of patients at high risk of subclinical nodal disease, particularly those with an involved sentinel lymph node. Such patients are known to have a low rate of additional lymph node involvement, and thus in this group, a short course of radiotherapy may be an adequate substitute for regional lymph node dissection. This will be the topic of future research.

Humans↗
PubMed2005

Chemoradiation for ductal pancreatic carcinoma: principles of combining chemotherapy with radiation, definition of target volume and radiation dose.

Review of the role of chemoradiotherapy in the treatment of locally advanced pancreatic cancer with a specific focus on the technical feasibility and the integration of chemoradiotherapy into multimodal treatment concepts. Combined chemoradiotherapy of pancreatic cancer is a safe treatment with an acceptable profile of side effects when applied with modern planning and radiation techniques as well as considering tissue tolerance. Conventionally fractionated radiation regimens with total doses of 45-50 Gy and small-volume boost radiation with 5.4 Gy have found the greatest acceptance. Locoregional lymphatic drainage should be included in the planning of target volumes because the risk of tumor involvement and local or loco-regional recurrence is high. Up to now, 5-fluorouracil has been considered the "standard" agent for concurrent chemoradiotherapy. The role of gemcitabine given concurrently with radiation has not yet been defined, since high local efficacy may also be accompanied by enhanced toxicities. In addition, no dose or administration form has been determined to be "standard" up to now. The focus of presently ongoing research is to define an effective and feasible regimen of concurrent chemoradiotherapy. While preliminary results indicate promising results using gemcitabine-based chemoradiotherapy, reliable data derived from mature phase III trials are greatly needed. Intensity-modulated radiotherapy has been developed to improve target-specific radiation and to reduce organ toxicity. Its clinical relevance still needs to be defined.

Antimetabolites, Antineoplastic↗