PD-4 Adjuvant chemotherapy and chemoradiation therapy after R0 resection for pancreatic ductal adenocarcinoma

Abstract Background Adjuvant therapy is a standard treatment for resected pancreatic cancer, and a variety of regimens are now used in clinical practice. We aimed to compare the efficacy of adjuvant chemotherapy and chemoradiation therapy in R0 resected pancreatic cancer. Methods Patients who underwent complete microscopic resection and subsequent adjuvant treatment for pancreatic ductal adenocarcinoma (N=277) at Seoul National University Hospital from September 2005 to December 2017 were retrospectively included. Patients were divided into two groups; systemic chemotherapy (SCT) and combined chemotherapy plus chemoradiation therapy (SCT-CRT). The primary outcomes were differences in overall survival (OS) between the two groups. Survival differences were compared using the log-rank test. Patients receiving either SCT or SCT-CRT were matched 1:1 on the propensity scores. Results Patients received SCT (n=78) and SCT-CRT (n=199). There was no significant difference in completion rate of planned regimens between the two groups (73.1% and 76.9%, respectively; P=0.534). In the propensity score-matched cohort, there was no significant difference in the median OS between the SCT and SCT-CRT groups (35.1 [95% CI, 26.9-82.1] months and 34.8 [95% CI, 26.2-69.2] months, respectively; P=0.993). The median RFS was 15.4 (95% CI, 12.1-31.1) months in the SCT group and 17.0 (95% CI, 13.2-37.3) months in SCT-CRT group (P=0.789). There were no significant differences in the incidence of loco-regional and distant recurrence between the two groups (P=0.833 and P=0.491, respectively). Adverse events greater than or equal to moderate grade occurred more frequently in the SCT-CRT group than in the SCT group (P=0.042). Conclusion Considering its efficacy and safety, adjuvant SCT alone might be a reasonable choice over SCT-CRT in R0 resected pancreatic cancer.

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A High C-Reactive Protein Level on Postoperative Day 7 is Associated with Poor Survival of Patients with Pancreatic Ductal Adenocarcinoma after Resection

The American Surgeon ◽

10.1177/00031348211023406 ◽

2021 ◽

pp. 000313482110234

Author(s):

Masaji Tani ◽

Hiroya Iida ◽

Hiromitsu Maehira ◽

Haruki Mori ◽

Toru Miyake ◽

...

Keyword(s):

Adjuvant Chemotherapy ◽

Pancreatic Ductal Adenocarcinoma ◽

Median Overall Survival ◽

Cox Regression ◽

Ductal Adenocarcinoma ◽

C Reactive Protein ◽

Reactive Protein ◽

Retrospective View ◽

Node Metastases ◽

Common Malignancy

Introduction Pancreatic ductal adenocarcinoma (PDAC) is a common malignancy. While inflammation-related biomarkers influence patient survival after resection, it has not been known whether postoperative inflammations affect the survival of PDAC patients or not. Methods It was investigated whether the universal biomarkers on postoperative day (POD) 7 affect the survival of PDAC patients in the retrospective view, and univariate and multivariate analyses were performed via the Cox regression method. Results Overall, 108 consecutive patients underwent resection; 98 (90.7%) had T3 disease and 73 (67.6%) had lymph node metastases. Thirty-four patients (31.5%) experienced postoperative complications. Compared with preoperative values, the white blood cell count and C-reactive protein (CRP) level on POD 7 were significantly elevated ( P < .001 for both); conversely, the lymphocyte count was significantly reduced ( P < .001). Among 108 patients, 72 received adjuvant chemotherapy. The median overall survival was 21.0 months; the 5-year survival rate was 22.3%. On multivariate analysis, receiving adjuvant chemotherapy and low CRP levels on POD 7 (<7.6 mg/dL) were prognosticators of better survival. However, the CD classification was not a prognosticator of survival after resection. Conclusions Adjuvant chemotherapy and postoperative low CRP levels on POD 7 were prognosticators of better survival of PDAC patients after resection. Surgeons should be aware of managing postoperative infections because a high postoperative CRP level is related with unfavorable survival.

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Prognostic Nomogram for Patients With Pancreatic Ductal Adenocarcinoma of Pancreatic Head After Pancreaticoduodenectomy

Clinical Medicine Insights Oncology ◽

10.1177/11795549211024149 ◽

2021 ◽

Vol 15 ◽

pp. 117955492110241

Author(s):

Hongkai Zhuang ◽

Zixuan Zhou ◽

Zuyi Ma ◽

Shanzhou Huang ◽

Yuanfeng Gong ◽

...

Keyword(s):

Regression Analysis ◽

Pancreatic Ductal Adenocarcinoma ◽

Perineural Invasion ◽

Cox Regression ◽

Area Under The Curve ◽

Pancreatic Head ◽

Ductal Adenocarcinoma ◽

R0 Resection ◽

Cox Regression Analysis ◽

Ajcc Stage

Background: The prognosis of patients with pancreatic ductal adenocarcinoma (PDAC) of pancreatic head remains poor, even after potentially curative R0 resection. The aim of this study was to develop an accurate model to predict patients’ prognosis for PDAC of pancreatic head following pancreaticoduodenectomy. Methods: We retrospectively reviewed 112 patients with PDAC of pancreatic head after pancreaticoduodenectomy in Guangdong Provincial People’s Hospital between 2014 and 2018. Results: Five prognostic factors were identified using univariate Cox regression analysis, including age, histologic grade, American Joint Committee on Cancer (AJCC) Stage 8th, total bilirubin (TBIL), CA19-9. Using all subset analysis and multivariate Cox regression analysis, we developed a nomogram consisted of age, AJCC Stage 8th, perineural invasion, TBIL, and CA19-9, which had higher C-indexes for OS (0.73) and RFS (0.69) compared with AJCC Stage 8th alone (OS: 0.66; RFS: 0.67). The area under the curve (AUC) values of the receiver operating characteristic (ROC) curve for the nomogram for OS and RFS were significantly higher than other single parameter, which are AJCC Stage 8th, age, perineural invasion, TBIL, and CA19-9. Importantly, our nomogram displayed higher C-index for OS than previous reported models, indicating a better predictive value of our model. Conclusions: A simple and practical nomogram for patient prognosis in PDAC of pancreatic head following pancreaticoduodenectomy was established, which shows satisfactory predictive efficacy and deserves further evaluation in the future.

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PancREatic Cancer and Individualised Supervised Exercise (PRECISE): a feasibility trial protocol for patients with resectable pancreatic ductal adenocarcinoma

AMRC Open Research ◽

10.12688/amrcopenres.12907.1 ◽

2020 ◽

Vol 2 ◽

pp. 22

Author(s):

Dominic O'Connor ◽

Malcolm Brown ◽

Roy Bowdery ◽

Martin Eatock ◽

Claire Hulme ◽

...

Keyword(s):

Pancreatic Cancer ◽

Adjuvant Chemotherapy ◽

Pancreatic Ductal Adenocarcinoma ◽

Exercise Intervention ◽

Feasibility Trial ◽

Ductal Adenocarcinoma ◽

Moderate Intensity ◽

Moderate Intensity Exercise ◽

Supervised Exercise ◽

Health And Social Care

Background: Patients with resectable pancreatic ductal adenocarcinoma (PDAC), undergoing adjuvant chemotherapy can experience an array of complications including fatigue, pain and the loss of physical function. Accumulating evidence from largely early stage breast cancer studies supports exercise as an adjunct therapy to help mitigate treatment complications. However, there is a lack of evidence of its feasibility in pancreatic cancer. The purpose of this study is to explore the initial feasibility of delivering a supervised, individualized, and progressive concurrent exercise intervention to individuals with resectable PDAC who are undergoing adjuvant therapy. Methodology: Ten patients with resectable PDAC undergoing adjuvant chemotherapy will be recruited. Clinical care teams will screen patients against inclusion criteria to determine eligibility. All enrolled participants will complete a 16-week, supervised, tailored, moderate intensity exercise intervention consisting of aerobic and muscle strengthening activities. The primary outcome will be feasibility of delivering a supervised exercise intervention. Secondary outcomes will include measures of physical fitness, fatigue, and quality of life. Outcomes will be measured at baseline (T1), 16 weeks (T2) and 3 months (T3). The feasibility, acceptability and potential utility of the supervised exercise intervention will be explored qualitatively through semi-structured interviews with key stakeholders (e.g. active participants, eligible participants that declined participation and the research staff including exercise physiologists and recruiting clinicians). The use of health and social care services, medications and personal expenses incurred during the trial will also be used to determine cost-effectiveness of this intervention and a potential further RCT in PDAC. Discussion: The overall aim of this study is to determine the utility of a supervised, tailored, moderate intensity exercise intervention in PDAC patients undergoing adjuvant chemotherapy. This feasibility study will help inform the design of future randomised controlled trials to determine the efficacy of the exercise intervention in PDAC.

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Complete Radiologic Response of Metastatic Pancreatic Ductal Adenocarcinoma to Microwave Ablation Combined with Second-Line Palliative Chemotherapy

Case Reports in Gastrointestinal Medicine ◽

10.1155/2020/4138215 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Hakon Blomstrand ◽

Karin Adolfsson ◽

Per Sandström ◽

Bergthor Björnsson

Keyword(s):

Adjuvant Chemotherapy ◽

Pancreatic Ductal Adenocarcinoma ◽

Palliative Chemotherapy ◽

Lung Metastases ◽

Performance Status ◽

Progression Free Survival ◽

Disease Recurrence ◽

Ductal Adenocarcinoma ◽

Second Line ◽

First Line

Pancreatic ductal adenocarcinoma (PDAC) has a bleak prognosis, especially for the majority of patients diagnosed with metastatic disease. The primary option for palliative treatment is chemotherapy, and responses beyond first-line treatment are rare and typically short. Here, we report a case of a 63-year-old woman with PDAC in the head of the pancreas who was initially successfully treated by pancreaticoduodenectomy followed by adjuvant chemotherapy with gemcitabine. However, disease recurrence with liver and para-aortic lymph node metastases was detected only two months after the completion of adjuvant chemotherapy. First-line palliative chemotherapy with gemcitabine-nab/paclitaxel was commenced. The results were discouraging, with disease progression (liver and lung metastases) detected at the first evaluation; the progression-free survival was just two months (64 days). Surprisingly, the response to second-line palliative chemotherapy with 5-fluorouracil-oxaliplatin was excellent; in combination with the ablation of a liver metastasis, this treatment regimen resulted in a complete radiological response and an 11-month treatment-free interval with a sustained good performance status.

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