Evaluation of Treatment Outcome and Acute Toxicity in Patients Undergoing Adjuvant Therapy in Ductal Carcinoma Pancreas: A Prospective Observational Study

Ductal adenocarcinoma of the pancreas is one of the commonly diagnosed cancers and is a leading cause of cancer mortality in the population. The prognosis of patients even after undergoing a complete resection is generally poor, with a median survival of 13–20 months and a 3-year survival of 30%. Therefore, adjuvant therapies including adjuvant chemoradiation and adjuvant chemotherapy are given in an effort to improve survival. In the authors’ centre, all patients undergoing resection are given adjuvant chemoradiation followed by adjuvant chemotherapy. This study was conducted to evaluate the acute toxicity and treatment outcome (patterns of failure, overall and disease-free survival) of patients undergoing adjuvant therapy in resected carcinoma pancreas. Adjuvant chemoradiation was well tolerated by most patients with resected carcinoma pancreas and all patients completed chemoradiation. Adjuvant chemotherapy was associated with high haematological toxicity, similar to previously published literature. However, treatment interruptions were higher and only 77% patients completed adjuvant chemotherapy. The adjuvant gemcitabine, given on Days 1, 8, and 15, for a 4-weekly schedule was poorly tolerated by the authors’ patient population and there were only fewer interruptions in patients who were switched to the 3-weekly schedule. Inclusion of a greater number of patients and longer follow-up of this study is required to clearly assess the patterns of failure and survival outcomes.

Capecitabine induced Steven–Johnson syndrome: A rare case report

Introduction Steven–Johnson syndrome (SJS) is a serious mucocutaneous reaction, characterized by fever, influenza-like symptoms and followed by dermatological manifestations. Capecitabine is an oral fluoropyrimidine carbamate analogue of 5-Fluorouracil (5-FU). It is widely accepted for many malignancies because of its better safety profile and tolerability. Hand-foot syndrome is the common dermatological toxicity associated with Capecitabine and SJS is the rarest manifestation. Case presentation: We report a case of Capecitabine induced SJS in a 70 years old male patient with metastatic carcinoma pancreas. He was treated with intravenous Gemcitabine and Carboplatin initially and then switched to oral therapy with Capecitabine 1000 mg twice daily. After ten days of treatment with Capecitabine, he developed vomiting, mucositis, hyperpigmentation, itching and scrotal mucosal peeling. The clinical status of the patient was suggestive of SJS, which was confirmed by dermatologic consultation. According to Naranjo, WHO-UMC, and Hartwig’s scale, the reaction was found to be probable and severe. Pharmacological as well as supportive care measures were provided, but the condition progressively worsened, and the patient was deceased. Conclusion Capecitabine can cause severe hypersensitivity reactions which can be dangerous and life-threatening. Health care providers must be aware of all rare adverse effects, including SJS. Clinicians and clinical pharmacists should educate and counsel the patients regarding the likely adverse effects of their chemo drugs because the early identification of toxic symptoms is crucial to reduce further complications to the patient.

Factors Affecting the Survival Trend in Carcinoma Pancreas- A Hospital Based Study

Carcinoma pancreas is the fourth common cause of the death from cancer in man and women in USA. The condition becomes increasingly common over the age of 70 years. The total number of carcinoma pancreas patients available for the study within the stipulated time was 22. Among them 68.18% patients were male and 31.82% patients were female. 0% belonged to age group ≤ 20, 9.09% belonged to age group 21-30, 18.18% belonged to age group 31-40, 18.18% belonged to age group 41-50, 13.64% belonged to age group 51-60, 27.27% belonged to age group 61-70 and 13.64% patients were >70 years of age. Mean age was 54.87 years ± 17.65 SD. In our study, 46.7% survived ≤3 months, 33.3% 4-6 months, 13.3% 7-9 months, 06.7% 10-12 months, 0% 13-24 months and >24 months. Among 15 expired patients, 02 got curative treatment and rest of 13 got palliative treatment. Those who got curative treatment, 50% survived 7-9 months and 50% 10-12 months. Those who got palliative treatment 53.8% survived ≤3 months, 38.5% 4-6 months and 7.7% 7-9 months. Overall median survival was 04 months, for curative treatment was 09 months and for palliative treatment was 03 months. TAJ 2020; 33(1): 11-16

Role of computed tomography in the determination of resectability of carcinoma pancreas

Background: Pancreatic cancer is one of the most aggressive neoplastic processes. Inspite of progress in the diagnosis and treatment of malignancies, the resectability and survival rates for pancreatic cancer are very poor. This study aims to determine the accuracy of computerised tomography in assessing the resectability of carcinoma pancreas.Methods: 66 patients with carcinoma pancreas, who were judged fit for surgery were studied. All cases had undergone preoperative contrast enhanced triphasic computed tomography (CT) for assessing the resectability. Radiological data was compared with per operative findings for assessments regarding vascular invasion and resectability.Results: Of the 66 cases, resectability reported by CT was 59 (89.4%). The rest of 7 (10.6%) cases were reported as unresectable. Per operatively vascular involvement was found in 14 (21.2%) cases and with no vascular invasion in 52 (78.8%) cases. All the unresectable cases reported in CT (7 cases) turned out to be unresectable. Out of 59 cases reported as resectable, 43 (65.2%) cases under went Whipples procedure, while rest of the 23 (34.8%) cases underwent palliative procedures. Out of these 23 cases, 14 (21.2%) cases were unresectable due to vascular involvement.Conclusions: The study has shown that CT does assess the operability in carcinoma pancreas, assessing mainly unresectability though less effective in assessing resectability. The role of endoscopic ultrasound and laparoscopic ultrasound in aiding CT in further assessment of resectable and borderline resectable cases are to be considered for further research.