A development and overview of the use of chemotherapy, and the role of radiotherapy and surgery, in patients with newly diagnosed pancreatic tumor and cancer in the current 5-year center practice
Abstract
Chemotherapy (CHT), surgery and radiotherapy (RT) are essential modalities in the treatment of pancreatic malignancies. Their use may be influenced by a number of factors.
Patients and methods: Retrospective analysis of CHT, surgery and RT indications and CHT results in patients reported with pancreatic tumor in Pilsen in 2012-2016. Results: 348 patients with median age 68 (19-89) years with newly diagnosed pancreatic tumor, respectively, with histology/cytology verified carcinoma in 74.5% cases, with v.s. carcinoma without verification in 21% and with other malignancy not further analyzed here in 4,5% (mostly NET).
In patients with generalized malignancy (n = 195), exploratory laparotomy was performed in 23% to get tissue samples or verify stagings, CHT was performed in 29%, RT of tumor in 1 and RT of metastases in 3 patients. In patients with local or regional nodal affection (n = 137) laparotomy was done in 59%, R0 resection in 34 (42%) of 81 operated, CHT or radio-CHT after resections was in 61% operated patients.
The indication of CHT in cytology/histology verified generalized cancers and with excluding patients refusing CHT was proposed in 2012 to 16%, in 2014 to 49% and in 2016 to 84% of patients. In the case of a local or regional nodal involvement the CHT was proposed to 40%, 55% and 86% of patients.
Median OS in generalized tumor patients receiving CHT (n = 137) vs. not-receiving CHT (n = 56) was 2 vs. 8 months (p = 0.0001), and in the local or regional nodal involvement patients receiving CHT (n = 74) vs. not-receiving CHT (n = 62) was 5 vs. 16 months (p = 0.0001). Conclusion: There has been an increase in the CHT and histology/cytology verifications indications.
With still very limited results in pancreatic cancer treatment, a careful assessment of each patient's indication, respecting patient's desire, is always required. Even in the case of advanced disease, chemotherapy can bring benefit, albeit limited.