Surgical outcomes and prognosis of pancreatic and periampullary cancer treated with neoadjuvant therapy in Turku University Central Hospital
Lehtinen, Marie (2024-04-25)
Surgical outcomes and prognosis of pancreatic and periampullary cancer treated with neoadjuvant therapy in Turku University Central Hospital
(25.04.2024)
Julkaisu on tekijänoikeussäännösten alainen. Teosta voi lukea ja tulostaa henkilökohtaista käyttöä varten. Käyttö kaupallisiin tarkoituksiin on kielletty.
avoin
Julkaisun pysyvä osoite on:
https://urn.fi/URN:NBN:fi-fe2024043024585
https://urn.fi/URN:NBN:fi-fe2024043024585
Tiivistelmä
Pancreatic ductal adenocarcinoma (PDAC) is the most common malignancy of the pancreas. Pancreatic cancer is the third leading cause of cancer related deaths in Finland. Its only curative treatment is surgery. The prognosis of the disease is poor, with an overall 5-year survival rate of only 10 %, and post-operative survival rate of around 20-30 %. Median overall survival after surgery is 16 to 23 months. Periampullary carcinoma is commonly used term to define diverse range of neoplasms originating from the head of the pancreas, the distal common bile duct, and the duodenum. Its prognosis is similar to that of PDAC.
Now the treatment protocol is to proceed directly to surgery if the PDAC is localised or only partially attached to the porta-vein. The median survival rate of patients undergoing surgery can be prolonged by neoadjuvant therapy (NAT), i.e. chemotherapy, radiation therapy or a combination of both. Recently, there have been promising results on the efficacy of NAT for locally advanced and borderline resectable PDACs. NAT is thought to allow a larger patient population to receive an effective dose of chemotherapy in addition to surgical resection, due to chemotherapy often being better tolerated before surgery than after.
The aim of this thesis is to illustrate the effects of NAT on overall survival and disease-free survival of pancreatic and periampullary cancer patients who underwent surgery at the Turku University Central Hospital between the years of 2019-2023.
The most used NAT regimens were Gemcitabine plus Nab-Paclitaxel (60%) and modified FOLFIRINOX (35%). The median duration of NAT was 21 weeks. Fifteen out of 20 NAT patients proceeded to pancreatoduodenectomy. Pathological analysis confirmed eight PDACs and seven periampullary cancers. Seventeen out of 20 patients received adjuvant therapy postoperatively. Eight out of 15 patients had disease recurrence postoperatively (median time of recurrence 15,9 months), and four of them were pathological analysis confirmed PDAC. The median postoperative prognosis free survival (PFS) was 9,3 months (range 2,5-13,7 months), and for only PDAC patients, it was 12,2 months (range 10,7-13,7 months). After follow-up (median follow-up time of 29,0 months, range 8,2-61,5 months) eleven patients were alive. Ten of these eleven patients underwent pancreatoduodenectomy.
Now the treatment protocol is to proceed directly to surgery if the PDAC is localised or only partially attached to the porta-vein. The median survival rate of patients undergoing surgery can be prolonged by neoadjuvant therapy (NAT), i.e. chemotherapy, radiation therapy or a combination of both. Recently, there have been promising results on the efficacy of NAT for locally advanced and borderline resectable PDACs. NAT is thought to allow a larger patient population to receive an effective dose of chemotherapy in addition to surgical resection, due to chemotherapy often being better tolerated before surgery than after.
The aim of this thesis is to illustrate the effects of NAT on overall survival and disease-free survival of pancreatic and periampullary cancer patients who underwent surgery at the Turku University Central Hospital between the years of 2019-2023.
The most used NAT regimens were Gemcitabine plus Nab-Paclitaxel (60%) and modified FOLFIRINOX (35%). The median duration of NAT was 21 weeks. Fifteen out of 20 NAT patients proceeded to pancreatoduodenectomy. Pathological analysis confirmed eight PDACs and seven periampullary cancers. Seventeen out of 20 patients received adjuvant therapy postoperatively. Eight out of 15 patients had disease recurrence postoperatively (median time of recurrence 15,9 months), and four of them were pathological analysis confirmed PDAC. The median postoperative prognosis free survival (PFS) was 9,3 months (range 2,5-13,7 months), and for only PDAC patients, it was 12,2 months (range 10,7-13,7 months). After follow-up (median follow-up time of 29,0 months, range 8,2-61,5 months) eleven patients were alive. Ten of these eleven patients underwent pancreatoduodenectomy.