Pre-surgical staging and surveillance after curative treatment for pancreatic ductal adenocarcinoma (PDAC): Survey of practice in the United Kingdom (UK)
Lamarca, Angela Roberts, K. Graham, J. Kocher, H. Chang, D. Ghaneh, P. Jamieson, N. Propper, D. Bridgewater, J. Ajithkumar, T.
Lamarca, Angela
Roberts, K.
Graham, J.
Kocher, H.
Chang, D.
Ghaneh, P.
Jamieson, N.
Propper, D.
Bridgewater, J.
Ajithkumar, T.
Citations
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Abstract
Background: Differences in pre-operative staging and surveillance after curative
treatment for PDAC hamper interpretation of outcome data.
Methods: This survey aimed to assess current practice and identify areas for
improvement; it was circulated to members of the United Kingdom National Cancer
Research Institute (NCRI) pancreatic cancer subgroup between 14/4-4/5 2021.
Results: A total of 23 responses were collected (medical oncologist 52.2%, surgeon
26.1%, radiation oncologist 13.0%, other 8.7%); the majority were Consultants
(91.3%) working in tertiary care institutions (86.9%) who attended PDAC tumour
boards (90.9%). For staging prior to curative surgery, all responders used compu-
terised tomography (CT) (100%), and 61.1% used routine 18FDG positron emission
tomography (PET) (16.7% used it only in specific occasions); only 38.9% used routine
liver magnetic resonance imaging (MRI). In terms of surveillance following curative
treatment, practice varied widely: 64.7% of responders considered imaging, tumour
marker and clinical follow-up as routine practice after curative treatment, while 29.4%
undertook follow-up without imaging; 5.9% did not offer any form of surveillance.
Frequency of follow-up was either 6-monthly (60.0%), 3-monthly (26.7%), or variable
(13.3%) and lasted for 5 years (73.3%), 2 years (6.7%), 3 years (6.7%), or other (13.3%). Surveillance imaging performed was by CT scanning in all cases (46.7% as
routine, 6.7% if not done previously, 6.7% on occasions); none of the responders used
FDG-PET (0%) or liver-MRI (0%). During surveillance, tumour marker (CA 19.9) was
tested 6-monthly (66.7%), 3-monthly (40.0%), or annually (26.7%). Most (62.5%)
stated that routine follow-up after curative treatment should be performed, but that
clear evidence determining the impact on patient’s outcome was required.
Conclusions: Pre-surgical staging with 18FDG-PET is not yet routine. Surveillance after
curative treatment varies between institutions, both in terms of investigations per-
formed (if any) and duration. Further guidance is required to establish standardised practice.
Description
Date
2022
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Lamarca A, Roberts K, Graham J, Kocher H, Chang D, Ghaneh P, et al. Pre-surgical staging and surveillance after curative treatment for pancreatic ductal adenocarcinoma (PDAC): Survey of practice in the United Kingdom (UK). Annals of Oncology. 2022 Jun;33:S278-S9. PubMed PMID: WOS:000823826500098.