Pre-surgical staging and surveillance after curative treatment for pancreatic ductal adenocarcinoma (PDAC): Survey of practice in the United Kingdom (UK)

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.