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Pre-surgical staging and surveillance after curative treatment for pancreatic ductal adenocarcinoma (PDAC): Survey of practice in the United Kingdom (UK)
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 computerised 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 performed (if any) and duration. Further guidance is required to establish standardised practice.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosures
A. Lamarca: Advisory / Consultancy: Advisory and consultancy honoraria from EISAI, Nutricia Ipsen, QED, Roche, Servier, Boston Scientific, Albireo Pharma, AstraZeneca, Boehringer Ingelheim and GENFIT. ; Speaker Bureau / Expert testimony: Speaker honoraria from Merck, Pfizer, Ipsen, Incyte, AAA, QED, Servier, Astra Zeneca and EISAI. ; Research grant / Funding (self): Member of the Knowledge Network and NETConnect Initiatives funded by Ipsen. Roche; Travel / Accommodation / Expenses: Travel and educational support from Ipsen, Pfizer, Bayer, AAA, SirtEx, Novartis, Mylan and Delcath. D. Palmer: Advisory / Consultancy: Servier, Celgene. J. Valle: Advisory / Consultancy: AstraZeneca. All other authors have declared no conflicts of interest.
