711P - Does FDG-PET-CT based re-staging influences initial management decision and clinical outcome in patients with locally advanced pancreatic carcinoma...

Date 30 September 2012
Event ESMO Congress 2012
Session Poster presentation II
Topics Pancreatic Cancer
Imaging, Diagnosis and Staging
Presenter Cem Parlak
Authors C. Parlak1, O.C. Guler2, U. Selek3, O. Ozyilkan4, E. Topkan2
  • 1Baskent University Adana Medical Faculty, 01120 - Adana/TR
  • 2Department Of Radiation Oncology, Baskent University Adana Medical Faculty, 01120 - Adana/TR
  • 3Department Of Radiation Oncology, American Hospital- University of Texas M.D. Anderson Radiation Oncology Center, 34120 - Istanbul/TR
  • 4Medical Oncology, Baskent University Faculty of MedicineAdana Uygulama Ve Arastirma Mer., TR-01120 - Adana/TR

Abstract

Background

Impact of re-staging with 18F-fluoro-deoxy-glucose positron emission tomography (PET-CT) on management decision and clinical outcomes in patients with locally-advanced pancreatic carcinoma (LAPC) initially planned to undergo concurrent chemoradiotherapy (CRT) was investigated.

Materials and methods

Seventy-one consecutive patients with conventionally staged LAPC were re-staged with PET-CT before CRT. Patients were categorized into non-metastatic (M0) and metastatic (M1) groups according to PET-CT findings. M0patients underwent 50.4 Gy (1.8 Gy/fr) of radiotherapy and concurrent 5-FU followed by maintenance gemcitabine.

Results

Re-staging PET-CT revealed conventional imaging occult distant metastases in 19 cases (26.8%). Of 52 patients with LAPC confirmed by PET-CT, additional regional lymph nodes were identified to be involved in 7 (13.4%), mandating enlargement of radiation field. Taken together, PET-CT results changed or revised initial management decision in 37.2% patients. Median follow-up times for the whole, M0 and M1 cohorts were 11.3, 14.5, and 6.2 months, respectively. Median overall, locoregional progression-free, and progression-free survivals for the same cohorts were 11.4, 7.8, and 5.1 months,16.1, 9.9, and 7.4 months, and 6.2, 3.4, and 2.5 months, respectively. Survival differences between M0 and M1 cohorts were statistically significant (p < 0.05, for each).

Conclusions

Current results demonstrated the importance of PET-CT based re-staging of LAPC in selection of suitable patients for CRT, prevention of useless aggressive treatment in metastatic cases, and precise estimation of survival outcomes of LAPC patients following radical CRT.

Disclosure

All authors have declared no conflicts of interest.