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19-08-2023 | Systemic Therapy | Peritoneal Surface Malignancy

Oncologic Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Highly Selected Patients with Metastatic Pancreatic Ductal Adenocarcinoma

Authors: Hallbera Gudmundsdottir, MD, Jennifer A. Yonkus, MD, Cornelius A. Thiels, DO, Susanne G. Warner, MD, Sean P. Cleary, MD, Michael L. Kendrick, MD, Mark J. Truty, MD, Travis E. Grotz, MD

Published in: Annals of Surgical Oncology | Issue 12/2023

Abstract

Background

Peritoneal metastases (PM) from pancreatic ductal adenocarcinoma (PDAC) are currently treated with palliative systemic chemotherapy alone, with unsatisfactory results. Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) may provide an oncologic benefit for highly selected patients.

Patients and Methods

Patients with PDAC and isolated PM who completed ≥ 6 months of systemic chemotherapy with objective response between 2017 and 2022 were retrospectively reviewed. All patients met the inclusion/exclusion criteria as per our previously published PDAC CRS/HIPEC protocol. Patients who underwent CRS/HIPEC were compared with matched patients who underwent systemic therapy alone. Overall survival (OS) from diagnosis of PM and progression-free survival (PFS) from CRS/HIPEC was evaluated.

Results

In total, 61 patients met the inclusion criteria: 38 underwent systemic therapy alone and 23 CRS/HIPEC. There were no differences in baseline prognostic factors, including age, sex, tumor size, tumor location, anatomic resectability, or serum cancer antigen (CA) 19-9 (p > 0.05). Median OS from PM diagnosis in patients who underwent systemic therapy alone was 19 months with 1, 2, and 3 year OS of 81%, 31%, and 8%, respectively. In contrast, median OS from PM diagnosis in patients who underwent CRS/HIPEC was 41 months with improved 1, 2, and 3 year OS of 91%, 66%, and 59%, respectively (p = 0.002). In the 21 patients who achieved complete cytoreduction (CC-0), no adjuvant therapy was administered and the median PFS was 17 months.

Conclusions

CRS/HIPEC in highly selected patients with PDAC and PM results in promising oncologic outcomes that are unlikely to be achieved with systemic chemotherapy alone. Further investigation is warranted and ongoing (NCT04858009).

Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022;72:7–33.CrossRefPubMed

Rahib L, Smith BD, Aizenberg R, Rosenzweig AB, Fleshman JM, Matrisian LM. Projecting cancer incidence and deaths to 2030: the unexpected burden of thyroid, liver, and pancreas cancers in the United States. Cancer Res. 2014;74:2913–21.CrossRefPubMed

Saad AM, Turk T, Al-Husseini MJ, Abdel-Rahman O. Trends in pancreatic adenocarcinoma incidence and mortality in the United States in the last four decades; a SEER-based study. BMC Cancer. 2018;18:688.CrossRefPubMedPubMedCentral

Rijken A, Bakkers C, van Erning FN, et al. Incidence, treatment, and survival of synchronous peritoneal metastases in pancreatic cancer: update of a nationwide cohort. Pancreas. 2021;50:827–33.CrossRefPubMed

Takeda T, Sasaki T, Mie T, et al. Improved prognosis of pancreatic cancer patients with peritoneal metastasis. Pancreatology. 2021;21:903–11.CrossRefPubMed

Takahara N, Isayama H, Nakai Y, et al. Pancreatic cancer with malignant ascites: clinical features and outcomes. Pancreas. 2015;44:380–5.CrossRefPubMed

Jimenez RE, Warshaw AL, Fernandez-Del Castillo C. Laparoscopy and peritoneal cytology in the staging of pancreatic cancer. J Hepatobiliary Pancreat Surg. 2000;7:15–20.CrossRefPubMed

Gudmundsdottir H, Yonkus JA, Alva-Ruiz R, et al. Yield of staging laparoscopy for pancreatic cancer in the modern era: analysis of over 1000 consecutive patients. J Am Coll Surg. 2023. https://doi.org/10.1097/XCS.0000000000000704. (Online ahead of print).CrossRefPubMedPubMedCentral

Tempero MA, Malafa MP, Al-Hawary M, et al. Pancreatic adenocarcinoma, version 2.2021, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw. 2021;19:439–57.CrossRef

10.

Chicago Consensus Working Group. The Chicago consensus on peritoneal surface malignancies: management of appendiceal neoplasms. Ann Surg Oncol. 2020;27:1753–60.CrossRef

11.

Chicago Consensus Working Group. The Chicago consensus on peritoneal surface malignancies: management of gastric metastases. Ann Surg Oncol. 2020;27:1768–73.CrossRef

12.

Chicago Consensus Working Group. The Chicago consensus on peritoneal surface malignancies: management of colorectal metastases. Ann Surg Oncol. 2020;27:1761–7.CrossRef

13.

Chicago Consensus Working Group. The Chicago consensus on peritoneal surface malignancies: management of ovarian neoplasms. Cancer. 2020;126:2553–60.CrossRef

14.

Grotz TE, Yonkus JA, Thiels CA, et al. Cytoreduction with hyperthermic intraperitoneal chemoperfusion for pancreatic cancer with low-volume peritoneal metastasis: results from a prospective pilot study. Ann Surg Oncol. 2022;30:395–403.CrossRefPubMed

15.

Sugarbaker PH. Management of peritoneal-surface malignancy: the surgeon’s role. Langenbecks Arch Surg. 1999;384:576–87.CrossRefPubMed

16.

Subramaniam S, Aalberg JJ, Soriano RP, Divino CM. New 5-factor modified frailty index using American College of Surgeons NSQIP data. J Am Coll Surg. 2018;226:173–81.CrossRefPubMed

17.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMedPubMedCentral

18.

Tentes AA, Pallas N, Karamveri C, Kyziridis D, Hristakis C. Cytoreduction and HIPEC for peritoneal carcinomatosis of pancreatic cancer. J BUON. 2018;23:482–7.PubMed

19.

Beal EW, Ahmed A, Grotz T, et al. Trends in the indications for and short-term outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Am J Surg. 2020;219:478–83.CrossRefPubMed

20.

Leimkühler M, Hentzen JEKR, Hemmer PHJ, et al. Systematic review of factors affecting quality of life after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2020;27:3973–83.CrossRefPubMedPubMedCentral

Title: Oncologic Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Highly Selected Patients with Metastatic Pancreatic Ductal Adenocarcinoma
Authors: Hallbera Gudmundsdottir, MD
Jennifer A. Yonkus, MD
Cornelius A. Thiels, DO
Susanne G. Warner, MD
Sean P. Cleary, MD
Michael L. Kendrick, MD
Mark J. Truty, MD
Travis E. Grotz, MD
Publication date: 19-08-2023
Publisher: Springer International Publishing
Keywords: Systemic Therapy
Laparoscopy
Metastasis
Cytostatic Therapy
Published in: Annals of Surgical Oncology / Issue 12/2023
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-023-14138-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Oncologic Outcomes of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Highly Selected Patients with Metastatic Pancreatic Ductal Adenocarcinoma

Abstract

Background

Patients and Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Patients and Methods

Results

Conclusions

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