SAN FRANCISCO—Does PET/CT as initial staging work-up for pancreatic cancer prevent futile laparotomy by detecting occult metastatic disease in patients with resectable/borderline disease? One institution’s experience suggests the answer is “yes,” according to results presented at the 2014 Gastrointestinal Cancers Symposium.
“In pancreatic cancer, early detection and complete surgical resection with negative margins offers the only cure for the disease,” noted Gopi Kesaria Prithviraj, MD, of the Louis Stokes Cleveland VA Medical Center, Cleveland, OH, and colleagues. “PET/CT helped improve detection of occult metastases, ultimately sparing these patients a potentially unnecessary operation.”
The study sought to determine if PET/CT prevents futile laparotomy by detecting occult metastatic disease in patients with resectable/borderline pancreatic cancer.
“We looked at our institutional PET/CT database incorporating National Oncologic PET Registry with diagnosis of resectable or borderline pancreatic cancer from 2005-2012,” Dr. Prithviraj noted. Evaluated were clinical, radiographic, and pathologic follow-up that included age, gender, evidence of metastatic disease, and initial CA19-9 levels. “The impact of PET/CT on patient management was estimated by calculating the percentage of patients whose treatment plan was altered due to PET/CT,” she added.
The investigators identified 287 patients with early-stage pancreatic cancer who received initial CT plus endoscopic ultrasonography as initial staging work-up. Of these, 62% were considered resectable and 38%, resectable/borderline. Median time from CT to PET/CT was 5 days, at which point the PET/CT findings changed management in 34 patients (11.9%): 33 were upstaged to stage IV and one patient, to stage III. In 21 patients, metastatic lesions were confirmed on biopsy.
They found that the proportion in change in treatment plan was significantly higher in patients who were resectable/borderline (odds ratio, 2.94; 95% CI: 1.38-6.26; P = 0.005).
In 204 patients taken to surgery, 17.7% (n = 36) had metastatic disease detected intraoperatively.
“The role of PET/CT scan should be validated in prospective study,” she concluded.
The 2014 Gastrointestinal Cancers Symposium is sponsored by the American Gastroenterological Association (AGA) Institute, the American Society of Clinical Oncology (ASCO), the American Society for Radiation Oncology (ASTRO), and the Society of Surgical Oncology (SSO).