Source: DGNews  |  Posted 2 years ago

By Ed Susman

HOLLYWOOD, Florida -- March 14, 2009 -- Laparoscopy can be considered for the diagnosis and excision of malignant masses in patients with pancreatic cancer, according to research presented here at the National Comprehensive Cancer Network (NCCN) 14th Annual Conference: Clinical Practice Guidelines & Quality Cancer Care.

A panel of clinicians inserted laparoscopy into the minimally revised pancreatic cancer treatment algorithm of NCCN, noted Margaret A. Tempero, MD, University of California San Francisco - Helen Diller Family Comprehensive Cancer Center, San Francisco, California, speaking here on March 12 on behalf of a 21-member consortium of tertiary cancer-specialty institutions.

The guidelines give doctors the option of considering laparoscopy “prior to resection in high-risk patients,” Dr. Tempero explained. “Laparoscopy could be used after neoadjuvant therapy, especially in borderline resectable disease, prior to laparotomy.”

The guidelines define high-risk patients as those individuals who are suffering from disabling symptoms, who have very high levels of the pancreatic cancer tumour marker CA 19-9, and those patients who have equivocal computer-assisted tomography (CT) findings.

Dr. Tempero noted that the new pancreatic cancer guidelines clarify the recommendations for diagnostic imaging in patients with pancreatic cancer. The panel recommends that imaging should include a pancreatic CT scan performed according to a defined pancreas protocol, such as triphasic cross-sectional imaging and thin slices, and that positron emission tomography (PET) scans may be considered useful if CT results are equivocal.

The panel feels that decisions about disease management and resectability should involve close multidisciplinary cooperation, Dr. Tempero emphasised.

A revised set of criteria that define borderline resectable disease constitutes another important addition to the NCCN Guidelines, based on the consensus of the panel members.

Dr. Tempero provided additional clarification regarding the importance of upfront systemic therapy prior to administration of chemoradiation therapy, stating that, “Radiation is important for a subset of patients with local disease only, but systemic chemotherapy should be given first.”

Upfront systemic therapy provides for disease control and allows selection of those patients most likely to benefit from subsequent chemoradiation.

Dr. Tempero recommended fluorinated pyrimidine-based therapy with oxaliplatin as a second-line option for patients with advanced disease and good performance status, based on results of clinical trials that show a significant survival benefit for patients receiving this combination of therapies.

“Single-agent gemcitabine or selected gemcitabine combinations followed by a fluorinated pyrimidine plus oxaliplatin is the standard of care,” Dr. Tempero stated, summarising the recommendations for patients with metastatic disease.

[Presentation title: NCCN Pancreatic Adenocarcinoma Guidelines Update Session.]