GI Symptoms in Pancreatic Cancer

Chang, Victor Tsu-Shih; Sandifer, Christopher; Zhong, Fengming

doi:10.1016/j.clcc.2022.12.002

Cited by 4 publications

(3 citation statements)

References 188 publications

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“…Additionally, we noticed that previously operated patients tended to experience more short-term (although lowgrade) toxicities, such as fatigue and diarrhea. While diarrhea could be sporadic or a result of pancreatic endocrine insufficiency, in their review, Chang et al (27) show that fatigue is more common in previously operated patients in comparison to inoperable patients (73% and 53%, respectively). Thus, it is possible that these findings are essentially disease-related symptoms as opposed to treatment-related toxicities.…”

Section: Discussionmentioning

confidence: 99%

Pancreatic cancer outcome—local treatment with radiation using MRI-LINAC

Almog,

Pfeffer,

Zalmanov

et al. 2023

Front. Oncol.

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IntroductionStereotactic MR-guided on-table adaptive radiotherapy (SMART) allows the precise delivery of high-dose radiation to tumors in great proximity to radiation-sensitive organs. The aim of this study is to evaluate the toxicity and clinical outcome in locally advanced or recurrent pancreatic tumors, with or without prior irradiation, treated with SMART.MethodsPatients were treated for pancreatic cancer (PC) using SMART technology to a prescribed dose of 50 Gy (BED10, 100 Gy) in five fractions, with daily on-table adaptation of treatment plan. Endpoints were acute and late toxicities, local control, local disease-free period, and overall survival.ResultsA total of 54 PC patients were treated between August 2019 and September 2022, with a median follow-up of 8.9 months from SMART. The median age was 70.4 (45.2–86.9) years. A total of 40 patients had upfront inoperable PC (55% were locally advanced and 45% metastatic), and 14 had local recurrence following prior pancreatectomy (six patients also had prior adjuvant RT). Of the patients, 87% received at least one chemotherapy regimen (Oxaliplatin based, 72.2%), and 25.9% received ≥2 regimens. Except from lower CA 19-9 serum level at the time of diagnosis and 6 weeks prior to SMART in previously operated patients, there were no significant differences in baseline parameters between prior pancreatectomy and the inoperable group. On-table adaptive replanning was performed for 100% of the fractions. No patient reported grade ≥2 acute GI toxicity. All previously irradiated patients reported only low-grade toxicities during RT. A total of 48 patients (88.9%) were available for evaluation. Complete local control was achieved in 21.7% (10 patients) for a median of 9 months (2.8–28.8); three had later local progression. Eight patients had regional or marginal recurrence. Six- and 12-month OS were 75.0% and 52.1%, respectively. Apart from mild diarrhea 1–3 months after SMART and general fatigue, there were no significant differences in toxicity and outcomes between post-pancreatectomy and inoperable groups.ConclusionSMART allows safe delivery of an ablative dose of radiotherapy, with minimal treatment-related toxicity, even in previously resected or irradiated patients. In this real-world cohort, local control with complete response was achieved by 20% of the patients. Further studies are needed to evaluate long-term outcome and late toxicity.

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Section: Discussionmentioning

confidence: 99%

Pancreatic cancer outcome—local treatment with radiation using MRI-LINAC

Almog,

Pfeffer,

Zalmanov

et al. 2023

Front. Oncol.

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“…Pancreatic body tumors frequently infiltrate nearby vascular systems, such as the portal vein, hepatic, and superior mesenteric veins, and are therefore more likely to manifest with back discomfort. Because they have fewer anatomical neighbors, pancreatic tail tumors frequently have room to develop unchecked and are typically advanced when discovered (Figure 1 )[ 18 , 19 ].…”

Section: Clinical Presentationmentioning

confidence: 99%

Systemic treatment for advanced pancreatic cancer

Leowattana,

Leowattana

2023

World J Gastrointest Oncol

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Minimally invasive surgery is increasingly indicated in the management of malignant disease. Although oesophagectomy is a difficult operation, with a long learning curve, there is actually a shift towards the laparoscopic/thoracoscopic/ robotic approach, due to the advantages of visualization, surgeon comfort (robotic surgery) and the possibility of the whole team to see the operation as well as and the operating surgeon. Although currently there are still many controversial topics, about the surgical treatment of patients with gastro-oesophageal junction (GOJ) adenocarcinoma, such as the type of open or minimally invasive surgical approach, the type of oesophago-gastric resection, the type of lymph node dissection and others, the minimally invasive approach has proven to be a way to reduce postoperative complications of resection, especially by decreasing pulmonary complications. The implementation of new technologies allowed the widening of the range of indications for this type of surgical approach. The short-term and long-term results, as well as the benefits for the patient - reduced surgical trauma, quick and easy recovery - offer this type of surgical treatment the premises for future development. This article reviews the updates and perspectives on the minimally invasive approach for GOJ adenocarcinoma.

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“…In‐hospital post‐operative refractory diarrhoea poses a considerable challenge for nursing (Scholten et al., 2019), with a previous study reporting that 39% of patients experience it after pancreatic surgery (Kuroki et al., 2022). Factors such as changes in bowel anatomy and function, pancreatic exocrine insufficiency and peripancreatic nerve dissection can result in diarrhoea (Burch, 2021; Chang et al., 2023). Moreover, chemotherapeutic agents might accelerate cell division in the epithelium of the gastrointestinal tract, leading to chemotherapy‐induced diarrhoea (Andreyev et al., 2014).…”

Section: Introductionmentioning

confidence: 99%

Risk factors of post‐operative diarrhoea in patients with pancreatic cancer after neoadjuvant chemotherapy: A retrospective cohort study

Zhu,

Wang,

et al. 2024

Journal of Clinical Nursing

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BackgroundPost‐operative diarrhoea is a common adverse event after pancreatic surgery. While the risk factors for this condition have been identified, the increasing trend of administering chemotherapy before surgery might change these factors. This study aimed to identify the risk factors of post‐operative diarrhoea in patients with pancreatic ductal adenocarcinoma (PDAC) who underwent neoadjuvant chemotherapy.DesignA retrospective cohort study.MethodsPatients who underwent neoadjuvant chemotherapy and pancreatectomy because of PDAC between 2021 and 2023 were included. The preoperative characteristics of, operative details of and post‐operative outcomes in patients with and without post‐operative diarrhoea were collected and compared. The independent risk factors of post‐operative diarrhoea were identified using logistic regression analysis. STROBE checklist was used.ResultsPost‐operative diarrhoea occurred in 65 out of 145 (44.8%) patients during hospitalization. Elevated white blood cell count, advanced tumour stage, and late abdominal drain removal were independent risk factors for post‐operative diarrhoea (p < .001, p = .006 and p = .009, respectively).ConclusionsSome perioperative factors influence post‐operative diarrhoea in patients who undergo neoadjuvant chemotherapy. More attention should be paid to patients at a higher risk of post‐operative diarrhoea, with an emphasis on high‐quality management for these patients.

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GI Symptoms in Pancreatic Cancer

Cited by 4 publications

References 188 publications

Pancreatic cancer outcome—local treatment with radiation using MRI-LINAC

Pancreatic cancer outcome—local treatment with radiation using MRI-LINAC

Systemic treatment for advanced pancreatic cancer

Risk factors of post‐operative diarrhoea in patients with pancreatic cancer after neoadjuvant chemotherapy: A retrospective cohort study

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