Surgery of pancreas tumors in children and adolescents: a single institution experience

Abstract

Introduction: Neoadjuvant chemotherapy for pancreatic cancer is increasingly utilized. However, no guidelines exist for optimal adjuvant therapy after pancreatectomy with a partial or poor response to neoadjuvant therapy. This qualitative study seeks to describe our institution's patterns of adjuvant chemotherapy regimen selection after neoadjuvant therapy. Methods: All patients at a single institution from January 2013 through June 2019 receiving neoadjuvant chemotherapy followed by pancreatectomy for pancreatic cancer were reviewed. Patients enrolled in trials limiting chemotherapy or with missing medical oncology notes were excluded. Chemotherapy regimen, the College of American Pathologists pathologic tumor response, and medical oncology plans were recorded. Results: Fifty-three patients were reviewed and 41 patients met inclusion criteria. Neoadjuvant chemotherapy regimen are shown. Twenty-nine (70.7%) underwent pancreatoduodenectomy, 10 (24.3%) distal pancreatectomy, and 2 (4.8%) total pancreatectomy. Pathologic review of treatment effect demonstrated that 3 (7.3%) patients had complete pathologic response (cPR), 3 (7.3%) had near cPR, 16 (39%) had partial response, and 14 (34.1%) had poor/no response to neoadjuvant chemotherapy. Treatment effect was missing in 5 (12.2%) patients. Thirty-three (80.5%) patients received adjuvant chemotherapy, with 15 (45.5%) switching regimen adjuvantly. Pathology results guided therapy in 53.6% of patients and tumor response specifically guided therapy in 11 (30.5%) patients.Conclusions: Despite 73.1% of patients having partial or poor response to neoadjuvant chemotherapy, only 45.5% switched chemotherapy adjuvantly. Medical oncologists rarely considered treatment effect when choosing adjuvant therapy. Future trials should be designed to determine the optimal adjuvant regimen guided by pathologic treatment effect of neoadjuvant therapy.