Trends in Receipt and Timing of Multimodality Therapy in Early-Stage Pancreatic Cancer

Abstract

INTRODUCTION Pancreatic cancer is considered a systemic disease at presentation. Therefore, multimodality therapy with surgical resection and chemotherapy is the standard of care for locoregional disease. We described treatment patterns and time trends with regards to age and treatment center in the receipt of multimodality therapy. METHODS We used the National Cancer Data Base to identify patients ≥18 years old with stage I and II pancreatic adenocarcinoma. Treatment was defined as no treatment, resection only, chemotherapy only, or multimodality therapy, which consisted of both chemotherapy (neoadjuvant or adjuvant) and resection. Trends in the receipt and type of treatment were compared. RESULTS Of 39,441 patients, 22.8% of patients received no treatment, 18.5% received chemotherapy only, 23.0% underwent surgical resection alone, and 35.8% of patients received multimodality therapy. Receipt of multimodality therapy increased from 31.3% in 2004 to 37.9% in 2011 (p<0.0001). Patients >55 years were less likely to receive multimodality therapy (56–64 years: OR 0.83, 95% CI 0.78–0.89; 65–75: OR 0.60, 95% CI 0.55–0.65; ≥76: OR 0.17, 95% CI 0.16–0.19 compared to patients 18–55). Compared to community hospitals, patients treated at an NCI-designated center were more likely to receive multimodality therapy (OR 1.62, 95% CI 1.46–1.81) and, if they received multimodality therapy, delivery of chemotherapy in the neoadjuvant compared to adjuvant setting (OR 2.82, 95% CI 2.00–3.98). CONCLUSION Despite increased use of multimodality therapy, it remains underutilized in all patients and especially in older patients. Receipt of multimodality therapy and neoadjuvant therapy are highly dependent on treatment at NCI-designated cancer centers.

Palliative Care for Pancreatic and Periampullary Cancer

“…[4, 8–11] The highest median survival rates are 22–26 months in patients who are candidates to undergo surgical resection, with the addition of neoadjuvant or adjuvant therapy further improving survival. [12–15] More recent studies evaluating the impact of neoadjuvant therapy on highly selected patients with resectable disease have yielded median survival times as long as 44 months in patients with R0, node negative disease. [16–18]…”

Neoadjuvant therapy affects margins and margins affect all: perioperative and survival outcomes in resected pancreatic adenocarcinoma

“…9 While the use of neoadjuvant therapy is recommended in patients with borderline resectable disease and increasingly applied for resectable pancreatic adenocarcinoma, there remains a lack of conclusive results from randomized controlled trials. 10,11 Over the past decades, pancreatic surgeons have been pushing the boundaries of surgical resection in an effort to attain negative margins. Nonetheless, data from high-volume academic centers show R0-resection rates of only 70%-76% after upfront surgery.…”

“…17 As neoadjuvant therapy becomes a more widespread treatment strategy for pancreatic adenocarcinoma, a better understanding of its potential significance for surgical margin clearance is pivotal. 11 Therefore, the aim of this study was to assess the impact of neoadjuvant therapy on resection margin status, and the prognostic impact of incomplete margin clearance after neoadjuvant therapy in resected stage I-III pancreatic adenocarcinoma patients using national cancer registry data.…”

“…Therefore, complete margin clearance should continue to be the central aim of pancreatic cancer surgery, even in light of the current increase in the use and efficacy of neoadjuvant therapy. 11 New innovative surgical techniques, methods of intraoperative margin assessment, preoperative imaging for patient selection, and improved neoadjuvant chemotherapy are needed to further decrease the rates of incomplete tumor clearance.…”

Melatonin potentiates &ldquo;inside-out&rdquo; nano-thermotherapy in human breast cancer cells: a potential cancer target multimodality treatment based on melatonin-loaded nanocomposite particles

“…A rational combination of the aforementioned protocols (for instance, chemotherapy combined with radiotherapy, or biotherapy combined with hyperthermia, etc) has been investigated for the enhancements or synergistic effects that may significantly improve the therapeutic effect and reduce the side effect in the meanwhile. 22,23 Recently, nanoparticles (NPs) for therapeutic carriers have aroused continuous interest as the particles in nanoscale normally possess high surface area and enable sophisticated functionalization with different therapeutic agents, thus to achieve the multifunctions within one nanoplatform. 24 In particular, such precisely engineered multifunctional NPs can simultaneously target cancer cells, enable the location of therapeutic agents and consequently release drugs triggered by an external stimulus.…”