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Stereotactic body hypofractionated radiotherapy for inoperable pancreatic cancer, with or without metastases
Electronic Poster Abstracts administration of perioperative blood transfusions negatively impacts overall survival. We aimed to assess the impact of preoperative anaemia on overall survival in patients undergoing potentially curative resection for pancreatic ductal adenocarcinoma (PDAC). Methods: In a single-centre cohort of 156consecutive patients who underwent pancreaticoduodenectomy for PDAC with curative intent, between 2009 and 2013, the prognostic significance of preoperative haemoglobin was investigated along with perioperative blood transfusion. Anaemia was defined according to the WHO classification (haemoglobin <130 g/L in men and <120 g/L in women) and assessed within one week before surgical intervention. Multivariate Cox-regression analysis was used to establish independent prognostic factors. Results: For the 89patients (57%) with preoperative anaemia, there was a significantly reduced overall median survival (16.0 months; 95% confidence interval, 12.0e 19.1) compared to 67 non-anaemic patients (43%) (29.0 months; 95% confidence interval, 19.7e38.3; P < 0.0001, log-rank test). However, preoperative anaemia was not related to 90day survival (P > 0.5). In a Cox-regression analysis, preoperative anaemia was a predictor of overall survival (P < 0.05) independent of established pathological prognostic factors, including tumour stage, size and lymph node status, and administration of perioperative blood transfusion. Conclusion: Preoperative anaemia is commonly present in resectable PDAC and negatively influences overall survival independent not only of established pathological factors but also of perioperative blood transfusion. These data have implications for the optimization of patients in the perioperative period in addition to longer-term risk stratification.
EP02C-054 STEREOTACTIC BODY HYPOFRACTIONATED RADIOTHERAPY FOR INOPERABLE PANCREATIC CANCER, WITH OR WITHOUT METASTASES A. J. Oar1, W. Wong1, C. Chen1, K. S. Haghighi1,2, S. Thompson1 and D. Goldstein1 1 Prince of Wales Hospital, and 2HPB & Transplant Surgery, University of New South Wales, Australia Introduction: Curative resection of pancreatic cancer may not always be possible due to patient and disease factors. Biological dose escalation through stereotactic body radiotherapy (SBRT) is emerging as a treatment option to achieve long term control for those patients who are not surgical candidates. Methods: We present our case series of patients who underwent SBRT to pancreatic primary lesions. Patients were identified retrospectively through electronic medical records. All patients were deemed unresectable on basis of imaging or laparoscopic findings and/or had progressed on chemotherapy.
HPB 2016, 18 (S1), e1ee384
e359
Results: From September 2013 to December 2014, twelve patients were treated with SBRT. Patients were aged between 50 and 84 years. Median CA-19.9 at time of diagnosis was 383 (range 50e15,179). Primary tumour size ranged from 2.4 to 7 cm at time of SBRT. All patients had locally advanced disease with five having synchronous metastases at time of SBRT. The median dose was 48 Gy (Range 35e 48 Gy) in 8 fractions (range 5e8 fractions). Median followup was 70 days. Four patients achieved local control, six failed locally and for two patients local control was unknown. Median progression free survival was 32 days (range 0e133 days) and median overall survival was 84 days (range 7e449 days) from completion of radiotherapy. Conclusion: From the limited data available we do not recommend SBRT for patients with inoperable pancreatic cancer who had progressed on palliative chemotherapy. These patients have very short survival despite SBRT. However, further information on symptom control, toxicity and quality of life in patients receiving SBRT is needed.
EP02C-055 FROZEN SECTION OF THE PANCREATIC NECK MARGIN IN PANCREATICODUODENECTOMY FOR PANCREATIC ADENOCARCINOMA IS IMPORTANT OR NOT FOR SURVIVAL M. Kerem1, K. Dikmen2, H. Bostanci2, M. Sare2 and O. Ekinci3 1 General Surgery, Gazi University, School of Medicine, 2 General Surgery, and 3Department of Pathology, Gazi University, Turkey The aim of the study was to assess the overall survival (OS) benefit of taking additional neck margin at the time of pancreatico-duodenectomy (PD) in patients with pancreatic adenocarcinoma (PAC). Patients and methods: 437 patients underwent PD for pancreatic adenocarcinoma between 2008 and 2015 at Gazi University Hospital, a tertiary referral center in Ankara, Turkey, were analyzed. FS was taken out 237 of these patients and they were included to study. FS assessment of the neck and common bile duct (CBD) margin was requested at the surgeons’ discretion after resection and prior to reconstruction. Hereby FS assessment was negative in 209 (88 %), and positive in 28 (12 %) patients. Re-resections were carried out to all patients had R1 for getting of R0 resection margin. While OS was 14.1 months on patients (n = 16) who to be achieved R0 margin after reresection to result of positive FS, otherwise, its 11.5 months on patients who had not been achieved R0 (p < 0.05). Patients (n = 17, %7), who had final R1 pancreatic neck margin, have 12.5 months OS, there was no significantly difference between first of two groups. On the other hand, on its 22.3 months in patients had final R0 and whom had statistically significantly higher survival than the others (p < 0.05). Results: FS assessment for achieving resection margin during PD, allows us to be perform re-resection and consequently improve survival, but final R0 resection margin is most important for survival in patients have PAC.
EP02C-054 STEREOTACTIC BODY HYPOFRACTIONATED RADIOTHERAPY FOR INOPERABLE PANCREATIC CANCER, WITH OR WITHOUT METASTASES A. J. Oar1, W. Wong1, C. Chen1, K. S. Haghighi1,2, S. Thompson1 and D. Goldstein1 1 Prince of Wales Hospital, and 2HPB & Transplant Surgery, University of New South Wales, Australia Introduction: Curative resection of pancreatic cancer may not always be possible due to patient and disease factors. Biological dose escalation through stereotactic body radiotherapy (SBRT) is emerging as a treatment option to achieve long term control for those patients who are not surgical candidates. Methods: We present our case series of patients who underwent SBRT to pancreatic primary lesions. Patients were identified retrospectively through electronic medical records. All patients were deemed unresectable on basis of imaging or laparoscopic findings and/or had progressed on chemotherapy.
HPB 2016, 18 (S1), e1ee384
e359
Results: From September 2013 to December 2014, twelve patients were treated with SBRT. Patients were aged between 50 and 84 years. Median CA-19.9 at time of diagnosis was 383 (range 50e15,179). Primary tumour size ranged from 2.4 to 7 cm at time of SBRT. All patients had locally advanced disease with five having synchronous metastases at time of SBRT. The median dose was 48 Gy (Range 35e 48 Gy) in 8 fractions (range 5e8 fractions). Median followup was 70 days. Four patients achieved local control, six failed locally and for two patients local control was unknown. Median progression free survival was 32 days (range 0e133 days) and median overall survival was 84 days (range 7e449 days) from completion of radiotherapy. Conclusion: From the limited data available we do not recommend SBRT for patients with inoperable pancreatic cancer who had progressed on palliative chemotherapy. These patients have very short survival despite SBRT. However, further information on symptom control, toxicity and quality of life in patients receiving SBRT is needed.
EP02C-055 FROZEN SECTION OF THE PANCREATIC NECK MARGIN IN PANCREATICODUODENECTOMY FOR PANCREATIC ADENOCARCINOMA IS IMPORTANT OR NOT FOR SURVIVAL M. Kerem1, K. Dikmen2, H. Bostanci2, M. Sare2 and O. Ekinci3 1 General Surgery, Gazi University, School of Medicine, 2 General Surgery, and 3Department of Pathology, Gazi University, Turkey The aim of the study was to assess the overall survival (OS) benefit of taking additional neck margin at the time of pancreatico-duodenectomy (PD) in patients with pancreatic adenocarcinoma (PAC). Patients and methods: 437 patients underwent PD for pancreatic adenocarcinoma between 2008 and 2015 at Gazi University Hospital, a tertiary referral center in Ankara, Turkey, were analyzed. FS was taken out 237 of these patients and they were included to study. FS assessment of the neck and common bile duct (CBD) margin was requested at the surgeons’ discretion after resection and prior to reconstruction. Hereby FS assessment was negative in 209 (88 %), and positive in 28 (12 %) patients. Re-resections were carried out to all patients had R1 for getting of R0 resection margin. While OS was 14.1 months on patients (n = 16) who to be achieved R0 margin after reresection to result of positive FS, otherwise, its 11.5 months on patients who had not been achieved R0 (p < 0.05). Patients (n = 17, %7), who had final R1 pancreatic neck margin, have 12.5 months OS, there was no significantly difference between first of two groups. On the other hand, on its 22.3 months in patients had final R0 and whom had statistically significantly higher survival than the others (p < 0.05). Results: FS assessment for achieving resection margin during PD, allows us to be perform re-resection and consequently improve survival, but final R0 resection margin is most important for survival in patients have PAC.