Multidisciplinary Management of Pancreatic Adenocarcinoma: Clinical Practice Guideline AUNA
DOI:
https://doi.org/10.35434/rcmhnaaa.2022.15Supl.%201.1518Keywords:
Pancreatic cancer, Clinical practice guideline, Diagnosis, Bile duct obstruction, ChemotherapyAbstract
Introduction: This article provides recommendations for the Multidisciplinary Management of Pancreatic Adenocarcinoma in the RED AUNA. Methods: A systematic search of clinical practice guidelines (CPG) similar to topics of interest was developed, it was assessed with the AGREE II instrument, a list of questions was elaborated under the PICO structure, a de novo search was carried out prioritizing reviews systematic with or without meta-analysis, followed by primary studies, the elaboration of the evidence tables and the evaluation of the global quality for the outcomes of the clinical questions was carried out following the GRADE methodology. Results: 5 PICO questions corresponding to initial management and systemic management were formulated with 18 recommendations regarding the most effective method for pathological diagnosis, biliary drainage and the most effective and safe systemic treatment in the neoadjuvant, adjuvant and metastatic setting. Conclusions: This article summarizes the methodology and evidence-based recommendations of the CPG for the multidisciplinary management of pancreatic adenocarcinoma of the AUNA Clinic Network.
Downloads
Metrics
References
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-49. DOI: 10.3322/caac.21660
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. DOI: 10.3322/caac.21492
Saad AM, Turk T, Al-Husseini MJ, Abdel-Rahman O. Trends in pancreatic adenocarcinoma incidence and mortality in the United States in the last four decades; a SEER-based study. BMC Cancer. 2018;18(1):688. DOI: 10.1186/s12885-018-4610-4
Sharma C. Advances in diagnosis, treatment and palliation of pancreatic carcinoma: 1990-2010. World J Gastroenterol. 2011;17(7):867. doi:10.3748/wjg.v17.i7.867
Malvezzi M, Bertuccio P, Levi F, La Vecchia C, Negri E. European cancer mortality predictions for the year 2014. Ann Oncol. 2014;25(8):1650-6. DOI: 10.1093/annonc/mdu138
Canto MI, Harinck F, Hruban RH, Offerhaus GJ, Poley JW, Kamel I, et al. International Cancer of the Pancreas Screening (CAPS) Consortium summit on the management of patients with increased risk for familial pancreatic cancer. Gut. 2013;62(3):339-47. DOI: 10.1136/gutjnl-2012-303108
National Institute for Health and Care Excellence. Pancreatic cancer in adults: diagnosis and management [Internet]. NICE; 2018 [Cited 2022 Mar 21]. Available from: https://bit.ly/3j65taN
Khorana AA, McKernin SE, Berlin J, Hong TS, Maitra A, Moravek C, et al. Potentially Curable Pancreatic Adenocarcinoma: ASCO Clinical Practice Guideline Update. J Clin Oncol. 2019;37(23):2082-8. June 10. DOI: 10.1200/JCO.19.00946.
Sohal DPS, Kennedy EB, Cinar P, Conroy T, Copur MS, Crane CH, et al. Metastatic Pancreatic Cancer: ASCO Guideline Update. J Clin Oncol. 2020;38(27):3217-30. DOI: 10.1200/JCO.20.01364.
Tempero MA, Malafa MP, Al-Hawary M, Behrman SW, Benson AB, Cardin DB, et al. Pancreatic Adenocarcinoma, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2021;19(4):439–57. doi: 10.6004/jnccn.2021.0017.
Ducreux M, Cuhna ASa, Caramella C, Hollebecque A, Burtin P, Goéré D, et al. Cancer of the pancreas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015;26:v56-68. DOI: 10.1093/annonc/mdv295
American Society for Radiation Oncology. Radiation Therapy for Pancreatic Cancer: ASTRO Clinical Practice Guideline. 2019; 9(5):322-332. doi: 10.1016/j.prro.2019.06.016.
Dumonceau JM, Deprez P, Jenssen C, Iglesias-Garcia J, Larghi A, Vanbiervliet G, et al. Indications, results, and clinical impact of endoscopic ultrasound (EUS)-guided sampling in gastroenterology: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated January 2017. Endoscopy. 2017;49(07):695-714. doi: 10.1055/s-0043-109021.
Dumonceau JM, Tringali A, Papanikolaou I, Blero D, Mangiavillano B, Schmidt A, et al. Endoscopic biliary stenting: indications, choice of stents, and results: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline – Updated October 2017. Endoscopy. 2018;50(09):910-30. doi: 10.1055/a-0659-9864
Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J, et al. GRADE guidelines: 1. Introduction—GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64(4):383-94. doi: 10.1016/j.jclinepi.2010.04.026
Banafea O, Mghanga FP, Zhao J, Zhao R, Zhu L. Endoscopic ultrasonography with fine-needle aspiration for histological diagnosis of solid pancreatic masses: a meta-analysis of diagnostic accuracy studies. BMC Gastroenterol. 2016;16(1):108. doi: 10.1186/s12876-016-0519-z
Yang Y, Li L, Qu C, Liang S, Zeng B, Luo Z. Endoscopic ultrasound-guided fine needle core biopsy for the diagnosis of pancreatic malignant lesions: a systematic review and Meta-Analysis. Sci Rep. 2016;6(1):22978. doi: 10.1038/srep22978
Huang Y, Shi J, Chen YY, Li K. Ultrasound-Guided Percutaneous Core Needle Biopsy for the Diagnosis of Pancreatic Disease. Ultrasound Med Biol. 2018;44(6):1145-54. doi: 10.1016/j.ultrasmedbio.2018.02.016.
Hébert-Magee S, Bae S, Varadarajulu S, Ramesh J, Frost AR, Eloubeidi MA, et al. The presence of a cytopathologist increases the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration cytology for pancreatic adenocarcinoma: a meta-analysis. Cytopathology. 2013;24(3):159-71. doi: 10.1111/cyt.12071.
Harewood GC, Wiersema MJ. A cost analysis of endoscopic ultrasound in the evaluation of pancreatic head adenocarcinoma. Am J Gastroenterol. 2001;96(9):2651-6. doi: 10.1111/j.1572-0241.2001.04116.x.
Wang L, Lin N, Xin F, Ke Q, Zeng Y, Liu J. A systematic review of the comparison of the incidence of seeding metastasis between endoscopic biliary drainage and percutaneous transhepatic biliary drainage for resectable malignant biliary obstruction. World J Surg Oncol. 2019;17(1):116. doi: 10.1186/s12957-019-1656-y
Inamdar S, Slattery E, Bhalla R, Sejpal DV, Trindade AJ. Comparison of Adverse Events for Endoscopic vs Percutaneous Biliary Drainage in the Treatment of Malignant Biliary Tract Obstruction in an Inpatient National Cohort. JAMA Oncol. 2016;2(1):112. doi: 10.1001/jamaoncol.2015.3670.
Liu P, Lin H, Chen Y, Wu YS, Tang M, Liu C. Comparison of Metal and Plastic Stents for Preoperative Biliary Drainage in Resectable and Borderline Resectable Periampullary Cancer: A Meta-Analysis and System Review. J Laparoendosc Adv Surg Tech. 2018;28(9):1074-82. doi: 10.1089/lap.2018.0029.
Almadi MA, Barkun A, Martel M. Plastic vs. Self-Expandable Metal Stents for Palliation in Malignant Biliary Obstruction: A Series of Meta-Analyses. Am J Gastroenterol. 2017;112(2):260-73. doi: 10.1038/ajg.2016.512.
Arkadopoulos N, Kyriazi MA, Papanikolaou IS, Vasiliou P, Theodoraki K, Lappas C, et al. Preoperative biliary drainage of severely jaundiced patients increases morbidity of pancreaticoduodenectomy: results of a case-control study. World J Surg. 2014;38(11):2967-72. doi: 10.1007/s00268-014-2669-x.
Ye M, Zhang Q, Chen Y, Fu Q, Li X, Bai X, et al. Neoadjuvant chemotherapy for primary resectable pancreatic cancer: a systematic review and meta-analysis. HPB. 2020;22(6):821-32. doi: 10.1016/j.hpb.2020.01.001.
Motoi F, Kosuge T, Ueno H, Yamaue H, Satoi S, Sho M, et al. Randomized phase II/III trial of neoadjuvant chemotherapy with gemcitabine and S-1 versus upfront surgery for resectable pancreatic cancer (Prep-02/JSAP05). Jpn J Clin Oncol. 2019;49(2):190-4. doi: 10.1093/jjco/hyy190.
Janssen QP, Buettner S, Suker M, Beumer BR, Addeo P, Bachellier P, et al. Neoadjuvant FOLFIRINOX in Patients With Borderline Resectable Pancreatic Cancer: A Systematic Review and Patient-Level Meta-Analysis. JNCI J Natl Cancer Inst. 2019;111(8):782-94. doi: 10.1093/jnci/djz073.
Versteijne E, Suker M, Groothuis K, Akkermans-Vogelaar JM, Besselink MG, Bonsing BA, et al. Preoperative Chemoradiotherapy Versus Immediate Surgery for Resectable and Borderline Resectable Pancreatic Cancer: Results of the Dutch Randomized Phase III PREOPANC Trial. J Clin Oncol. 2020;38(16):1763-73. doi: 10.1200/JCO.19.02274.
Chang JS, Chiu YF, Yu JC, Chen LT, Ch’ang HJ. The Role of Consolidation Chemoradiotherapy in Locally Advanced Pancreatic Cancer Receiving Chemotherapy: An Updated Systematic Review and Meta-Analysis. Cancer Res Treat. 2018;50(2):562-74. doi: 10.4143/crt.2017.105.
Tzeng CWD, Fleming JB, Lee JE, Xiao L, Pisters PWT, Vauthey JN, et al. Defined Clinical Classifications Are Associated with Outcome of Patients with Anatomically Resectable Pancreatic Adenocarcinoma Treated with Neoadjuvant Therapy. Ann Surg Oncol. 2012;19(6):2045-53. doi: 10.1245/s10434-011-2211-4.
Hellan M, Sun CL, Artinyan A, Mojica-Manosa P, Bhatia S, Ellenhorn JD, et al. The Impact of Lymph Node Number on Survival in Patients With Lymph Node-Negative Pancreatic Cancer. Pancreas. 2008;37(1):19-24. doi: 10.1097/MPA.0b013e31816074c9.
Slidell MB, Chang DC, Cameron JL, Wolfgang C, Herman JM, Schulick RD, et al. Impact of Total Lymph Node Count and Lymph Node Ratio on Staging and Survival after Pancreatectomy for Pancreatic Adenocarcinoma: A Large, Population-Based Analysis. Ann Surg Oncol. 2008;15(1):165-74. doi: 10.1245/s10434-007-9587-1.
Tamm EP, Silverman PM, Charnsangavej C, Evans DB. Diagnosis, Staging, and Surveillance of Pancreatic Cancer. Am J Roentgenol. 2003;180(5):1311-23. doi: 10.2214/ajr.180.5.1801311.
Nawaz H, Fan CY, Kloke J, Khalid A, McGrath K, Landsittel D, et al. Performance Characteristics of Endoscopic Ultrasound in the Staging of Pancreatic Cancer: A Meta-Analysis. JOP J Pancreas. 2013;Vol 14:484-497 Paginazione. doi: 10.6092/1590-8577/1512.
Soriano A, Castells A, Ayuso C, Ayuso JR, de Caralt MT, Ginès MÀ, et al. Preoperative Staging and Tumor Resectability Assessment of Pancreatic Cancer: Prospective Study Comparing Endoscopic Ultrasonography, Helical Computed Tomography, Magnetic Resonance Imaging, and Angiography. Am J Gastroenterol. 2004;99(3):492-501. doi: 10.1111/j.1572-0241.2004.04087.x.
Mitsuhashi T, Ghafari S, Chang CY, Gu M. Endoscopic ultrasound-guided fine needle aspiration of the pancreas: cytomorphological evaluation with emphasis on adequacy assessment, diagnostic criteria and contamination from the gastrointestinal tract1. Cytopathology. 2006;17(1):34-41. doi: 10.1111/j.1365-2303.2006.00277.x.
Shin J, Shin S, Lee JH, Song KB, Hwang DW, Kim HJ, et al. Lymph node size and its association with nodal metastasis in ductal adenocarcinoma of the pancreas. J Pathol Transl Med. 2020;54(5):387-95. DOI: 10.4132/jptm.2020.06.23
Isaji S, Mizuno S, Windsor JA, Bassi C, Fernández-del Castillo C, Hackert T, et al. International consensus on definition and criteria of borderline resectable pancreatic ductal adenocarcinoma 2017. Pancreatology. 2018;18(1):2-11. DOI: 10.1016/j.pan.2017.11.011
Galvano A, Castiglia M, Rizzo S, Silvestris N, Brunetti O, Vaccaro G, et al. Moving the Target on the Optimal Adjuvant Strategy for Resected Pancreatic Cancers: A Systematic Review with Meta-Analysis. Cancers. 2020;12(3):534. DOI: 10.3390/cancers12030534
Chen H, He R, Shi X, Zhou M, Zhao C, Zhang H, et al. Meta-analysis on resected pancreatic cancer: a comparison between adjuvant treatments and gemcitabine alone. BMC Cancer. 2018;18(1):1034. DOI: 10.1186/s12885-018-4948-7
Hsu CC, Herman JM, Corsini MM, Winter JM, Callister MD, Haddock MG, et al. Adjuvant chemoradiation for pancreatic adenocarcinoma: the Johns Hopkins Hospital-Mayo Clinic collaborative study. Ann Surg Oncol. 2010;17(4):981-90. DOI 10.1245/s10434-009-0743-7
Ren F, Xu YC, Wang HX, Tang L, Ma Y. Adjuvant chemotherapy, with or without postoperative radiotherapy, for resectable advanced pancreatic adenocarcinoma: Continue or stop? Pancreatology. 2012;12(2):162-9. DOI: 10.1016/j.pan.2012.02.002
Gong J, Tuli R, Shinde A, Hendifar AE. Meta-analyses of treatment standards for pancreatic cancer. Mol Clin Oncol. 2016;4(3):315-25. DOI: 10.3892/mco.2015.716
Liu G, Li G, Zhao H. Efficacy and Toxicity of Different Chemotherapy Regimens in the Treatment of Advanced or Metastatic Pancreatic Cancer: A Network Meta‐Analysis. J Cell Biochem. 2018;119(1):511-23. DOI: 10.1002/jcb.26210
Goldstein D, El-Maraghi RH, Hammel P, Heinemann V, Kunzmann V, Sastre J, et al. nab-Paclitaxel Plus Gemcitabine for Metastatic Pancreatic Cancer: Long-Term Survival From a Phase III Trial. JNCI J Natl Cancer Inst. 2015;107(2):dju413-dju413. DOI: 10.1093/jnci/dju413
de Jesus VHF, Camandaroba MPG, Calsavara VF, Riechelmann RP. Systematic review and meta-analysis of gemcitabine-based chemotherapy after FOLFIRINOX in advanced pancreatic cancer. Ther Adv Med Oncol. 2020;12. DOI: 10.1177/1758835920905408
Chiorean EG, Von Hoff DD, Tabernero J, El-Maraghi R, Ma WW, Reni M, et al. Second-line therapy after nab-paclitaxel plus gemcitabine or after gemcitabine for patients with metastatic pancreatic cancer. Br J Cancer. 2016;115(2):188-94. DOI: 10.1038/bjc.2016.185
Pelzer U, Schwaner I, Stieler J, Adler M, Seraphin J, Dörken B, et al. Best supportive care (BSC) versus oxaliplatin, folinic acid and 5-fluorouracil (OFF) plus BSC in patients for second-line advanced pancreatic cancer: A phase III-study from the German CONKO-study group. Eur J Cancer. 2011;47(11):1676-81. DOI: 10.1016/j.ejca.2011.04.011
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2022 Paola Montenegro Beltrán, Fernando Hurtado de Mendoza, Fernando Suazo Casanova, Víctor Castro Oliden, Cristian Pacheco Román, Connie Rabanal Carretero, Frank Young Tabusso, Carlos Luque Vásquez, Javier Targarona Módena, Gustavo Sarria Bardales, Bernardo Jesús Vizcarra Ladrón de Guevara, Alberto Lachos Dávila, David Martínez Pérez, Christian Rau Vargas, Richard Dyer Velarde-Alvarez, Pamela Mora Alferez, Diana Lau Manrique, Carlos Ramos Morante, Fernando Palacios Salas, Bruno Li Salvatierra, Jorge Guerrero Gil, Edgar Yana Pari, Juan Carlos Arapa García, Álvaro Carrillo Díaz, Ana María Posada Arango, Deysi Tarazona López, Mariana Serrano Cardoso, Virgilio Efraín Failoc Rojas, Karina Aliaga Llerena, Leydi Laura Pérez Tazzo, Fradis Gil-Olivares, Johanny Fidela de Fátima Muro Cieza, Germán Calderillo Ruiz, Jorge León Chong
This work is licensed under a Creative Commons Attribution 4.0 International License.
