Case:
60 years old male with no previous significant past medical history, he presented with epigastric pain, weight loss and lethargy. After multiple investigations including CT chest abdomen pelvis, MRCP, ERCP, he was diagnosed with locally advanced pancreatic cancer T4N1M0, the pancreatic mass was encasing the superior mesenteric artery (SMA), his case was discussed at the gastroenterology MDT. In view of the patient’s good performance status(PS), the initial management was for induction chemotherapy with FOLFIRINOX then for rescan after 3 months, if there was a good response to treatment, patient will proceed to have surgery or chemoradiotherapy(CRT) depending on the operability of the tumour. Unfortunately, after 3 months of induction chemotherapy, patient …show more content…
However, chemotherapy remains the mainstay of treatment for this group of patients. And primary chemotherapy with or without consolidating CRT is the current treatment choice in the UK.1
(Chauffert et al 2008); randomised patient with a diagnosis of LAPC between upfront CRT with a dose of 60 Gy in 30 fractions delivered concurrently with cisplatin and 5FU followed by maintenance gemcitabine and the second arm were treated with gemcitabine alone. the median survival was shorter in the CRT arm 8.4 months comparing to gemcitabine arm with median survival of 14.3 months. The author concluded that CRT followed by gemcitabine was more toxic and less effective comparing to chemotherapy alone and this clearly shows the important of chemotherapy.3
In LAPC there is high risk of micrometastaic disease and disease progression occurs in 30-40%of patients within the first 3-4 months, therefore initiating chemotherapy is the preferred treatment over upfront
60 years old male with no previous significant past medical history, he presented with epigastric pain, weight loss and lethargy. After multiple investigations including CT chest abdomen pelvis, MRCP, ERCP, he was diagnosed with locally advanced pancreatic cancer T4N1M0, the pancreatic mass was encasing the superior mesenteric artery (SMA), his case was discussed at the gastroenterology MDT. In view of the patient’s good performance status(PS), the initial management was for induction chemotherapy with FOLFIRINOX then for rescan after 3 months, if there was a good response to treatment, patient will proceed to have surgery or chemoradiotherapy(CRT) depending on the operability of the tumour. Unfortunately, after 3 months of induction chemotherapy, patient …show more content…
However, chemotherapy remains the mainstay of treatment for this group of patients. And primary chemotherapy with or without consolidating CRT is the current treatment choice in the UK.1
(Chauffert et al 2008); randomised patient with a diagnosis of LAPC between upfront CRT with a dose of 60 Gy in 30 fractions delivered concurrently with cisplatin and 5FU followed by maintenance gemcitabine and the second arm were treated with gemcitabine alone. the median survival was shorter in the CRT arm 8.4 months comparing to gemcitabine arm with median survival of 14.3 months. The author concluded that CRT followed by gemcitabine was more toxic and less effective comparing to chemotherapy alone and this clearly shows the important of chemotherapy.3
In LAPC there is high risk of micrometastaic disease and disease progression occurs in 30-40%of patients within the first 3-4 months, therefore initiating chemotherapy is the preferred treatment over upfront