Meet The Professors: Pancreatic Cancer Edition, 2016 - Video 27Stent use for patients with locally advanced pancreatic cancer undergoing neoadjuvant therapy
2:09 minutes.
TRANSCRIPTION:
DR TEMPERO: So the NCCN Guidelines are very clear on the need for stenting if neoadjuvant therapy is planned. So that must be done for safety reasons, preferably with a short-segment metal stent. What was the other question? DR GLYNN: But doesn’t that change the pool of patients who are going to say that they benefited from systemic therapy? Because in my mind, anyways, it becomes a little difficult to say, “Did they really benefit from systemic therapy, or did they benefit from having stent and better palliation?” DR TEMPERO: You can’t give systemic therapy unless you put in a stent. And a stent does not treat their cancer. DR GLYNN: Right. But in putting the stent in, if you’re talking about somebody who’s then subsequently going to go to surgery and you’re selecting patients who are going to be now resectable and you’re using performance status based on that, is the performance status that much improved by better palliation than actually by the chemotherapy? DR TEMPERO: They don’t get the chemotherapy unless they have a good performance status. So it may be a chicken-and-egg thing, but you have to stent in order to give treatment. Patients do feel better after having a stent. And it allows you to give the treatment that the patient needs. DR BEKAII-SAAB: More effectively. DR GLYNN: But maybe those patients could go right to surgery. DR BEKAII-SAAB: So the definition of borderline resectable and locally advanced is independent of the involvement of the biliary system or the presence or absence of jaundice. It’s mostly whether there is abutment or involvement of the vessels or of the celiac plexus. And that’s really what determines, regardless of — and it could be an abutting lesion or a tail lesion that hasn’t really involved the bile ducts, and you may not even need stenting. But for the head of the pancreas, almost all these patients will require stenting. And stenting is always captured in the data in all the studies and doesn’t seem to affect the generalized outcome, although it will affect the quality of life and the performance of the patients. |