Nosheen Fatima, Sidra Zaman, M Naeem Pasha, Areeba Zaman, Unaiza Zaman, Anamta Zaman, Rabia Tahseen, Maseeh Uz Zaman



Aim/Introduction: Pancreatic duct adenocarcinomas (PDAC) are known to have dismal survival as more than 80% tumors are un-resectable at diagnosis. Chemotherapy with or without radiation is the standard regime in these patients with lower over-all survival (OS). In recent year immunotherapy has been introduced with reported better OS. FDG PET/CT is an effective tool for staging and response evaluation in these patients. Aims of this study were to compare OS in patients with un-resectable PDACs who had chemoradiation with or without immunotherapy and its predictor(s) using demographic and imaging parameters of baseline FDG PET/CT scan.

Methods: This retro-prospective study was conducted at PET/CT Imaging facility of JCIA healthcare facility of Pakistan from (March 2017 till December 2020). Total 29 patients with un-resectable PDACs were included who had FDG PET/CT for staging. Seventeen patients (17/29) received only chemoradiation (CRT-Group) while 12/29 received CRT with immunotherapy (CRT+Im Group). These patients were followed for a median period of 4 months (2-10 months). Kaplan Meier’s survival curves were analyzed to measure OS in both groups. Using Receiver operating characteristics (ROC) curve, demographic and baseline FDG PET/CT parameters were plotted to find out significant predictor(s) of OS in both groups.

Results: Patients with CRT had mean OS 6.9 month (5.3 – 8.5) compared to 8.3 months (6.3 – 10.2) who had CRT+Im (p value > 0.5). Using ROC analysis, age, gender, body mass index (BMI), primary tumor size (PTS) and SUVmax of primary tumor in baseline FDG PET/CT did not show significant impact on OS in either group. However, hypermetabolic bony and pulmonary metastases were found to be significant predictors of shorter OS in both groups (AUC: 0.879 and 0.875 in CRT and CRT+Im respectively; p value <0.05).

Conclusion: In un-resectable PDAC no significant difference in mean OS was found in patients treated with CRT and CRT+Im.  Age, gender, BMI, PTS and SUVmax of primary tumor in baseline FDG PET/CT were found non-significant predictors for OS in either group.  Hypermetabolic bony and pulmonary metastases on baseline FDG PET/CT were found to be significant predictors of shorter OS in both groups.


Key Words: Pancreatic Duct Adenocarcinoma; FDG PET/CT; Chemoradiationtherapy; Immunotherapy; over-all survival; predictors

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