Endoscopic ultrasound procedures on panceatic fluid

Abstract

s / Pancreatology Division of Radiology, University of Pisa, Pisa, Italy Division of Pathology, University of Pisa, Pisa, Italy Introduction: 20% of the patients have a primary-resectable pancreatic ductal adenocarcinoma (PDAC), in 30-40% surgery is denied because of local tumor growth, in the absence of metastasis. These patients could be still be considered for resection, if responsive to neaodjuvant chemotherapy (NACT). Aims: We report the results of a phase-II-clinical-trial, coupling highdose-multi-drug-NACT with aggressive surgery. Patients & methods: All patients enrolled were selected by a multidisciplinary workgroup. Selection criteria: stage-III-locally-advancedPDAC (suspected arterial involvement), ECOG PS 0-1, age 18-75years. A modified-FOLFIRINOX regimen was used. Tumor response was evaluated according to RECIST. The opportunity to add a local treatment, either surgery or radiation-therapy, was evaluated after every CT follow-up. Results: Between 11/2010-11/2012, 26 patients (mean age 59years) were enrolled: 9/26 celiac axis involvement, 11/26 superior mesenteric artery, 6/26 celiac axis and superior mesenteric artery. 9 had a partial response (34%), 15 stable disease, 2 progressed. 14/26 underwent to surgery, 11/26 to resection with curative intent (47.8%): 2 pancreaticoduodenectomy, 9 total-splenopancreatectomy. Mean-operative-time was 618minutes. In-hospital-mortality was 9%, overall-postoperative-morbidity 62%, surgical morbidity 12%, medical morbidity 50%. Mean-hospital-stay was 26 days. 11/11 were R0. Resectedlymph-nodes-mean-number was 67, nodal-metastasis-mean-number 4. 12% of resected venous segments and 33% of resected arterial segments weren’t involved on histology. Overall-progression-free-survival was 17.6months, resected-patient-progression-free-survival 17.8, out-of-surgery-patient-progression-free-survival 10.3, median-overall-survival 24 Conclusion: The modified-FOLFIRINOX protocol in PDAC allows extended resection in a relevant percentage of stage-III-PDAC with results comparable to those in primary-resectable-patients. New data from further studies are needed before any final conclusion may be drawn. PII-124 Abstract id: 343. Endoscopic ultrasound procedures on panceatic fluid Jozsef Hamvas , Laszlo Nehez . 1 Bajcsy-Zsilinszky Hospital, Budapest, Hungary 2 Semmelweis University 1st. Surgical Clinic, Budapest, Hungary Background: Pancreatic fluid often appear after acut pancreatitis, or associate with pancreatic neoplasms. Aim: Fluid samlpe taking by endoscopic ultrasound guided FNA for diagnosis pseodocyst malignancy. Patients & methods: In four years period 981 patient were examined by echoendoscop, 221 of them for pancreatic laesions. In 15 cases endoscopic pseudocysts drainage (EPD) were performed. Most of the cases went throught on ERCP to exclude major ductal leakage. In 14 caeses the pseuodocysts were drainaged with double pigtail endocystic plastic drain (7 and/or 10 F) throw the gastric wall, using endosonography. In one case self expanded metal stent (SEMS) was used to emptying the pseudocyst followed acut necrotising pancreatitis. Results: Our results revealed eligible cystemptying. Applying SEMS the EPD become “one step” procedure assured a large diameter of flow. In 30 cases the pancreatic fluid were only punctured.for diagnostic goals the cysts were not drainged, because of small diameter in 15 cases (2-3,5 cm) or bescause of septal structure of the pseudocyst. Mucinous cystadenoma were found in several cases mostly females (60-75 yrs), were operated on. In other cases pancreas neoplasm were the cytological diagnosis. Conclusion: The echoendoscope fine needle biopsy and aspiration is a well known method to distinguish malignant formations. In caeses of EPD using doppler echo effect ideal puncture site could be localising by excluding the intra cystic mass, and cystic wall vessels. Applying SEMS assured more simple modality of pseudocyst drainage. PII-125 Abstract id: 292. Comparison of chemoradiotherapy (CRT) and chemotherapy (CT) in patients with locally advanced pancreatic cancer (LAPC) controlled after 4 months of gemcitabine with or without erlotinib: Final results of the international phase III LAP 07 study Pascal Hammel , Florence Huguet , Jean-Luc van Laethem , David Goldstein , Bengt Glimelius , Ivan Borbath , Olivier Bouch e , Jenny Shannon , Thierry Andr e , Franck Bonnetain , Christophe Louvet . Hopital Beaujon Clichy, France 2 Facult e de M edecine, Universit e Pierre-et-Marie-Curie, Paris, France 3 Erasme University Hospital, Brussels Department of Radiology, Oncology and Radiation Science, Uppsala University, Akademiska Sjukhuset, Uppsala, Sweden Background: In patients with LAPC controlled with CT, CRT could be superior to continuing CT (Huguet, JCO 2007). The role of erlotinib is unknown. Aim: To define: the roleof 1) CRTafter disease control with gemcitabine and 2) role of erlotinibin LAPC. Patients & methods: LAPC PS 0-2 patients, 1st randomization: gemcitabine þ/erlotinib 100 mg/d for 4 months (R1, stratification: center, PS). 2d randomization: patients with controlled LAPC had 2 additional months of CT (Arm 1) or CRT (Arm 2) 54 Gy and capecitabine 1600 mg/ m2/d (R2, stratification: center, initial arm). Patients receiving erlotinib at R1 had maintenance therapy. Quality control for RT: dummy runs /assessment of treated patients. Primary objective: overall survival (OS) in R2 patients. Secondary objectives: role of erlotinib on OS (R1), tolerance, predictive markers. 722 patients required to observe 392 deaths to show a median OS increase from 9 to 12 m (HR1⁄40.75) in the CRT arm with planned interim analyses. Kaplan-Meier, log rank and univariate Cox tests were used. Results: From 442 pts included for R1, 269 pts reached R2 (arm1:136; arm 2:133). Main baseline characteristics in arms 1/2: female 44%/56%, mean age 63/62, head tumor 65%/62%, PS 0 56%/48%. After a median follow-up of 36 m, 221 deaths had occurred allowing the planned interim analysis. OS in R2 pts was 16.5 m [15.5-18.5] and 15.3 m [13.9–17.3] in arms 1 and 2, respectively (HR1⁄41.03 [0.79-1.34], p1⁄40.83). IDMC has confirmed that the futility boundary for the hypothesis of CRT superiority was crossed. Conclusion: Administering CRT is not superior to continuing CT in patients with controlled LAPC after 4 months of CT. Symposium Presentations 13 (2013) S2–S98 S89 Symposium on Pancreatic Regeneration and Repair S-1 Abstract id: 83. Sirtuin-1 regulates acinar to ductal metaplasia and supports cancer cell viability in pancreatic cancer Ilse Rooman , Victor J. Sanchez-Ar~ A valo Lobo , Andreia V. Pinho , Luc Bouwens , Francisco X. Real , Andrew V. Biankin , Elke Wauters . 1 The Garvan Institute of Medical Research, Vrije Universiteit Brussel, Australia 2 Spanish National Cancer Research Center (CNIO), Spain 3 The Garvan Institute of Medical Research, Spanish National Cancer Research Center (CNIO), Australia