Abstract
ObjectiveTo evaluate the incidence of pulmonary metastases on chest computed tomography (CT) in patients with locally advanced pancreatic cancer (LAPC).MethodsAll patients diagnosed with LAPC in a single tertiary center (Erasmus MC) between October 2011 and December 2017 were reviewed. The staging chest CT scan and follow‐up chest CT scans were evaluated. Pulmonary nodules were divided into three categories: apparent benign, too small to characterize, and apparent malignant.ResultsIn 124 consecutive patients diagnosed with LAPC, 119 (96%) patients underwent a staging chest CT scan at the initial presentation. In 88 (74%) patients no pulmonary nodules were found; in 16 (13%) patients an apparent benign pulmonary nodule was found, and in 15 (13%) patients a pulmonary nodule too small to characterize was found. Follow‐up chest CT scan(s) were performed in 111 (93%) patients. In one patient with either no pulmonary nodule or an apparent benign pulmonary nodule at initial staging, an apparent malignant pulmonary nodule was found on a follow‐up chest CT scan. However, a biopsy of the nodule was inconclusive. Of 15 patients in whom a pulmonary nodule too small to characterize was found at staging, 12 (80%) patients underwent a follow‐up CT scan; in 4 (33%) of these patients, an apparent malignant pulmonary nodule was found.ConclusionIn patients with LAPC in whom at diagnosis a chest CT scan revealed either no pulmonary nodules or apparent benign pulmonary nodules, routine follow‐up chest CT scans is not recommended. Patients with pulmonary nodules too small to characterize are at risk to develop apparent malignant pulmonary nodules during follow‐up.
Highlights
Projections indicate that pancreatic cancer will be the second leading cause of cancer‐related death by 2030.1 At the time of diagnosis, advanced pancreatic cancer (LAPC; stage III), and 50% of patients initially present with metastatic disease.[2]
We retrospectively reviewed all consecutive patients diagnosed with locally advanced pancreatic cancer (LAPC) between October 2011 to December 2017 seen at Erasmus MC, The Netherlands
All patients with LAPC were offered a treatment consisting of eight cycles of FOLFIRINOX followed by either conventional or stereotactic body radiotherapy when no disease progression was observed on follow‐up scanning
Summary
Projections indicate that pancreatic cancer will be the second leading cause of cancer‐related death by 2030.1 At the time of diagnosis, advanced pancreatic cancer (LAPC; stage III), and 50% of patients initially present with metastatic disease (stage IV).[2]. A chest computed tomography (CT) scan is more sensitive and specific in detecting pulmonary metastases than a conventional chest X‐ray.[4] In patients with pancreatic cancer, the National Comprehensive Center Network (NCCN) guidelines recommend routine chest CT scans.[5] Chest CT scan in (borderline) resectable pancreatic cancer, was found to be of no influence on survival.[6,7,8] Chest CT scans frequently reveal subcentimeter pulmonary nodules that are often said to be too small to characterize They impose a clinical dilemma, as these nodules of uncertain nature induce uncertainty with regard to their nature and as such carry a huge emotional burden to patients. The aim of this study is to evaluate the yield of routine chest CT scans in patients with LAPC at initial staging and during follow‐up
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