Portal Vein or Superior Mesenteric Vein Thrombosis with Dose-Escalated Radiation for Borderline or Locally Advanced Pancreatic Cancer.

Autor: Smart AC; Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA., Niemierko A; Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA., Wo JY; Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA., Ferrone CR; Department of Surgery, Massachusetts General Hospital, Boston, MA, USA., Tanabe KK; Department of Surgery, Massachusetts General Hospital, Boston, MA, USA., Lillemoe KD; Department of Surgery, Massachusetts General Hospital, Boston, MA, USA., Clark JW; Division of Medical Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA., Blaszkowsky LS; Division of Medical Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA., Allen JN; Division of Medical Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA., Weekes C; Division of Medical Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA., Ryan DP; Division of Medical Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA., Warshaw AL; Department of Surgery, Massachusetts General Hospital, Boston, MA, USA., Castillo CF; Department of Surgery, Massachusetts General Hospital, Boston, MA, USA., Hong TS; Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA., Keane FK; Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA. Florence.Keane@MGH.HARVARD.EDU.
Jazyk: angličtina
Zdroj: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract [J Gastrointest Surg] 2023 Nov; Vol. 27 (11), pp. 2464-2473. Date of Electronic Publication: 2023 Aug 14.
DOI: 10.1007/s11605-023-05796-5
Abstrakt: Purpose: Portal vein and superior mesenteric vein thrombosis (PVT/SMVT) are potentially morbid complications of radiation dose-escalated local therapy for pancreatic cancer. We retrospectively reviewed records for patients treated with and without intraoperative radiation (IORT) to identify risk factors for PVT/SMVT.
Methods: Ninety-six patients with locally advanced or borderline resectable pancreatic adenocarcinoma received neoadjuvant therapy followed by surgical exploration from 2009 to 2014. Patients at risk for close or positive surgical margins received IORT boost to a biologically effective dose (BED10) > 100. Prognostic factors for PVT/SMVT were evaluated using competing risks regression.
Results: Median follow-up was 79 months for surviving patients. Fifty-six patients (58%) received IORT. Twenty-nine patients (30%) developed PVT/SMVT at a median time of 18 months. On univariate competing risks regression, operative blood loss and venous repair with a vascular interposition graft, but not IORT dose escalation or diabetes history, were significantly associated with PVT/SMVT. The development of thrombosis in the absence of recurrence was significantly associated with a longstanding diabetes history, post-neoadjuvant treatment CA19-9, and operative blood loss. All 4 patients who underwent both IORT and vascular repair with a graft developed PVT/SMVT. PVT/SMVT in the absence of recurrence is not associated with significantly worsened overall survival but led to frequent medical interventions.
Conclusions: Approximately 30% of patients who underwent neoadjuvant chemoradiation for PDAC developed PVT/SMVT a median of 18 months following surgery. This was significantly associated with venous reconstruction with vascular grafts, but not with escalating radiation dose. PVT/SMVT in the absence of recurrence was associated with significant morbidity.
(© 2023. The Society for Surgery of the Alimentary Tract.)
Databáze: MEDLINE
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