G Quero1, L Salvatore2, C Fiorillo3, C Bagalà2, R Menghi3, B Maria2, C Cina3, V Laterza3, B Di Stefano2, M G Maratta2, M Ribelli2, F Galiandro3, G C Mattiucci4, M G Brizi5, E Genco6, F D'Aversa7, L Zileri7, F Attili8, A Larghi8, V Perri8, F Inzani9, A Gasbarrini10, V Valentini4, G Costamagna11, R Manfredi5, G Tortora2, S Alfieri12. 1. Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy; CRMPG (Advanced Pancreatic Research Center), Rome, Italy; Università Cattolica del Sacro Cuore di Roma, Rome, Italy. Electronic address: giuseppe.quero@policlinicogemelli.it. 2. Università Cattolica del Sacro Cuore di Roma, Rome, Italy; Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy. 3. Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy; CRMPG (Advanced Pancreatic Research Center), Rome, Italy. 4. Università Cattolica del Sacro Cuore di Roma, Rome, Italy; Radiation Oncology Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy. 5. Università Cattolica del Sacro Cuore di Roma, Rome, Italy; Radiology Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy. 6. Radiology Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy. 7. Internal Medicine, Gastroenterology and Hepatology Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy. 8. Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy; CERTT, Center for Endoscopic Research Therapeutics and Training, Università Cattolica del Sacro Cuore di Roma, Rome, Italy. 9. Pathology Unit, Università Cattolica del Sacro Cuore di Roma, Rome, Italy. 10. Università Cattolica del Sacro Cuore di Roma, Rome, Italy; Internal Medicine, Gastroenterology and Hepatology Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy. 11. Università Cattolica del Sacro Cuore di Roma, Rome, Italy; Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy; CERTT, Center for Endoscopic Research Therapeutics and Training, Università Cattolica del Sacro Cuore di Roma, Rome, Italy. 12. Digestive Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy; CRMPG (Advanced Pancreatic Research Center), Rome, Italy; Università Cattolica del Sacro Cuore di Roma, Rome, Italy.
Abstract
BACKGROUND: The implementation of multidisciplinary tumor board (MDTB) meetings significantly ameliorated the management of oncological diseases. However, few evidences are currently present on their impact on pancreatic cancer (PC) management. The aim of this study was to evaluate the impact of the MDTB on PC diagnosis, resectability and tumor response to oncological treatment compared with indications before discussion. PATIENTS AND METHODS: All patients with a suspected or proven diagnosis of PC presented at the MDTB from 2017 to 2019 were included in the study. Changes of diagnosis, resectability and tumor response to oncological/radiation treatment between pre- and post-MDTB discussion were analyzed. RESULTS: A total of 438 cases were included in the study: 249 (56.8%) were presented as new diagnoses, 148 (33.8%) for resectability assessment and 41 (9.4%) for tumor response evaluation to oncological treatment. MDTB discussion led to a change in diagnosis in 54/249 cases (21.7%), with a consequent treatment strategy variation in 36 cases (14.5%). Change in resectability was documented in 44/148 cases (29.7%), with the highest discrepancy for borderline lesions. The treatment strategy was thus modified in 27 patients (18.2%). The MDTB brought a modification in the tumor response assessment in 6/41 cases (14.6%), with a consequent protocol modification in four (9.8%) cases. CONCLUSIONS: MDTB discussion significantly impacts on PC management, especially in high-volume centers, with consistent variations in terms of diagnosis, resectability and tumor response assessment compared with indications before discussion.
BACKGROUND: The implementation of multidisciplinary tumor board (MDTB) meetings significantly ameliorated the management of oncological diseases. However, few evidences are currently present on their impact on pancreatic cancer (PC) management. The aim of this study was to evaluate the impact of the MDTB on PC diagnosis, resectability and tumor response to oncological treatment compared with indications before discussion. PATIENTS AND METHODS: All patients with a suspected or proven diagnosis of PC presented at the MDTB from 2017 to 2019 were included in the study. Changes of diagnosis, resectability and tumor response to oncological/radiation treatment between pre- and post-MDTB discussion were analyzed. RESULTS: A total of 438 cases were included in the study: 249 (56.8%) were presented as new diagnoses, 148 (33.8%) for resectability assessment and 41 (9.4%) for tumor response evaluation to oncological treatment. MDTB discussion led to a change in diagnosis in 54/249 cases (21.7%), with a consequent treatment strategy variation in 36 cases (14.5%). Change in resectability was documented in 44/148 cases (29.7%), with the highest discrepancy for borderline lesions. The treatment strategy was thus modified in 27 patients (18.2%). The MDTB brought a modification in the tumor response assessment in 6/41 cases (14.6%), with a consequent protocol modification in four (9.8%) cases. CONCLUSIONS:MDTB discussion significantly impacts on PC management, especially in high-volume centers, with consistent variations in terms of diagnosis, resectability and tumor response assessment compared with indications before discussion.
Authors: Simona Gaudino; Carolina Giordano; Francesca Magnani; Simone Cottonaro; Amato Infante; Giovanni Sabatino; Giuseppe La Rocca; Giuseppe Maria Della Pepa; Quintino Giorgio D'Alessandris; Roberto Pallini; Alessandro Olivi; Mario Balducci; Silvia Chiesa; Marco Gessi; Pamela Guadalupi; Rosellina Russo; Chiara Schiarelli; Luca Ausili Cefaro; Giuseppe Maria Di Lella; Cesare Colosimo Journal: J Pers Med Date: 2022-01-20