Overview
Metastatic adenocarcinoma involving the pancreatic duct in patients with metastatic pancreatic ductal adenocarcinoma (mPDAC) often presents with significant pain symptoms, necessitating comprehensive management strategies including systemic therapy and local treatments.Diagnosis
Histologically confirmed metastatic pancreatic ductal adenocarcinoma 1.
Presence of pain symptoms in the upper abdomen and back, prevalent in 80% of patients 1.
Imaging studies (e.g., CT, MRI) to assess primary tumor and metastatic spread 1.Management
First-line treatment: Systemic therapy with at least doublet chemotherapy for fit patients 1.
Adjunctive treatments:
- Palliative low-dose radiotherapy for pain control 1.
- MR-guided adaptive stereotactic body radiotherapy (SBRT) of the primary tumor between chemotherapy cycles for potential improved pain control and reduced chemotherapy-free intervals 1.
Palliative care integration: Early systematic palliative care consultation to potentially reduce end-of-life aggressiveness, including decreased chemotherapy use in the last 30 days of life 2.Special Populations
No specific guidance provided for pregnancy, pediatrics, elderly, or comorbidities in the given abstracts [].Key Recommendations
Incorporate MR-guided adaptive SBRT of the primary pancreatic tumor between cycles of standard doublet chemotherapy for pain control in fit patients with mPDAC (Evidence: Moderate) 1.
Implement systematic early palliative care consultations to improve quality of care and reduce aggressive end-of-life treatments, such as minimizing chemotherapy use in the last 30 days of life (Evidence: Moderate) 2.
Prioritize systemic doublet chemotherapy as the cornerstone of first-line treatment for fit patients with mPDAC (Evidence: Strong) 1.References
1 Pavic M, Niyazi M, Wilke L, Corradini S, Vornhülz M, Mansmann U et al.. MR-guided adaptive stereotactic body radiotherapy (SBRT) of primary tumor for pain control in metastatic pancreatic ductal adenocarcinoma (mPDAC): an open randomized, multicentric, parallel group clinical trial (MASPAC). Radiation oncology (London, England) 2022. link
2 Maltoni M, Scarpi E, Dall'Agata M, Schiavon S, Biasini C, Codecà C et al.. Systematic versus on-demand early palliative care: A randomised clinical trial assessing quality of care and treatment aggressiveness near the end of life. European journal of cancer (Oxford, England : 1990) 2016. link