Dynamic Behavior of Ca 19-9 and Pancreatic Cancer Recurrence: Enough Data to Drive Salvage Therapy?
Ann Surg Oncol. 2018 Aug 20. doi: 10.1245/s10434-018-6703-3
Up to 80% of patients undergoing pancreatectomy for pancreatic ductal adenocarcinoma (PDAC) followed by adjuvant therapy will recur within 2 years, with median recurrence-free survival (RFS) of only 1 year.1 Historically, the attitude towards postresection follow-up has been mixed: while some authors recommended that surveillance should be only focused on symptoms, others advocated active, recurrence-focused follow-up to assess for early, asymptomatic disease. This latter concept has been fostered by the emerging effectiveness of newly introduced chemotherapy regimens and radiation therapy techniques, which are potentially applicable to recurrent PDAC. Active surveillance involves computed tomography (CT) or positron emission tomography (PET/CT), in combination with measurement of serum carbohydrate antigen (Ca) 19-9 every 3–6 months at least for the first 2 years postoperatively. However, the accuracy of cross-sectional imaging to detect recurrence in the earliest stages is poor, especially in the resection bed, where perivascular soft tissue around major arteries creates diagnostic problems in distinguishing postoperative changes from recurrent disease.2 Conversely, failure of serum Ca 19-9 normalization or sudden elevation postoperatively could hint at occult recurrence in advance of radiologic and clinical changes.