Individuals at high-risk for developing pancreatic cancer: surveillance by endosonography and magnetic resonance imaging (PANCREATIC CANCER SURVEILLANCE STUDY IN HIGH RISK INDIVIDUALS)
Projectomschrijving
Omdat alvleesklierkanker in een vroeg stadium meestal geen klachten geeft, wordt deze ziekte in de meerderheid van de patiënten pas in een vergevorderd en ongeneselijk stadium ontdekt. Screening heeft als doel een ziekte eerder op te sporen, voordat deze klachten geeft, om op deze manier de kans op genezing te vergroten. In de PANCREATIC CANCER SURVEILLANCE STUDY IN HIGH RISK INDIVIDUALS onderzoeken wij of screenen naar alvleesklierkanker wel of niet zinvol en mogelijk is. Hierbij focussen we ons op personen die door een erfelijke aanleg een verhoogd risico hebben op het krijgen van alvleesklierkanker en vergelijken we de effectiviteit van twee verschillende onderzoekstechnieken, inwendige echo (EUS) en Magnetic Resonance Imaging (MRI).
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Background: Pancreatic cancer (PC) is among the most fatal of human cancers with an overall 5-year survival rate below 3%. Aside from cigarette smoking, family history is the only other well-established risk factor in PC. About 10 to 15% of cases are caused by inherited genetic factors with a risk of developing PC that exceeds 40% in selected cases. Importantly, the only hope for cure is surgical resection of an asymptomatic precursor lesion or a small cancer. Novel imaging techniques potentially offer the opportunity to detect precursor lesions or PC by interval surveillance at an early and curable stage.
Study goal: The aim of this study is to assess and compare the effectiveness of two different surveillance techniques to detect (early) neoplastic lesions in patients with a high (familial) risk for pancreatic cancer (cumulative life time risk >10%) that prompt for a change in clinical management. Methods: Prospective comparative cohort study. Individuals will be surveilled yearly by both endoscopic ultrasonography (EUS) (with videotaping) and MRI. Investigators are blinded to the result of the competing imaging modality, but also to interpretation of his/her fellow colleague endosonographist or radiologist. Depending on the test outcome, clinical management is unchanged with the continuation of surveillance at yearly intervals, or changed to surgical resection in case of the detection of a solid lesion or intensifying follow-up by shortening the surveillance interval to 6 months in case of the detection of a potential precursor lesion.
Relevance: The potential and relevance of such a surveillance program is highlighted by the results of a pilot study in 46 individuals (inclusion until 28-1-2008) which showed an unprecedented high yield of the first (baseline) surveillance investigations with detection of asymptomatic cancerous lesions in 3 patients (6,5%), potential precursor lesions in 8 patients (17,4%) and a left adrenal gland mass suspected for adrenal cell carcinoma in 1 patient (2,2%) who is presently awaiting surgery.