The effect of neoadjuvant chemoradiation on pancreatic cancer-associated diabetes mellitus

Timothy B. Gardner, Nigeen Hessami, Kerrington D. Smith, Gregory H. Ripple, Richard J. Barth, David A. Klibansky, Thomas A. Colacchio, Bassem Zaki, Michael J. Tsapakos, Arief A. Suriawinata, Juan Putra, Gregory J. Tsongalis, Kabir Mody, Stuart R. Gordon, J. Marc Pipas

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

Objectives: Pancreatic cancer-associated diabetes mellitus (PaCDM) occurs in approximately 50% of patients. In patients with new-onset PaCDM undergoing neoadjuvant chemoradiation therapy before surgical resection, we hypothesized that pancreatic tumor destruction would lead to improvement in fasting glucose levels.

Methods: A retrospective chart review was performed on patients with newly diagnosed pancreatic adenocarcinoma without a history of DM treated with neoadjuvant therapy at our center. All patients underwent combined modality neoadjuvant chemoradiation therapy, followed by surgical excision of the primary tumor.

Results: Sixty-nine patients (31 with PaCDM) met inclusion criteria for the study; 18 had Evans grade II tumor kill response, 10 had grade III response, and 3 had grade IV response. In patients with grade IV response, the odds ratio (OR) for achieving a normal preoperative glucose was 5.0 (95% confidence interval [CI], 0.4-63.2), compared with grade III (OR, 0.5; 95% CI, 0.1-3.0) and grade II (OR, 1.1; 95% CI, 0.2-5.2). When adjusted for percent kilogram weight loss and tumor size in a multivariable regression model, the grade IV response became significant to an OR of 6.5 (95% CI, 1.2-77.3).

Conclusions: In patients with new-onset PaCDM undergoing neoadjuvant chemoradiation therapy, fasting glucose response may mirror the extent of tumor destruction.

Original languageEnglish (US)
Pages (from-to)1018-1021
Number of pages4
JournalPancreas
Volume43
Issue number7
DOIs
StatePublished - Jan 1 2014

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Keywords

  • Adenocarcinoma
  • Diabetes
  • Mortality
  • Pancreatic cancer

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Endocrinology

Cite this

Gardner, T. B., Hessami, N., Smith, K. D., Ripple, G. H., Barth, R. J., Klibansky, D. A., Colacchio, T. A., Zaki, B., Tsapakos, M. J., Suriawinata, A. A., Putra, J., Tsongalis, G. J., Mody, K., Gordon, S. R., & Pipas, J. M. (2014). The effect of neoadjuvant chemoradiation on pancreatic cancer-associated diabetes mellitus. Pancreas, 43(7), 1018-1021. https://doi.org/10.1097/MPA.0000000000000162