title: The effect of neoadjuvant chemoradiation on pancreatic cancer-associated diabetes mellitus.
abstract: OBJECTIVE
  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.
authors.affiliation: From the *Section of Gastroenterology and Hepatology, †Department of Surgery, ‡Section of Hematology and Oncology, and Departments of §Radiology and ∥Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
authors.forename: Timothy B
authors.initials: TB
authors.lastname: Gardner
authors.forename: Nigeen
authors.initials: N
authors.lastname: Hessami
authors.forename: Kerrington D
authors.initials: KD
authors.lastname: Smith
authors.forename: Gregory H
authors.initials: GH
authors.lastname: Ripple
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Barth
authors.forename: David A
authors.initials: DA
authors.lastname: Klibansky
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Colacchio
authors.forename: Bassem
authors.initials: B
authors.lastname: Zaki
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Tsapakos
authors.forename: Arief A
authors.initials: AA
authors.lastname: Suriawinata
authors.forename: Juan
authors.initials: J
authors.lastname: Putra
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Tsongalis
authors.forename: Kabir
authors.initials: K
authors.lastname: Mody
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Gordon
authors.forename: J Marc
authors.initials: JM
authors.lastname: Pipas
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001786:Blood Glucose / Q000032:analysis*; D021441:Carcinoma, Pancreatic Ductal / Q000150:complications* / Q000601:surgery; D000068818:Cetuximab; D059248:Chemoradiotherapy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D003920:Diabetes Mellitus / Q000097:blood / Q000209:etiology / Q000628:therapy*; D000077143:Docetaxel; D005215:Fasting / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000601:surgery; D010257:Paraneoplastic Syndromes / Q000097:blood / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D016037:Single-Blind Method; D043823:Taxoids / Q000008:administration & dosage; D016896:Treatment Outcome; D047368:Tumor Burden; D000093542:Gemcitabine
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000964:Antimetabolites, Antineoplastic; D001786:Blood Glucose; D043823:Taxoids; D003841:Deoxycytidine; D000077143:Docetaxel; D000068818:Cetuximab; D000093542:Gemcitabine