Surgery a Good Option for Pancreatic Cancer Patients

Surgery combined with chemotherapy and radiation may be a good option for pancreatic cancer patients whose tumors involved blood vessels.

Approximately one third of patients with pancreatic cancer have tumors that have surround critical blood vessels. Typically, surgery for these patients is not an option, and the disease progresses.

Researchers from various fields discovered in 2 recent studies that these patients may be a candidate for surgery, and have been creating a protocol to treat them that has resulted into years-long survival.

"We're definitely seeing a revolution. A lot of this has to do with better chemotherapy drugs and use of what we call multimodal therapy: chemotherapy, radiation and then an aggressive operation,” said Mark Truty, MD, first author of one study and senior author of the other. “Now we can potentially offer these therapies to patients who previously were told they had no options."

Approximately 7% of patients have survival more than 5 years. Since pancreatic cancer typically spreads before symptoms appear, surgery is an option for only 15% of patients who caught it early enough, according to the first study presented at the Pancreas Club and Society for Surgery of the Alimentary Tract annual meetings in San Diego.

Researchers evaluated the surgical outcome for stage 3 patients whose surgery required removing and reconstructing arteries over the past 25 years. A majority of the surgeries occurred within the past 5 years.

Researchers noted a survival benefit for patients who underwent chemotherapy, radiation, and surgery. Patients who underwent surgery without chemotherapy or radiation first did not have better long term survival than patients who underwent the treatments first.

"All in all, it shows that these patients, who would typically not be offered an operation, can have good short-term and long-term results with the appropriate protocol and treatment sequence," Dr Truty concluded.

Researchers in the second study, presented at the Pancreas Club meeting, evaluated the surgical outcomes of stage 3 patients with tumors that surround blood vessels and had a protocol of chemotherapy, radiation, and surgery. In total, 80 patients have undergone the Mayo protocol. According to the study, the median survival of these patients is almost 4 years, which is approximately 4 times the amount of patients who did not have surgery.

Researchers found that patients who have more chemotherapy prior to surgery have tumor marker CA 19-9 that returns to normal after chemotherapy, and patients whose tumors have minimal cancer left were found to have even better outcomes. Researchers found that CT scans showed that the chemotherapy did not shrink their tumor, but once removed, a majority of the cancer cells were dead.

"We're hoping that data from this analysis will now spread to the rest of the country, and now people will have a road map for how to treat these patients and how to choose which patients will benefit from such complex operations," Dr. Truty said.

Researchers are hopeful that patients with pancreatic cancer will be more optimistic since they have another option.

"Not everyone wants to sign up for these big operations or these long protocols of chemotherapy and radiation. But they have the options available to them to make that educated decision about whether this is something that would benefit them," Dr Truty concluded. "We're offering an additional bit of hope for a pretty substantial number of patients who had previously been ignored."