Chemotherapy Combined with Surgery Improves Survival in Difficult-to-Treat Pancreatic Cancer

A team of researchers from the Mayo Clinic found that patients with pancreatic cancer whose tumors have grown to surround critical blood vessels are candidates for surgery after all, despite popular opinion that the removal of these tumors are a risky option.

Pancreatic cancer tends to metastasize in about half of patients before symptoms begin to appear, ruling out surgery. In a study presented at the annual meeting of the Society for Surgery of the Alimentary Tract, researchers analyzed surgical outcomes from the past 25 years in pancreatic cancer patients who had their disease grow around the veins and arteries located inside and around the pancreas.

Patients who received surgery to remove and reconstruct the arteries and the operations all had the procedure performed in the past 5 years, since the improvement of radiation and chemotherapy.

“We're definitely seeing a revolution,” said Mark Truty, MD, first author of one abstract and senior author of another. “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. Now we can potentially offer these therapies to patients who previously were told they had no options.”

Although there is risk associated with these surgeries, the findings show significant long-term survival and advantage in patients who received chemotherapy and radiation followed by surgery. Patients who underwent surgery without first receiving radiation and chemotherapy had unsuccessful results long-term.

Patients who received chemotherapy and/or radiation before surgery did significantly better long-term. Researchers found that the complication rates have decreased over time.

“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,” Truty said.

For a study presented at the Pancreas Club meeting, modern surgical outcomes were analyzed for stage 3 patients whose tumors involved blood vessels and had specific protocol of chemotherapy, radiation, and aggressive surgery. Thus far, 80 patients have gone through the Mayo protocol and their data is available for review.

The results of the study revealed that the median survival for patients after they completed the protocol is approaching 4 years, which is approximately 4 times that of patients who did not have surgery.

Patients who received more chemotherapy before surgery who had a particular tumor marker called CA 19-9 that returns to normal after chemotherapy, or whose tumors were found to have only minimal cancer left when analyzed after removal, were found to have even better results.

Additional findings showed that a majority of patients who had CT scans before surgery revealed that chemotherapy did not shrink the tumors, but once the tumors were removed, most of the cancer was 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,” Truty said. “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. We're offering an additional bit of hope for a pretty substantial number of patients who had previously been ignored.”