Surgery in Advanced Pancreatic Cancer Can Improve Survival, Says Mayo Study

Oncologists at the Mayo Clinic have developed a more aggressive approach to treating patients with pancreatic cancer—combining surgery, chemotherapy, and radiation, surgical oncologists have been successful in significantly improving survival in a small number of patients. Outcomes in these patients were measured in years, rather than months as is typical with this disease.

A very deadly disease with a single-digit 5-year survival rate (7%), pancreatic cancer is a very aggressive disease that is hard to detect due to lack of early signs or symptoms. Additionally, the disease pathology is such that it quickly progresses from stage I to stage IV in just over a year, which makes the development of early diagnostic tools very critical.

According to the Pancreatic Cancer Action Network, more than 50% of the patients are diagnosed in the advanced stage when the disease had metastasized—less than 10% of cases are diagnosed when the disease is still confined to the pancreas. Statistically, less than 20% of patients are considered candidates for a surgical intervention, although surgery is not a very effective strategy either. A majority of the patients (80%) experience recurrence, which ultimately reduces survival. Those who cannot undergo surgery are then treated with radiation or chemotherapy—both non-curative.

Mark Truty, MD, a surgical oncologist at the Mayo Clinic who has actively participated in the current trials, believes their study findings—presented at Pancreas Club and Society for Surgery of the Alimentary Tract annual meetings in San Diego—can revolutionize the field. “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,” Truty said in a statement.

Results from 2 different studies were presented at the meetings. In one, surgical outcomes of stage 3 patients who had surgery that involved removal and reconstruction of arteries was analyzed. The study observed significant long-term survival advantage when patients had undergone aggressive chemotherapy, radiation, and then the surgery. Surgery alone was not beneficial, the authors found. The other study analyzed surgical outcomes for stage 3 patients whose tumors involved blood vessels.

Surgery following chemotherapy and/or radiation improved median survival to nearly 4 years among 80 patients who have now undergone the procedure, compared with just about a year in patients who do not undergo surgery. The authors found that the following patients showed the best outcomes:

• Those who received higher doses of chemotherapy before surgery
• Those who showed a drop in their CA 19-9 levels to normal following chemotherapy
• Those whose tumors, analyzed post-surgery, showed minimal cancer

An important observation that came out of these studies was that while the tumors did not appear to shrink following computed tomography scans following chemotherapy, when the tumor were surgically removed, a majority of the cancer cells were dead.

“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,” said Truty. “We're offering an additional bit of hope for a pretty substantial number of patients who had previously been ignored.”

Reference

Chemo, radiation, surgery combo boosts survival for pancreatic cancer patients. ScienceDaily website. https://www.sciencedaily.com/releases/2016/05/160524163803.htm. Published May 24, 2016. Accessed May 25, 2016.