A team discovers three factors that prolong the lives of patients with advanced pancreatic cancer

Historically, most patients with pancreatic cancer and whose tumors grow outside the pancreas, encompbading the veins and arteries, have learned that the cancer was inoperable and needed to prepare for a average survival from 12 to 18 months. A recently published Mayo Clinic study reveals that a preoperative treatment plan focused on three factors can extend years of life beyond that. The results are published in the Annals of surgery, the journal of the American Surgical Association and the European Surgical Association.

The study followed 194 patients from the Mayo Clinic who received chemotherapy, followed by radiation therapy and surgery. An average survival time of 58.8 months, just under five years, was reached. The researchers found that patients with these three factors had significantly longer survival times than those who did not:

• Prolonged chemotherapy before surgery; the more cycles they had, the longer the survival.
• A CA 19-9 tumor marker that fell to a normal level after chemotherapy.
• A tumor that, when removed surgically, was found to be largely dead due to chemotherapy.

Lead author Mark Truty, M.D., estimates that about half of his patients with venous and arterial damage have reached him after being told elsewhere that their cancer was inoperable. He hopes that the results of the study will convince doctors that for many patients of this type, long-term survival is possible if they receive appropriate treatment before surgery.

"We now have more advanced surgical techniques and more effective chemotherapy and radiotherapy – we can take all these advances and combine them to achieve the desired results," says Dr. Truty, an oncologist surgeon at the Mayo Clinic in Rochester. , Minnesota. "The goal is to extend the lives of patients and maintain or improve their quality of life."

In the United States, approximately 55,000 people are diagnosed with pancreatic cancer each year. In about one-third of the cases, the tumor did not spread to any other organs, but developed outside the pancreas to envelop the veins and arteries; in medical jargon, they are considered borderline or locally advanced. Conventional wisdom is that surgery gives patients with pancreatic cancer the only chance for long-term survival, but that these patients are inoperable because of the high risk that cancer will be missed and that their survival prognosis is poor. . The Mayo Clinic study refutes this misconception.

The research team tracked 194 of these patients treated at Mayo for seven years; all received personalized chemotherapy followed by radiation therapy and surgery to remove the tumor. For most patients, the surgical procedure consisted of removing and reconstructing veins and / or arteries trapped by pancreatic tumors. Before surgery, it was crucial to find the right chemotherapy and continue until the tumor marker CA 19-9 became normal and positron emission tomography, an advanced form of imaging called PET scan, shows that the tumor is dead, said Dr. Truty. .

The more these three factors had factors, the better they went. Since the three factors were all related to chemotherapy and the response to this chemotherapy, it may be possible to help many more patients achieve them by adjusting their chemotherapy before surgery, says Dr. Truty. Twenty-nine percent of the patients had the three factors identified in the study; their median survival time has not yet been calculated because more than half are still alive. An additional 29% had two factors; their median survival was 58.6 months.

Thirty-one percent had a factor and a median survival of 29.7 months. Eleven percent had none of the factors; their median survival was 18.5 months.

"Ultimately, patients with these advanced cancers may very well get them if they are treated properly before the operation," says Dr. Truty. "Our data show that there is no difference in long-term survival if a vein or artery is involved or not.These are all three factors related to how chemotherapy was administered and if it has been effective, then move on to radiotherapy and surgery. "

It is just as important to identify the right candidate for surgery as to determine who is a poor candidate, says Dr. Truty; The operation is more complex than surgery in patients whose cancer has not spread beyond the pancreas, and the risks must be weighed against the predicted benefit. Given the scale of the surgery, it is only performed in a few centers in the United States, including the Mayo Clinic.