Boosted Radiation Dose May Make Some Pancreatic Cancers Resectable

Boosted Radiation Dose May Make Some Pancreatic

The ASCO Post
Key Points:

  • Less than one out of five pancreatic cancers appears to be confined to the pancreas at diagnosis, and even fewer turn out to be truly resectable.
  • Researchers found that patients who received the vessel boost were more likely to undergo surgical resection than patients who received only the standard dose of radiation.
  • There was no difference in side effects between the two groups.

Because of their location, cancers on the pancreas often invade and wrap around nearby veins and arteries in the abdomen. When these vessels become involved, surgery to remove the cancer, which is typically the standard treatment, becomes significantly more difficult—sometimes impossible. Researchers at Fox Chase Cancer Center have identified a way to safely shrink these tumors, pulling them away from these vessels and allowing patients to undergo potentially curative surgery. Their findings were published by Wang et al in Practical Radiation Oncology.

Standard Treatment

For patients with pancreatic cancer that is borderline resectable or unresectable as a result of vessel involvement, neoadjuvant therapy with chemotherapy and/or radiation therapy is standard. Lora Wang, MD, Resident in the Department of Radiation Oncology at Fox Chase, and colleagues found that giving extra boosts of radiation therapy to the tumor areas that are dangerously involved with the major vessels improved the rate of surgical resection in these patients.

Less than one out of five pancreatic cancers appears to be confined to the pancreas at diagnosis, and even fewer turn out to be truly resectable.

“In patients with nonmetastatic pancreatic cancer, the tumor’s involvement with the nearby vessels is what determines whether or not a tumor is resectable,” Dr. Wang said. “Some small vessels can be removed surgically without issue, but there are many important veins and arteries in the abdomen that cannot be removed easily or at all. Our practice is to give patients with borderline resectable or unresectable cancer chemotherapy and/or radiation therapy first, in hopes that their tumor will shrink, so they can proceed to surgery.”

Study Details

The researchers evaluated patients with borderline resectable and locally advanced pancreatic cancer that were treated with neoadjuvant chemotherapy and radiation therapy to determine whether the ‘vessel boost’ improved the rate of curative surgery. The study included 104 patients; 23 received a vessel boost, and the remaining 81 did not. All patients also received concurrent chemotherapy.

The median standard dose of radiation was 50.4 Gy. Patients who received the vessel boost received a median dose of 56 Gy, with the extra being delivered to the areas involved with the vessels.

Researchers found that patients who received the vessel boost were more likely to undergo surgical resection than the patients who received only the standard dose of radiation. In addition, there was no difference in side effects between the two groups.

Dr. Wang concluded the research findings by advising that patients who show evidence of disease progression or metastatic disease during upfront chemotherapy and/or radiation therapy may be spared resection, a major surgery.

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