Neoadjuvant Radiation Improves Survival in Pancreatic Cancer
Preoperative radiation nearly doubles the survival rate for patients with operable pancreatic cancer, according to the results of a study published in the November 15, 2008 issue of the International Journal of Radiation Oncology Biology Physics.
The pancreas is an organ that is surrounded by the stomach, small intestine, bile ducts (tubes that connect the liver to the small intestine), gallbladder, liver, and spleen. The pancreas helps the body to break down food and also produces hormones, such as insulin, to regulate the body’s storage and use of food.
Pancreatic cancer has one of the highest mortality rates of all cancers. It accounts for approximately 2% of all newly diagnosed cancers in the United States each year but 5% of all cancer deaths. Pancreatic cancer is often called a “silent killer” because its symptoms are usually not recognizable until it has advanced and spread outside the pancreas. As a result the majority of pancreatic cancers are not diagnosed until they have reached advanced stages and are considered incurable.
If pancreatic cancer has not spread to surrounding or distant organs, it is usually considered operable. Historically, patients have been treated with surgery followed by chemotherapy and/or radiation to destroy any micrometastases (cancer cells that have spread outside the pancreas). New research indicates, however, that neoadjuvant radiation therapy (radiation delivered prior to surgery) might offer greater benefit to patients because it can potentially shrink the tumor prior to surgery, thereby ensuring a better chance of removal. Furthermore, because pancreatic surgery is so invasive, many patients are in no condition to undergo radiation treatment after surgery, so neoadjuvant treatment allows them to receive radiation that they might not receive otherwise.
Researchers from the Weill Cornell Medical College used data from the Surveillance, Epidemiology, and End Results (SEER) registry database to perform a retrospective analysis on patients who had surgically resected (removed) pancreatic cancer between 1994 and 2003. The researchers compared the overall survival rates among patients who received neoadjuvant radiation, adjuvant radiation, or no radiation. Patients who received neoadjuvant radiation survived 23 months, compared with 12 months for patients who did not receive radiation and 17 months for those who received adjuvant radiation (following surgery).
The researchers concluded that neoadjuvant radiation therapy offers a significant benefit over surgery alone or surgery with adjuvant radiation therapy in treating pancreatic cancer. Research will likely be ongoing to further explore these findings.
 Stessin AM, Meyer JE, Sherr DL. Neoadjuvant radiation is associated with improved survival in patients with resectable pancreatic cancer: An analysis of data from the Surveillance, Epidemiology, and End Results (SEER) Registry. International Journal of Radiation Oncology Biology Physics. 2008; 72: 1128-1133.
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