Pre-operative Treatment Effective at Preventing Return of Pancreatic Cancer

March 3, 2008

A combination of chemotherapy and radiation given to pancreatic cancer patients before surgery substantially lowered their risk of a local recurrence of the deadly disease, especially when compared to standard post-operative treatments. According to researchers at Dartmouth-Hitchcock's Norris Cotton Cancer Center, even patients whose initial condition was so advanced they were not considered candidates for a potentially life-saving surgical procedure became eligible after first receiving pre-operative chemoradiotherapy.

Results of the study of 102 Norris Cotton Cancer Center patients with pancreatic cancer are published in the March 2008 issue of the Journal of the American College of Surgeons. Led by surgeon Richard J. Barth, M.D., and surgical resident Sarah Greer, M.D., researchers found that only 5% of patients had a local recurrence of their cancer if they chose chemoradiotherapy before surgery, while 34% of patients had a recurrence if they waited for treatment until after surgery. The pre-operative treatment group showed better results, despite the fact that it included a higher percentage of more advanced tumors.

"Preventing a recurrence is important because it can prevent the return of local symptoms, such as swelling of the abdomen, problems with eating, and pain," explains Barth. Relieving patients of unpleasant symptoms significantly improves their quality of life.

Researchers documented an even more pronounced disparity when comparing treatment of the sickest patients, those with the biggest and most involved tumors. Of this group, those who received pre-operative treatment had a local recurrence rate of only 4%, while the post-operative treatment group had a much higher local recurrent rate of 44%. For patients whose tumors were operable from the outset, the local recurrence rate in the pre-operative treatment group was 7%, while patients treated with chemoradiotherapy after surgery had a local recurrence of 31%.

The National Cancer Institute estimates that in 2007 there were 37,170 new cases of pancreatic cancer in the U.S. National statistics have shown that surgery alone cannot prevent a local recurrence of the cancer in 50-80% of patients. Adding chemoradiotherapy after surgery can cut this rate to 25-50%. But Barth and Greer have shown that chemoradiotherapy before surgery is effective in reducing the rate to single digits.

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