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M. D. Anderson Study Shows Pre-Operative Chemoradiation Leads to Greater Tumor Kill for Pancreatic Cancer

M. D. Anderson Study Shows Pre-Operative Chemoradiation Leads to Greater Tumor Kill for Pancreatic Cancer
M. D. Anderson News Release 05/20/02

A study by researchers at The University of Texas M. D. Anderson Cancer Center reports that gemcitabine-based chemoradiation given before surgery for pancreatic cancer - rather than after - may be a better alternative for patients.

In the study presented today (Monday, May 20) at the annual meeting of the American Society of Clinical Oncology, researchers reported that pre-operative chemoradiation allows more patients to receive treatment that may prevent the onset of deadly metastasis or local recurrence. 

This is the largest pre-operative chemoradiation study ever conducted for pancreatic cancer, said Dr. Robert Wolff, assistant professor in the Department of Gastrointestinal Medical Oncology at M. D. Anderson who presented the study. Though the current standard of care is to give chemoradiation after surgery, M. D. Anderson has been studying pre-operative chemoradiation for about a decade. Additional study is necessary to determine how pre-operative chemoradiation affects long-term survival.

According to this three-year study, 86 patients with resectable pancreatic tumors received seven weekly doses of gemcitabine and 10 daily treatments with radiation therapy. Four to six weeks after completing their last dose of chemotherapy, the patients were re-evaluated and underwent surgery if their disease had not progressed. 

Disease progression during the 12-14 week pre-operative period was uncommon, and 64 patients
(74 percent) in the study were able to have potentially curative surgery, reported Dr. Wolff. In prior studies, only 60 percent of patients who underwent preoperative treatment programs were able to undergo this aggressive surgery. 

Twelve (14 percent) of the patients did not have surgery, and seven patients had signs of advancing  disease.

Microscopic evaluation of the pancreatic tumors revealed that there was greater tumor kill after gemcitabine and radiation than with other traditional chemotherapies. In 59 percent of the tumor specimens taken for the study, more than 50 percent of the tumor cells were destroyed, said Dr. Wolff. 

"We believe that the combination of the two modalities is key," said Dr. Wolff. "Gemcitabine is a drug that is approved for advanced pancreatic cancer, and alone it is a good chemotherapy. But because it also is a radiation sensitizer, it maximizes the effectiveness of the radiation therapy."

Pre-operative chemotherapy allows more patients to receive beneficial therapies than otherwise might after surgery, said Dr. Douglas Evans, a leader of the study and professor in the Department of Surgical Oncology at M. D. Anderson. 

About 25-30 % of patients who undergo the Whipple procedure, or pancreaticduodenectomy, are unable to receive postoperative therapy because they are not strong enough to continue treatment. The procedure is extensive, he said, and involves removing the head of the pancreas along with the gallbladder and the duodenum and then linking the rest of the pancreas, bile duct and stomach directly to the small intestine.

Giving patients chemotherapy and radiation before surgery also is important because physicians can identify those patients who may develop metastatic disease during the six to 12-week treatment period despite therapy, and those individuals would not be candidates for surgery, said Dr. Evans.

"The Whipple procedure is a very difficult surgery for patients, and some are unable to undergo further rigorous treatment like chemoradiation, which is very tough," said Dr. Evans. "If we can give the chemoradiation ahead of the surgery, there will be many more patients who can take the treatment and possibly benefit."

Cancer of the pancreas affects about 29,200 people each year and is the fourth leading cause of cancer death in the United States. According to the American Cancer Society, for all stages combined, the one-year relative survival rate is only 20 percent, and the five-year rate is four percent.


© 2015 The University of Texas MD Anderson Cancer Center