Radiation before surgery improves pancreatic cancer outcomes

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Researchers at NewYork-Presbyterian Hospital/Weill Cornell Medical Center have shown that administering radiation therapy prior to surgery nearly doubles survival in pancreatic cancer patients with operable tumors, according to a study published in the Nov. 15 issue of the International Journal of Radiation Oncology, Biology and Physics.

"Patients who received pre-surgical radiation had almost double the overall survival compared with similar patients who didn't undergo radiation, and survived significantly longer than patients who received radiation after the tumor was removed," said the study's senior author, David Sherr, MD, assistant professor of clinical radiation oncology at Weill Cornell Medical College, and a radiation oncologist at NewYork-Presbyterian Hospital/Weill Cornell Medical Center in New York City.

Because pancreatic tumors have often spread or have directly invaded critical structures by the time they are detected, just 15 to 20 percent of patients are deemed suitable candidates for surgical removal of the tumor. And while post-operative radiotherapy has long been used to sterilize residual cancer cells that may not have been removed by surgery, the notion of using radiation before resection has been a controversial one, Sherr noted.

Along with colleagues from Weill Cornell Graduate School of Medical Sciences student Alexander Stessin and NewYork-Presbyterian/Weill Cornell radiation oncology department, he analyzed data from 3,885 cases of resected pancreatic cancer, recorded between 1994 and 2003 as part of the national Surveillance, Epidemiology and End Results (SEER) registry database.

Of these cases, 60 percent of patients had received surgery alone, 38 percent received radiation after resection and 2 percent received neoadjuvant radiation therapy.

The team found that the overall survival of patients who received neoadjuvant radiation was 23 months, compared with 17 months for those receiving post-surgical radiotherapy and just 12 months for patients who received surgery alone.

Controlling for variables such as patient age, sex, cancer stage, grade and year of diagnosis, they found that neoadjuvant radiation cut the death risk for patients by 45 percent compared with other treatment strategies, and by 37 percent compared with radiation performed after surgery.

Sherr stressed that the findings need to be verified by a randomized, prospective trial before any firm recommendations can be made.

However, he noted that the findings suggest that there may be a real advantage to pre-operative radiation.

“Right now, when a pancreatic tumor is deemed operable, patients typically go straight to surgery. This suggests that -- in some cases at least -- we may be able to boost the odds of cure if we employ radiation first. More study is needed, but I believe this type of research has the potential to change practice,” Sherr concluded.