Chemoradiation enables resection in patients with locally advanced pancreatic cancer

Neoadjuvant chemoradiation facilitates subsequent surgical resection in patients with locally advanced pancreatic cancer (LAPC), which helps to substantially prolong survival, a study has found.

“Therefore, surgical exploration should be offered if vessel involvement is improved by chemoradiation and considered in radiographic unchanged vessel involvement if size and cancer antigen (CA) 19.9 levels decrease, as these factors may indicate resectable disease, too,” the authors said.

Forty-nine patients with unresectable LAPC underwent contouring of their pancreatic gross tumour and all major abdominal vessels before and after neoadjuvant chemoradiation. Paired t tests were carried out to compare changes. Finally, the authors used the Medical Imaging Interaction Toolkit to quantify tumour-vessel relationships, which were then examined for association with resectability and outcome.

Chemoradiation substantially reduced tumour volumes from 41 to 33 mL (p<0.0001). For majority of the patients, maximum circumferential vessel involvement decreased and was statistically significant for the superior mesenteric (p<0.003) and splenic veins (p<0.038).

Resection was possible in some patients, which resulted in prolonged survival (28 vs 15 mo; r, 0.40), a decrease in CA 19.9 levels (r, 0.48), and reduced involvement of most vessels.

Other patients who did not show improvement in radiographic vessel involvement, but rather a decrease in tumour volume and CA 19.9 levels, also achieved surgical resection with a successful detachment of tumour tissue from major vessels.

“Survival of patients with LAPC is improved when neoadjuvant chemoradiation enables subsequent surgical resection,” the authors said.