Research reports that patients with locally advanced pancreatic cancer have longer overall survival when they undergo surgical resection after neoadjuvant therapy. The development of advanced systematic treatments of radiotherapy and chemotherapy, patients with non-metastatic locally advanced pancreatic cancer have an increased chance for surgery and improved survival.
Locally advanced pancreatic cancer accounts for 30% of newly diagnosed pancreatic cancers and is surgically unresectable because of involvement of adjacent vessels. The current guidelines recommend that patients with good performance status be given non-operative treatment. Studies suggest that patients with locally advanced pancreatic cancer (LAPC) can be cured if given resection after induction chemotherapy.
The research was carried out on 415 patients with LAPC to confirm if surgical resection after neoadjuvant therapy was associated with improvement in survival rates compared to aggressive non-operative management. Thirteen patients underwent surgical exploration based on the response of tumor to neoadjuvant therapy, and to another 103 patients who had no signs of the progression or metastases of local disease after four months of neoadjuvant therapy.
- Eighty-four patients achieved the resection of the primary tumor (72% of patients eligible for exploration and 20% of all LAPC patients). Resection was aborted intraoperatively in 12 patients who showed occult abdominal metastatic disease and in 20 patients because of local extension of the tumor. In 89% of the cases, resection margins showed negative for tumor (R0).
- After resection, 40 patients developed recurrence of the disease, 13 patients with most commonly local recurrence and nine patients had distant liver metastases.
- The median survival during diagnosis was 35.3 months for the group under resection and 16.2 months for the 331 patients who were treated with radiation therapy and chemotherapy.
- The overall survival rates were significantly higher in the resected group at one year (96%) and three years (50%) than in the non-resected group which had 74% at one year and 11% at three years.
The overall results showed that the patients had comparable survival after the neoadjuvant therapy and surgery to those with the initially resectable disease which was a significant improvement. However, LAPC patients under neoadjuvant therapy treatment need to be monitored and repeatedly assessed to identify those who can be taken to surgery. Doctors concluded that aggressive neoadjuvant therapy could help in reducing tumor and making surgery feasible.