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Chemoradiation enables resection in patients with locally advanced pancreatic cancer

18 Nov 2020

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.

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Most Read Articles
07 Aug 2020
Concomitant treatment with a nonsteroidal anti-inflammatory drug (NSAID) following myocardial infarction (MI) is associated with a higher risk of cardiovascular and bleeding events, a study has shown.
Roshini Claire Anthony, 06 Oct 2020

Several strategies have been proposed to help manage the adverse events (AEs) that emerged during the BEACON CRC trial which assessed the effect of encorafenib plus cetuximab in patients with BRAF V600E mutant metastatic colorectal cancer (mCRC) who had progressed after one or two prior regimens.