Reproduced from Oncology Frontier
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| Matthew J. Weiss, MD Assistant Professor The John Hopkins Hospital Baltimore, Maryland |
Oncology Frontier(肿瘤瞭望): What do you think about the impact of postoperative concurrent radiotherapy and chemotherapy on survival and the prognosis for patients with pancreatic cancer?
Dr Weiss: The role of adjuvant radiation for the treatment of pancreas cancer is a somewhat controversial topic.
In our center, patients who undergo surgical resection of pancreas cancer are recommended for some type of adjuvant therapy for the most part and then the question becomes chemotherapy plus or minus radiation therapy.
I think your question really pertains as to whether they should get adjuvant radiation therapy. Patients who have pancreas cancer have the highest risk of dying from metastatic disease, so all patients in my opinion (and I think the data supports this) should get adjuvant chemotherapy following pancreatic resection.
We reserve radiation therapy for patients who have more locally advanced tumors. For instance, those patients who have positive resection margins and for those who do have positive resection margins, whether it is microscopic or the rarer instance of macroscopic, that occasionally have nodal negative disease.
So we have a bias at our institution to recommend radiation therapy post-operatively to patients. There has been a slight trend recently to go from standard radiation therapy to high-dose stereotactic radiation therapy.
We have had some promising results with that which were presented here at this conference.
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| IGCC 2015 meeting Dr. Weiss giving presentation International Gastric Cancer Congress 2015 June 04-06, 2015 Photo:Oncology Frontier |
In locally advanced unresectable pancreatic cancer, are there any other factors could influence the prognosis of pancreatic cancer exception for tumor size, lymph node and distant metastasis?
Dr Weiss: My presentation today was specifically discussing increasing the survival for patients with locally advanced pancreas cancer.
Besides the traditional predictive factors such as tumor size, lymph node status and distant metastases, for patients with truly locally advanced unresectable pancreas cancer, there are some other factors that should be taken into account.
Firstly, the patient's performance status and whether they will tolerate chemotherapy or surgery. Some of the predictive factors would also include the response to neoadjuvant chemotherapy.
We found that patients who consistently have good radiologic response to neoadjuvant therapy whether that is FOLFIRINOX or gemcitabine and abraxane, do seem to have a higher likelihood of having negative resection margins and also a higher likelihood of nodal negative disease.
So I think response to systemic chemotherapy and occasionally if we treat with neoadjuvant radiation therapy, the response to radiation therapy prior to surgical resection can be a good predictor of overall prognosis.
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| Picture of Sao Paulo, Brazil Photo: Oncology Frontier |
What do you think is the role of chemoradiation in the treatment of unresectable locoregional pancreatic cancer? How can we use multimodal therapy to improve the survival rate of locoregional pancreatic cancer?
Dr Weiss: In our experience, patients are responding better and better to systemic therapy and radiation therapy.
I presented some data today from our institution with approximately 100 patients, half of which received chemotherapy and half received stereotactic radiation therapy neoadjuvantly.
Interestingly, we found that there was a very high complete pathologic response rate in those patients who received neoadjuvant radiation therapy.
This would indicate that pancreatic cancer in certain patients is very responsive to both chemotherapy and occasionally radiation therapy. I think both of these modalities for truly locally advanced tumors should be standard of care.
Then the question becomes whether other local therapies may be of benefit including ablations or possibly even irreversible electroporation. The verdict is still out on those therapies.
Reprint from:
[IGCC访谈] 局部晚期胰腺癌 - 如何改善生存？原创 2015-06-04 Weiss 肿瘤瞭望© 微信公众号
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