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Blend of imaging, treatments allows removal of "inoperable" pancreatic cancer

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By Laura Sussman

A select number of high-risk pancreatic cancer patients initially deemed inoperable are, in fact, eligible for surgery and have a chance for a cure, thanks to a treatment protocol pioneered at MD Anderson.

The protocol combines a more accurate reading of CT scans, the use of chemo-radiation upfront and an advanced surgical resection of the pancreas and removal and reconstruction of appropriate blood vessels.   Jason Fleming, M.D., associate professor in the Department of Surgical Oncology and the study's lead author, says that collaboration between surgeons, radiologists, medical oncologists is also paramount.

Adenocarcinoma of the pancreas is the most common and lethal type of the disease, with a five-year survival rate of just 5%. According to the American Cancer Society, an estimated 43,920 new cases of pancreatic cancer will be diagnosed in the United States in 2012, with approximately 37,390 deaths expected. Surgical removal of the pancreas, known as the Whipple procedure, is a patient's best chance for survival, yet, currently, just 20% of patients are eligible for the high risk procedure.

Published in the Journal of American College of Surgeons, the MD Anderson study enrolled 88 high-risk pancreatic cancer patients from 1990-2010. All were initially told at outside institutions that they were surgical candidates; however, upon opening, their tumors were deemed more extensive and, thus, inoperable. They then were referred to MD Anderson for care.

Of these 88 patients, 66 were able to complete the MD Anderson protocol regimen, culminating with the removal of their tumor.  In surgical patients, the median survival was 29.6 months, compared to 10.6 months and 5.1 months in those with locally advanced disease at their time of referral or those who developed metastatic disease before resection, respectively.
 
"This exciting news was that of the 88 patients, 60 percent could have their tumor successfully removed, even though they had had surgery before and it was deemed unresectable, or not removable," said Fleming. "Even more exciting to us is that the survival of those patients who can have surgery here is the same as our group of patients on whom we do surgery first."

Fleming discusses the significance of the findings here:



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