Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

New treatment protocol extends survival in some cases of once inoperable pancreatic cancer

27.06.2012
Comprehensive strategy includes more accurate CT scan analysis, complex surgical technique

Investigators at the University of Texas MD Anderson Cancer Center, Houston, have reported on a new approach to treating previously inoperable complex pancreatic adenocarcinoma that has significantly increased long-term survival for some patients. Pancreatic adenocarcinoma is one of the most devastating forms of pancreatic cancer with survival rates of only 5 percent at five years.

Surgical removal of these tumors offers a chance for cure, but it is estimated that only about 20 percent of patients can undergo this treatment. The tumor in the pancreas often grows into adjacent vital blood vessels, and this is the most common reason a surgeon will consider pancreatic cancer to be inoperable and incurable. However, the MD Anderson investigators have achieved an important milestone in the surgical treatment of the disease in terms of improving prognosis for patients who meet the criteria for a newly developed protocol.

In a study published in the July issue of the Journal of the American College of Surgeons, the investigators reported on 88 patients who had been told their tumors were inoperable after an initial surgical attempt at removal, 66 of whom completed a multidisciplinary treatment regimen with successful tumor removal. This approach has been refined at MD Anderson over the last 20 years and involves a more accurate and collaborative interpretation of CT scans of the tumor between surgeons and radiologists; chemotherapy and radiation treatment of the tumor; and finally an advanced approach to surgical resection with planned removal and reconstruction of involved vital blood vessels near the tumor.

"We've been able to achieve survival numbers for these patients that are comparable to those receiving surgery for clearly operable tumors," reported lead study author Jason B. Fleming, MD, FACS. On average, patients in this study lived about 30 months after tumor removal, which is almost three times longer than the 11 months for patients who are never able to have their tumors surgically removed.

The study enrolled high-risk patients who had been originally diagnosed at outside institutions with operable, localized cancer. However, at their initial operations the intent to remove the tumor was aborted when the disease turned out to be more extensive than originally detected.

The study involved a cohort of patients referred to MD Anderson from 1990 to 2010, many of whom were ultimately able to undergo a successful operation to remove the tumors. While the results of small series and isolated cases in which this approach was used have been published, this is the largest study including only those patients who had a previous unsuccessful attempt to remove the tumor, according to Dr. Fleming.

The pancreas is located in the back of the abdomen, near vital arteries and veins that provide blood to the intestines and liver. If the tumor encroaches on these vessels, the operation to remove the tumor can also involve reconstructing these important blood vessels, raising the complexity of the procedure. Reconstructing these vessels in a way that restores appropriate blood flow is critical for the overall wellness and survivability of patients after the operation.

The investigators stratified each patient's risk for metastatic disease based on tumor involvement with local blood vessels, suspicious biopsy results and the nature of the tumor, and overall health status aside from pancreatic cancer. Patients who met these criteria underwent the protocol.

The key to screening patients for treatment and staging of their cancer is radiographic imaging, specifically in the interpretation of CT scans of the tumors before the operation, Dr. Fleming explained. "The interpretation needs to be performed in conjunction with the radiologist, but also with heavy involvement by the surgeon," he said. "The goal should be to give the surgeon a clear idea of tumor location and vessel involvement before beginning the operation," he said.

The MD Anderson protocol also uses a scoring system along with structured documentation for the radiologist to more accurately assess the extent of tumor-vessel involvement, according to Dr. Fleming. "With good imaging and good interpretation you have a high likelihood of being able to predict involvement of the vessels before surgical treatment, not after," he said. About 46 percent of the patients in this study required some type of vascular resection, according to Dr. Fleming.

Of the 88 patients enrolled in the study, 50 of them came from academic centers, 25 from community hospitals, and 13 from international centers. However, hospital type and surgeon skill are not necessarily indicators of the setting in which this protocol can be used, Dr. Fleming said. Removing the pancreatic tumor and then sparing the veins and arteries requires not only a high level of technical surgical skill but also a focused team of medical specialists collaborating on complex pancreatic cancer, Dr. Fleming said.

The MD Anderson study underscores the need for patients with inoperable pancreatic adenocarcinoma to seek out a second opinion, Dr. Fleming said. "I would say to these patients and loved ones that it is important to advocate for yourself and your family, to seek out opinions, and not necessarily go with the first thing you hear as the answer," Dr. Fleming said. "This study is an example of patients who have benefited by persisting. 'Hope exists' is the message we want these patients to hear," he concluded.

About the American College of Surgeons

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the care of the surgical patient. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 78,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org(.)
This work was supported by the Various Donor Fund for Pancreatic Cancer Research, The University of Texas MD Anderson Cancer Center.

CONTACT:
Cory Suzan Petty
312-202-5328
or
Sally Garneski
312-202-5409
Email: pressinquiry@facs.org

Cory Suzan Petty | EurekAlert!
Further information:
http://www.facs.org

More articles from Health and Medicine:

nachricht One gene closer to regenerative therapy for muscular disorders
01.06.2017 | Cincinnati Children's Hospital Medical Center

nachricht The gut microbiota plays a key role in treatment with classic diabetes medication
01.06.2017 | University of Gothenburg

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Can we see monkeys from space? Emerging technologies to map biodiversity

An international team of scientists has proposed a new multi-disciplinary approach in which an array of new technologies will allow us to map biodiversity and the risks that wildlife is facing at the scale of whole landscapes. The findings are published in Nature Ecology and Evolution. This international research is led by the Kunming Institute of Zoology from China, University of East Anglia, University of Leicester and the Leibniz Institute for Zoo and Wildlife Research.

Using a combination of satellite and ground data, the team proposes that it is now possible to map biodiversity with an accuracy that has not been previously...

Im Focus: Climate satellite: Tracking methane with robust laser technology

Heatwaves in the Arctic, longer periods of vegetation in Europe, severe floods in West Africa – starting in 2021, scientists want to explore the emissions of the greenhouse gas methane with the German-French satellite MERLIN. This is made possible by a new robust laser system of the Fraunhofer Institute for Laser Technology ILT in Aachen, which achieves unprecedented measurement accuracy.

Methane is primarily the result of the decomposition of organic matter. The gas has a 25 times greater warming potential than carbon dioxide, but is not as...

Im Focus: How protons move through a fuel cell

Hydrogen is regarded as the energy source of the future: It is produced with solar power and can be used to generate heat and electricity in fuel cells. Empa researchers have now succeeded in decoding the movement of hydrogen ions in crystals – a key step towards more efficient energy conversion in the hydrogen industry of tomorrow.

As charge carriers, electrons and ions play the leading role in electrochemical energy storage devices and converters such as batteries and fuel cells. Proton...

Im Focus: A unique data centre for cosmological simulations

Scientists from the Excellence Cluster Universe at the Ludwig-Maximilians-Universität Munich have establised "Cosmowebportal", a unique data centre for cosmological simulations located at the Leibniz Supercomputing Centre (LRZ) of the Bavarian Academy of Sciences. The complete results of a series of large hydrodynamical cosmological simulations are available, with data volumes typically exceeding several hundred terabytes. Scientists worldwide can interactively explore these complex simulations via a web interface and directly access the results.

With current telescopes, scientists can observe our Universe’s galaxies and galaxy clusters and their distribution along an invisible cosmic web. From the...

Im Focus: Scientists develop molecular thermometer for contactless measurement using infrared light

Temperature measurements possible even on the smallest scale / Molecular ruby for use in material sciences, biology, and medicine

Chemists at Johannes Gutenberg University Mainz (JGU) in cooperation with researchers of the German Federal Institute for Materials Research and Testing (BAM)...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Plants are networkers

19.06.2017 | Event News

Digital Survival Training for Executives

13.06.2017 | Event News

Global Learning Council Summit 2017

13.06.2017 | Event News

 
Latest News

Quantum thermometer or optical refrigerator?

23.06.2017 | Physics and Astronomy

A 100-year-old physics problem has been solved at EPFL

23.06.2017 | Physics and Astronomy

Equipping form with function

23.06.2017 | Information Technology

VideoLinks
B2B-VideoLinks
More VideoLinks >>>