There has not been very much study on when “adjuvant” chemotherapy should begin after pancreatic cancer surgery (this process of chemo AFTER surgery is called adjuvant therapy). What is known is that adjuvant chemotherapy tends to confer a significant survival boost to pancreatic cancer patients (those with ductal adenocarcinoma of the pancreas). And perhaps it is fair to say that it has generally been assumed as to the timing of the start of this chemotherapy – that it should begin after the immediate effects of surgery have been weathered by the patient – and when that the patient with pancreatic cancer is well enough to begin to accept the side-effects of the chemo. But, does this timing have more significance than is generally believed?
Sueda and associates from Hiroshima University in Japan recently reviewed the records of 104 patients who received chemotherapy after potentially curable surgery in pancreatic cancer – dividing the patients into two groups: those who began the chemo more than or less than 20 days after the day of the pancreatic cancer surgery. They found that those who had received the chemotherapy earlier in the process had significantly better 5-year survival rates (52% vs. 26%). One factor of note is that the early chemo group tended to have had fewer after-surgery complications. So, might these surgical complications be a tell – that the later group was not as predisposed to survival? In any case, this surprising finding is worth considering – and deserves more study.
Dale O’Brien, MD