The issue of offering combination treatment with radiation and chemotherapy AFTER pancreatic cancer surgery (for ductal adenocarcinoma of the pancreas) to improve survival has been in place based on the classic August, 1985 study by the (U.S.) Gastrointestinal Tumor Study Group under Kalser and Ellenberg published in the Archives of Surgery. These findings appear to have been essentially confirmed by European researchers, but the additional use of the radiation in the regimen has been strongly challenged by the work of the European Study Group for Pancreatic Cancer since the early 1990s.
This debate has raged on – with research appearing to support each side at different times.
A recent article by Landry and colleagues at Emory University in Atlanta may help shed some light on the subject. In the June 15th 2013 issue of the journal Cancer, the authors report reviewing National Cancer Data Bank information from 1998 until 2002 – specifically looking for the outcomes of the treatment of pancreatic cancer in those treated with surgery and subsequent adjuvant radiochemotherapy – as broken out by the dosage used in the radiation portion of the regimen.
The researchers looked at four radiation dosage categories – and found that those who received more than OR less than the perceived “optimal” dosage of radiation for post-surgical chemoradiation for pancreatic cancer, did not fare as well as those who received the optimal dose (between 50 to 55 Gy).
This is an intriguing finding – which could help explain apparent disparate results among serious scientists. The results are preliminary, and deserve further inquiry to help determine the extent and modalities of adjuvant treatment that is generally necessary to produce the best outcomes after the surgery for pancreatic cancer.
Dale O’Brien, MD