In pancreatic cancer, preceding surgery with part of chemotherapy combined with radiotherapy improves the operative result and survival.
Pancreatic cancer is cancer that is often diagnosed late and its progression is so important that surgery is often not enough to cure it, even in the early stages. Chemotherapy and radiotherapy are therefore started after surgery as standard treatment.
In a new study presented at the 2018 Congress of the American Cancer Society, ASCO, it appears that starting chemotherapy and radiotherapy before surgery improves patient survival at 2 years (42%) compared to chemotherapy. radiotherapy performed after surgery (30%).
Improvement in surgery
In addition, surgical resection could be performed more often in patients who had chemo-radiotherapy before (72%), whereas it could only be done in 62% of cases in other patients. In patients who had surgical resection, the tumor could be removed completely more often (based on microscopic examination of the cut edges of the surgical specimen) if chemo-radiotherapy is performed before surgery (63% versus 31% ). The tolerance of this protocol was good and did not delay the surgery.
A change in practices to come
The PREOPANC-1 study included 246 patients suffering from an operable pancreatic cancer (“resectable” cancer). Patients were drawn at random to either receive part of the chemo-radiotherapy (gemcitabine and radiotherapy) before surgery and the other after, or to receive all after surgery (the total dose of chemotherapy is equivalent within 2 groups).
The median overall survival is 17.1 months in the chemo-radiotherapy group before compared with 13.7 months if everything is done after surgery. In particular, in the group of patients in whom the surgery could have been completed, the difference in survival is even greater: 42.1 months versus 16.8 months.
Improvements in perspective
This is the first comparative study to demonstrate that the preoperative treatment of pancreatic cancer improves the prognosis and survival of operable patients.
There is still room for progression with an improvement in preoperative chemotherapy, for example by replacing gemcitabine with chemotherapy of the FOLFIRINOX type, which is more effective, as was demonstrated by adjuvanting in another study presented at the congress: the study PRODIVE 24-PA6. It is also possible to replace the usual radiotherapy with stereotaxic radiotherapy, which delivers the radiation doses much more precisely to the tumor and less to the surrounding tissues.
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