Regional Hepato-Pancreatico-Biliary Unit - Surrey and Sussex

Associated sites:   Liver-cancer.co.uk,    Liver.org.uk,   Gallstones.co.uk

Survival

Resection with curative intent provides the only chance of long term survival. The 1 year survival rate is 50-60% and published 5 year survival rates may reach 20%. However even in the group of long term survivors 40-50% of will also eventually die of recurrence. Long term survival is more likely if the tumour is well differentiated, is less than 3cm in diameter, has clear resection margins and there is no lymph node involvement. Those who are unfortunate enough to develop early spread (metastatic disease) of the cancer within the first year will have a median post-operative survival of up to 18months. 

Adjuvant treatment in resectable pancreatic cancer

After surgical resection for pancreatic cancer, 50-80% of patients develop local recurrence or metastases usually within 2 years of surgery. Adjuvant treatment has been given in pancreatic cancer either as hormonal therapy, chemotherapy, radiotherapy in combination with chemotherapy, or immunotherapy.

    Surgery plus systemic adjuvant chemotherapy

In a randomised controlled trial involving 61 patients who had undergone a Whipple's procedure post-operative chemotherapy (5-fluorouracil (5-FU), doxorubicin, and mitomicin -C) increased median survival from 11 months to 23 months (p=0.02), but not the proportion of patients alive at 2, 3 or 5 years.. Nearly 20% of patients discontinued chemotherapy prematurely due  to unwanted effects.

A multi-centre randomised controlled study involving 473 patients who had undergone surgery fro pancreatic cancer found that chemotherapy with 5FU and folinic acid daily for 5 days each month for 6 months, increased median survival from 14 months to 20 months . A quarter of the patients experienced serious side effects.

    Surgery plus radiotherapy or chemotherapy

Intra-operative or post-operative radiotherapy alone does ot appear to improve survival in randomised controlled trials. Nor does the use of adjuvant radiotherapy plus sensitising chemotherapy (Chemo-radiation) after surgery appear to confer benefits over surgery alone.

Giving chemo-radiation before surgery (neo-adjuvant therapy) has been tried in an attempt to reduce tumour size and might allow more complete resection. In a non-randomised study of this approach in 51 patients, local recurrence was 17% compared with 5--8-% in studies of surgery alone , but survival was similar. Neo adjuvant chemo-radiation was associated with nausea, vomiting, and dehydration severe enough to require hospitalisation of a third of patients.