Does radiotherapy have a place in the adjuvant treatment of pancreatic cancer?

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Published: 25 Jul 2013
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Dr Bernard Cummings - University of Toronto, Toronto, Canada

Dr Cummings discusses the role of Radiation Therapy in the adjuvant treatment of pancreatic cancer, and the most recent studies that have been conducted in relation to this topic.

I was invited to talk about the role of radiation therapy in the adjuvant treatment of pancreas cancer.

This is quite controversial because the results of the few trials that have been done have been conflicting.

However, most radiation oncologists believe that the emphasis should be on what radiation therapy can contribute to the local control of pancreas cancer, that is to prevent the tumour recurring in the tumour bed.

Unfortunately, most of the studies that have been done so far have emphasised survival rather than the pattern of failure after treatment and we’re only now starting to get that data.

There is evidence that with good quality modern radiotherapy which is done according to strict protocols that we are able to reduce the risk of local recurrence.

This is significant for patients because a recurrence in the tumour bed is often associated with pain and that pain can be very difficult to control.

So although at the moment radiation is not clearly contributing to an improvement in survival, since pancreas cancer so frequently metastasises, it very definitely appears to have a role in reducing the morbidity that’s associated with this cancer.

The most convincing study for radiation is actually one done in Europe where they were able to show a reduction in the local failure rate from 24% when the patients got adjuvant chemotherapy only to 11% when  the patients got both radiation and chemotherapy.

That study, while it’s relatively small, forms one of the pillars of our ongoing belief that radiation does have a role to play in the adjuvant management of pancreas cancer.

I think with pancreas cancer it’s not clear, there’s no doubt that the gall bladder cancer and biliary tract cancer is more common in South America but I’m afraid I’m not an epidemiologist and I don’t understand really what is the basis for that difference.

I know there’s a difference there so I know it’s a significant health problem but I’m not able to explain it.

The main message that I would send is that in all cancers the days of single modality therapy are probably past and we need to concentrate more on the best way to integrate various types of treatment, be they surgery, radiation treatment, systemic therapy.

How are we going to integrate those to the best advantage to the patient and then are we willing to commit the time and the effort to put patients into clinical trials which will give us the level of evidence that we really need?

Thank you very much, Dr Cummings, for being here with us today.

It’s a pleasure. Thank you very much for inviting me.