Johns Hopkins researchers have found that pancreatic cancer patients may live longer if they undergo chemotherapy and radiation after surgery, and that more people than previously thought may have an inherited risk for pancreatic cancer.
The findings provide further insight into the nation's fifth-leading cancer killer and may lead to earlier diagnosis and more effective treatment, say the Hopkins researchers.
Results of the two studies, which were supported by the National Institutes of Health, were presented recently at the annual meeting of the Southern Surgical Association and are published in the December issue of Cancer Research.
In the first study, researchers studied 174 Hopkins patients who underwent a complex surgery known as the Whipple procedure (pancreaticoduodenectomy) for a malignant cancer called adenocarcinoma of the head, neck or tail of the pancreas.
The patients were given three therapy options after surgery: 99 chose standard therapy, which included radiation and chemotherapy (chemoradiation); 21 selected intensive therapy, which included stronger chemoradiation; and 53 declined chemoradiation. (One patient died in the hospital after surgery).
Patients receiving either form of chemoradiation had a median survival rate of 19.5 months compared to 13.5 months for patients foregoing chemoradiation. Median survival rates were 21 months for the standard therapy and 17.5 months for the intensive therapy. The results were independent of tumor size, blood loss during surgery and whether the cancer had spread to the lymph nodes.
"Many patients choose not to receive postoperative chemoradiation therapy, but our findings show it appears to significantly improve survival for all patients," says Charles J. Yeo, M.D., the study's lead author and a professor of surgery. "Early diagnosis, surgery to remove the tumor and postoperative chemoradiation therapy appear to be needed for long-term survival and a potential cure."
The Whipple procedure involves removing part of the pancreas and all of the duodenum (a portion of the small intestine), gallbladder, bile duct and sometimes part of the stomach. Pancreatic cancer is the fifth-leading cause of cancer death in the United States.
In the second study, scientists analyzed tumors and healthy tissue from pancreatic cancer patients and found that 7 percent of the patients had inherited mutations in the BRCA2 gene, which has been linked to breast and ovarian cancer. Scientists also found several new mutations in the gene involved in pancreatic cancer.
Despite the large number of inherited mutations, none of the families involved had a history of pancreatic cancer. That may be, in part, because the disease usually strikes late in life and the cancer never developed because the person died of other causes, says Scott E. Kern, M.D., the study's senior author and an assistant professor of oncology.
"A familial inheritance was thought to be uncommon, but we found an usually high rate," says Kern. "Our results suggest that many people don't think they have a familial susceptibility, but yet they do."
Several genes and mutations have been identified thus far in pancreatic cancer, but Kern says several more may be involved and that actual rate of inherited susceptibility is even higher.
"This is an important first step toward developing a method for early diagnosis," he says. "Early screening is important, but we're still learning what genes and mutations are involved in pancreatic cancer."
Hopkins was joined in the second study by the Henry Ford Hospital and Creighton University School of Medicine.
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