A population of patients with borderline resectable or locally advanced pancreatic cancer who received a dose of radiation during surgery experienced disease recurrence of 5%.

Researchers at the Johns Hopkins Kimmel Cancer Center (MD, USA) have achieved what they believe is the lowest recurrence rate after surgery ever reported for patients with borderline resectable or locally advanced pancreatic cancer. In research presented at the American Society for Radiation Oncology Annual Meeting (27 September‒1 October, CA, USA), a 5% recurrence rate after surgery with intraoperative radiation, was reported.

Pancreatic cancer is associated with poor outcomes due to the late stage at which many cases are diagnosed. Often, tumors have already spread to the vasculature, which means that surgery is not possible or, if surgery is appropriate, there is often a high rate of recurrence.

Recent advances in combination treatments have used chemotherapy and radiation to reduce tumor size, which has enabled more patients to undergo surgery. However, this has had little impact on recurrence.

Targeting the site of recurrence

In this research, a team led by Amol Narang (Johns Hopkins Kimmel Cancer Center), identified that cancer cells were accumulating in a triangular area of tissue just above the pancreas, which they termed the Baltimore triangle. They discovered that targeting the triangle before surgery reduced the recurrence rate from 47% to 12%, 2 years post-surgery; when recurrence did occur, despite the pre-surgery radiation, it was located within the triangle.

To address this localized recurrence, Narang treated patients first with chemotherapy and radiation before their surgery. The team then used radioactive beads, similar to brachytherapy, to deliver radiation directly to the Baltimore triangle. Just one of the 20 patients treated experienced recurrence at the 24-month mark.

Study reveals how cigarette smoke toxins drive pancreatic tumor growth

Research has revealed chemicals found in cigarette smoke directly drive pancreatic cancer growth through IL22–mediated T–reg production.

“The combination of intraoperative radiation and targeting the Baltimore triangle has gotten us to a 5% recurrence rate, which is the lowest-ever reported recurrence rate around the pancreas for this population of patients to our knowledge. But I think we can drop to 0% in our next study,” Narang commented.

“We must do whatever we can to prevent recurrences from happening, because when pancreatic cancer comes back, it is often incurable. These results give us hope, though, that this can be done for a cancer where even a decade ago, most thought this wasn’t possible.”

The team is now investigating strategies to target the hardest-to-reach parts of the triangle, where the sole recurrence took place. They hope to bring this refined approach to other cancer centers to validate their results.