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Good news for borderline resectable patients

Postby Wife&Mum » Wed May 25, 2016 6:59 pm

For those with a recent diagnosis of 'borderline resectable', some very positive news has just come out of the U.S. Mayo Clinic ...patients who are treated with chemotherapy, radiation therapy then aggressive surgery are on average living 4 times longer than previously (median overall survival 4 years compared to median os of 1 year).

Further details and a video at this link:

http://newsnetwork.mayoclinic.org/discu ... -involved/

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Re: Good news for borderline resectable patients

Postby boa » Thu May 26, 2016 6:53 am

Wife&Mum, thanks for posting this. It seems very hopeful. I'd be interested in a view from the nurses here on this information. I can't get the video to play so maybe the answer is there. As far as I can see this research involves looking at historical outcomes for patients rather than a clinical trial. If the median survival time has moved from one year to four the that's pretty amazing. Catherine

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Re: Good news for borderline resectable patients

Postby Wife&Mum » Thu May 26, 2016 8:34 am

Catherine, I agree it would be great to have the view of a PCUK Nurse on this.

I have another link for the video that might work this time:

Also, here's another news report on the same study which I think is written more clearly:
http://www.news-medical.net/news/201605 ... r-patients.

My own interpretation of this info from Mayo is that:
- Mayo Clinic have studied the treatment and outcomes of their PC patients with vascular involvement over the last 25 years
- the patients treated more recently have, on average, shown an improvement in overall survival (os) of 4 times compared to patients treated earlier in the study.
- improvements in os over the 25 years are thought to be due to:
*increase in number of patients having aggressive surgery
*these same patients having chemo and radiotherapy before surgery
*new chemo regimes which are more effective than older regimes
- a group of 80 recent Mayo patients have followed this chemo+radio+aggressive surgery protocol and done well
- some of the 80 patients have done especially well: those who had a lot of chemo pre-surgery, those whose CA19-9 returned to normal after chemo and those whose tumour was found to be negligible at surgery.

Another factor talked about in the write ups of the study is that pre-surgery scans don't necessarily show reduction in the tumour - the only way to know if a tumour has shrunk is to take the patient to surgery.

W&M xx

PCUK Nurse Jeni
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Re: Good news for borderline resectable patients

Postby PCUK Nurse Jeni » Thu May 26, 2016 12:53 pm

Hi W & M,

Thanks so much for posting this - you are brilliant at searching, finding and sharing! We really appreciate you highlighting things on the forum as well - we are not always able, due to time, to keep searching, although some of us do have searches set up which come through weekly.

This is such a great article - and whats really fantastic is that some of the common misconceptions have been dispelled here - that people who have vessel involvement can in fact, be brought to surgery after several treatments - and that even if CT scans don't show reduction, at operation there were signs of tumour death! This is such good news, and also that if you had chemo pre -op, you were more likely to do well post operatively. Hoping that we may see some of these results coming through after ESPAC 5 is reported, but that is a long way off I know.

I think this is really exciting actually. I am going to pass this onto the rest of the team, and also our head of research, and get their comments as well.

Kind regards,


Pancreatic Cancer Specialist Nurse,

Support Team.

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Re: Good news for borderline resectable patients

Postby Wife&Mum » Thu May 26, 2016 4:09 pm

Hi Jeni

Thanks for your kind words. I am so pleased to help!

This isn't the first study to suggest that CT scans can't be relied on to show tumour death. My husband's surgeon (an expert in venous involvement of PC) was aware of this and hopefully the word has spread to surgery teams throughout the UK. But if they don't keep up with the literature they may not know :-(

Although my hubby's failed Whipple, just after diagnosis, felt at the time like the worst news in the world, we have come to believe that it was a blessing in disguise. Because it meant that he was given the same protocol as this Mayo one which is giving such great long term results.

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Re: Good news for borderline resectable patients

Postby Didge » Thu May 26, 2016 4:18 pm

A brilliant link, thanks! Let's hope it helps many more in this country xx

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Re: Good news for borderline resectable patients

Postby Wife&Mum » Sat May 28, 2016 5:41 pm

Hi again

At the risk of labouring the point, I thought I'd share here details of another new US article saying that after neoadjuvant chemo, scans can't be relied on to show where chemo has worked and PC disease has become operable:

Treatment of Locally Advanced Pancreatic Ductal Adenocarcinoma


It says:
"findings are consistent with other studies suggesting that radiologic indicators of resectability are unreliable after receipt of neoadjuvant chemotherapy or chemoradiation"

So if you or your loved one has PC that ticks all these boxes:
Borderline resectable or locally advanced
Treated aggressively with chemo and/or chemoradiation

....exploratory surgery might be the way to go even if scans show no change.

W&M (just a carer - not a medical professional!)