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Preoperative radiation nearly doubles the survival rate for patients with operable pancreatic cancer, according to the results of a study published in the November 15, 2008 issue of the International Journal of Radiation Oncology Biology Physics.[1]

The pancreas is an organ that is surrounded by the stomach, small intestine, bile ducts (tubes that connect the liver to the small intestine), gallbladder, liver, and spleen. The pancreas helps the body to break down food and also produces hormones, such as insulin, to regulate the body’s storage and use of food.

Pancreatic cancer has one of the highest mortality rates of all cancers. It accounts for approximately 2% of all newly diagnosed cancers in the United States each year but 5% of all cancer deaths. Pancreatic cancer is often called a “silent killer” because its symptoms are usually not recognizable until it has advanced and spread outside the pancreas. As a result the majority of pancreatic cancers are not diagnosed until they have reached advanced stages and are considered incurable.

If pancreatic cancer has not spread to surrounding or distant organs, it is usually considered operable. Historically, patients have been treated with surgery followed by chemotherapy and/or radiation to destroy any micrometastases (cancer cells that have spread outside the pancreas). New research indicates, however, that neoadjuvant radiation therapy (radiation delivered prior to surgery) might offer greater benefit to patients because it can potentially shrink the tumor prior to surgery, thereby ensuring a better chance of removal. Furthermore, because pancreatic surgery

is so invasive, many patients are in no condition to undergo radiation treatment after surgery, so neoadjuvant treatment allows them to receive radiation that they might not receive otherwise.

Researchers from the Weill Cornell Medical College used data from the Surveillance, Epidemiology, and End Results (SEER) registry database to perform a retrospective analysis on patients who had surgically resected (removed) pancreatic cancer between 1994 and 2003. The researchers compared the overall survival rates among patients who received neoadjuvant radiation, adjuvant radiation, or no radiation. Patients who received neoadjuvant radiation survived 23 months, compared with 12 months for patients who did not receive radiation and 17 months for those who received adjuvant radiation (following surgery).

The researchers concluded that neoadjuvant radiation therapy offers a significant benefit over surgery alone or surgery with adjuvant radiation therapy in treating pancreatic cancer. Research will likely be ongoing to further explore these findings.

Reference:
[1] Stessin AM, Meyer JE, Sherr DL. Neoadjuvant radiation is associated with improved survival in patients with resectable pancreatic cancer: An analysis of data from the Surveillance, Epidemiology, and End Results (SEER) Registry. International Journal of Radiation Oncology Biology Physics. 2008; 72: 1128-1133.

Like to eat meat? Consider this unappetizing truth: When you gulp down a nice juicy steak or hamburger, you are contributing to tumor-fueling inflammation in your body.In fact, eating a diet rich in red meat has long been linked to a host of ills including an increased risk of several types of cancer. But what is it about meat consumption that could impact cancer growth? Now scientists at the University of California, San Diego School of Medicine, have found a mechanism that explains how eating red meat, as well as milk, could spur the growth of malignancies. The new study, headed by Ajit Varki, M.D., suggests that inflammation resulting from a molecule introduced through eating these foods could make cancer grow. The research is set for upcoming publication in the Proceedings of the National Academy of Sciences (PNAS).Dr.Varki, UC San Diego School of Medicine distinguished professor of medicine and cellular and molecular medicine and co-director of the UCSD Glycobiology Research and Training Center, and his research team studied a non-human glycan, or sugar molecule, known as N-glycolylneuraminic acid (Neu5Gc). Although this molecule is not produced naturally in the human body, it’s incorporated into human tissues if you eat red meat. The body then develops antibodies against Neu5Gc – and this immune response could potentially trigger a low-grade chronic inflammation, spurring the growth of cancer. In a statement prepared for the media, Dr. Varki explained it has been recognized by scientists for some time that chronic inflammation can stimulate cancer progression."We've shown that tumor tissues contain much more Neu5Gc than is usually found in normal human tissues. We therefore surmised that Neu5Gc must somehow benefit tumors,” Dr. Varki said in the press statement. So the scientists came up with this hypothesis: The fact that Neu5Gc accumulates in human tumors despite circulating anti-Neu5Gc antibodies suggests a low-grade, chronic inflammation has developed, and caused the tumor to grow. To test this idea, the researchers worked with specially bred mice. The animals lacked the Neu5Gc molecule , just as humans do before they eat red meat and the molecule is absorbed into their bodies, and they had tumors.Anti-Neu5Gc antibodies were given to half of the mice . In those animals, the antibodies induced inflammation and their cancers started growing faster. In the control group comprised of mice that were not treated with antibodies, their tumor growth was far less aggressive.Building on previous research that has shown that humans who take non-steroidal anti-inflammatory drugs (commonly known as NSAIDs) have a reduced risk of cancer, the researchers tried giving NSAIDs to the mice with cancerous tumors fueled by anti-Neu5Gc antibodies. The result? The anti-inflammatory treatment blocked the effect of the Neu5Gc antibodies and the tumors became smaller."Taken together, our data indicate that chronic inflammation results from interaction of Neu5Gc accumulated in our bodies from eating red meat with the antibodies that circulate as an immune response to this non-human molecule – and this may contribute to cancer risk," Varki said in the media statement.For anyone interested in reducing inflammation through natural, non-drug methods, here are seven top strategies to incorporate into your lifestyle:1. Stop eating meat and dairy products.2. Concentrate on a Mediterranean flavored style of eating with lots of fruits, vegetables, whole grains , olive oils and nuts. Research has shown these foods lower inflammation levels.3. Don’t smoke and avoid those who do – second hand smoke can contribute to inflammation.4. Know your oils. Avoid all inflammation-causing trans-fats, hydrogenated and partially hydrogenated oils as well as saturated animal fats. Instead, add inflammation-fighting omega-3 oils like flaxseed, canola and walnut oil to your diet.5. Lose weight if you need to. Research has shown that a waist that measures over 40 inches in a man or over 35 inches in a woman is a sign of probable high inflammation.6. Don’t skimp on sleep. Previous studies have concluded less than six hours of sleep can result in inflammation .7. De-stress. Try yoga, meditation, walking and other forms of exercise. Staying continually stressed out means your body is releasing excess, inflammation-promoting stress hormones . Schedule a minimum of 20 minutes a day to let your worries go.

Researchers recommend that at least 15 lymph nodes be removed and examined in patients with early gastric or pancreatic cancers. These results were recently published in the Archives of Surgery.
For accurate staging, or determination of extent of spread of gastric and pancreatic cancers, surgeons remove lymph nodes near the cancer. The lymph nodes are examined under a microscope to assess whether the cancer has spread to the lymph nodes, and if so, the extent of spread. Because treatment options are determined by the stage of the disease, an accurate assessment of spread to lymph nodes (nodal metastases) is imperative for optimal therapeutic choices.
Medical institutions that treat a high volume of patients with this disease or institutions affiliated with the National Comprehensive Cancer Network (NCCN) or National Cancer Institute (NCI), which follow strict guidelines, often tend to remove a larger number of lymph nodes during surgery than community centers or centers that treat a lower volume of patients with these diseases. It is currently not clear whether the removal of more nodes is associated with improved outcomes; however, patients treated at NCCN or NCI-designated centers or treated at medical centers that experience a high volume of these patients tend to have improved outcomes.
To further explore the possibility that the removal of more lymph nodes is associated with improved outcomes for patients diagnosed with gastric or pancreatic cancers, researchers evaluated outcomes among patients with gastric and pancreatic cancers who were treated at either high-volume or community medical centers (lower-volume centers). Included was data from the National Cancer Data Base from 2003-2004, which included more than 4,000 patients.
Patients undergoing surgery at National Comprehensive Cancer Network (NCCN) or National Cancer Institute (NCI)-designated institutions had more lymph nodes removed and examined than those treated at a community medical center.
Patients undergoing surgery at medical centers treating high volumes of patients with either gastric or pancreatic cancers also had more lymph nodes removed than those undergoing treatment at medical centers treating low volumes of these patients.
The researchers concluded that NCCN and NCI-designated centers and medical centers that treat a high volume of patients with pancreatic and gastric cancers tend to surgically remove more lymph nodes than community centers or medical centers that treat a low volume of patients with these diseases. The authors state: “Examination of at least 15 lymph nodes is an appropriate quality surveillance measure for gastric and pancreatic cancer because it is a feasible, achievable, and modifiable factor that is associated with improved outcomes.”
Patients diagnosed with gastric or pancreatic cancers may wish to speak with their physician regarding the status of the center at which they are receiving surgery. They may also wish to discuss their individual risks and benefits of greater removal of lymph nodes at the time of surgery.
Reference: Bilimoria K, Talamonti M, Wayne J, et al. Effect of hospital type and volume on lymph node evaluation for gastric and pancreatic cancer. Archives of Surgery. 2008;143:671-678

According to the results of a Phase II clinical trial, the addition of the investigational drug EndoTAG™-1 to chemotherapy with Gemzar® (gemcitabine) may improve survival among patients with inoperable pancreatic cancer. These results were presented at the 33rd Congress of the European Society for Medical Oncology (ESMO).
Pancreatic cancer has one of the highest mortality rates of all cancers. It accounts for approximately 2% of all newly diagnosed cancers in the United States each year but 5% of all cancer deaths. Pancreatic cancer is often called a “silent killer” because its symptoms are usually not recognizable until it has advanced and spread outside the pancreas. As a result the majority of pancreatic cancers are not diagnosed until they have reached advanced stages and are considered incurable.
Chemotherapy is a common treatment for advanced pancreatic cancer. However, due to the poor long-term survival achieved with chemotherapy alone, researchers continue to evaluate novel ways to improve outcomes for these patients.
EndoTAG™-1 is an investigational drug that is intended to “starve” cancer by destroying blood vessels that supply the tumor. It binds to cells that line new blood vessels and then releases the chemotherapy drug paclitaxel.
To evaluate EndoTAG™-1 in the treatment of pancreatic cancer, researchers conducted a Phase II clinical trial among 200 patients with inoperable, locally advanced or metastatic pancreatic cancer. In addition to treatment with the chemotherapy drug Gemzar® (gemcitabine), patients were assigned to receive one of three doses of EndoTAG™-1 or a placebo.
12-month survival was 17% among patients treated with Gemzar alone. Among patients treated with both Gemzar and EndoTAG™-1, survival was 22% among patients treated with the low dose of EndoTAG™-1, 36% among patients treated with the medium dose of EndoTAG™-1, and 33% among patients treated with the high dose of EndoTAG™-1.
During the latter part of the study, patients who responded to EndoTAG™-1 had the opportunity to continue treatment with EndoTAG™-1 for a longer period of time. Among these patients 12-month survival was 25% among patients treated with the low dose of EndoTAG™-1, 52% among patients treated with medium dose of EndoTAG™-1, and 40% among patients treated with the high dose of EndoTAG™-1.
This study suggests that EndoTAG™-1 may improve survival among patients with inoperable pancreatic cancer. Dr. Mathias Löhr, the principal investigator on the study, noted that “These study data demonstrate a noticeably higher efficacy from EndoTAG™-1 treatment compared to currently available treatments for pancreatic cancer.” These results will need to be confirmed in other studies.
Patients with pancreatic cancer may wish to discuss with their physician the risks and benefits of participating in a clinical trial further evaluating this or other promising therapeutic approaches. Two sources of information about ongoing clinical trials are the National Cancer Institute (www.cancer.gov) and www.eCancerTrials.com.
Reference: MediGene press release. MediGene reports positive 12-month survival data for EndoTAG™-1 from Phase II pancreatic cancer study. Available at: http://www.medigene.de/englisch/pressemitteilungen.php?ID=2599 (Accessed September 17, 2008).

Preoperative radiation nearly doubles the survival rate for patients with operable pancreatic cancer, according to the results of a study published in the November 15, 2008 issue of the International Journal of Radiation Oncology Biology Physics.[1]
The pancreas is an organ that is surrounded by the stomach, small intestine, bile ducts (tubes that connect the liver to the small intestine), gallbladder, liver, and spleen. The pancreas helps the body to break down food and also produces hormones, such as insulin, to regulate the body’s storage and use of food.
Pancreatic cancer has one of the highest mortality rates of all cancers. It accounts for approximately 2% of all newly diagnosed cancers in the United States each year but 5% of all cancer deaths. Pancreatic cancer is often called a “silent killer” because its symptoms are usually not recognizable until it has advanced and spread outside the pancreas. As a result the majority of pancreatic cancers are not diagnosed until they have reached advanced stages and are considered incurable.
If pancreatic cancer has not spread to surrounding or distant organs, it is usually considered operable. Historically, patients have been treated with surgery followed by chemotherapy and/or radiation to destroy any micrometastases (cancer cells that have spread outside the pancreas). New research indicates, however, that neoadjuvant radiation therapy (radiation delivered prior to surgery) might offer greater benefit to patients because it can potentially shrink the tumor prior to surgery, thereby ensuring a better chance of removal. Furthermore, because pancreatic surgery is so invasive, many patients are in no condition to undergo radiation treatment after surgery, so neoadjuvant treatment allows them to receive radiation that they might not receive otherwise.
Researchers from the Weill Cornell Medical College used data from the Surveillance, Epidemiology, and End Results (SEER) registry database to perform a retrospective analysis on patients who had surgically resected (removed) pancreatic cancer between 1994 and 2003. The researchers compared the overall survival rates among patients who received neoadjuvant radiation, adjuvant radiation, or no radiation. Patients who received neoadjuvant radiation survived 23 months, compared with 12 months for patients who did not receive radiation and 17 months for those who received adjuvant radiation (following surgery).
The researchers concluded that neoadjuvant radiation therapy offers a significant benefit over surgery alone or surgery with adjuvant radiation therapy in treating pancreatic cancer. Research will likely be ongoing to further explore these findings.