Dr. Katz on Preoperative Chemoradiation in Localized Pancreatic Cancer

Matthew H.G. Katz, MD, FACS, associate professor, Department of Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, discusses the role of preoperative chemoradiation for the treatment of patients with localized pancreatic cancer.

Chemotherapy has long been a mainstay of treatment in this space, but what investigators are still trying to understand is if there is a role for radiation therapy in these patients—particularly if these modalities can be given concurrently. Katz says he believes radiation has a place either preoperatively or postoperatively, but the definitive data are still out there.

There was a study that suggested the benefit of radiation in the preoperative setting, but this trial did not randomize patients to receive either radiation or chemotherapy; it randomized them to radiation or surgery alone. As such, it does not definitively show that radiation has a true benefit, Katz notes.

Chemoradiation seems to be beneficial before surgery, but phase III trials still need to confirm that. In general, physicians are more comfortable giving chemotherapy alone in the preoperative setting. For example, Katz says, he would not give chemoradiation to a patient at risk for subclinical metastatic disease or if their CA 19-9 level was astronomically high.