The Dutch Cancer Society (KWF Kankerbestrijding) has awarded a total of 5.5 million euro to ten Amsterdam UMC research groups for cancer research. One of the project proposals selected is entitled “Randomized trial of local treatment with high-dose precision radiation in vulnerable (elderly) patients with locally limited pancreatic cancer” by principal investigator Dr. Anna Bruynzeel (€ 452.487). Dr. Bruynzeel aims to improve outcome for this group of patients by testing if highly focused radiotherapy can improve survival and quality of life.
Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal cancers, and its incidence increases with age. Currently, the standard treatment consists of surgical removal of the tumor, possibly in combination with chemotherapy, or chemotherapy alone. Many patients that are diagnosed with localized (non-metastatic) PDAC have significant comorbidities, advanced age or a poor performance status which preclude chemotherapy and surgery. The overall survival of this (frail) patient group with localized but non-metastasized PDAC is poor, with an estimated median survival of 3-4 months, in comparison to 11 months for patients undergoing treatment. In current clinical practice, the only treatment that is available for this group is best supportive care, focused on symptom management. In addition to their short lifespan, many patients with localized PDAC experience pain, nausea and poor nutritional status that greatly reduces their quality of life. These patients may, however, be fit enough to undergo a short course of stereotactic ablative body radiotherapy (SABR). For them, a local, non-invasive treatment with high dose irradiation could therefore be of added value compared to symptom control alone.
SABR has been reported as ablative treatment resulting in a high local control rate and acceptable toxicity in patients with PDAC. The aim of the multicenter randomized PANCOSAR trial is to investigate the potential benefit in survival and quality of life after SABR in patients with localized PDAC for whom no other treatment is available, as compared to controls managed with best supportive care. With a positive outcome, this may set a novel standard of care for these patients.
