Pancreas

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Proton therapy for pancreatic cancer

Pancreatic cancer is ranked fourth in the list of cancer induced deaths in men and women. At the same time it poses an enormous therapeutic problem: this type of cancer can remain entirely without any symptoms, and thus undetected, until the stage where it has already metastasised.

Today, an increasing number of examinations are undertaken, which can detect pancreatic carcinoma at an early stage, while it is still symptomless and curable.

Chemotherapy as stand-alone treatment method cannot cure the cancer but merely extends life for a few months. Despite the introduction of new chemotherapeutics and targeted-therapy, this method remains restricted to prolonging life.

This surgery is not only of very high risk; it is also prone to cause numerous complications and has negative effects on the functionality of the gastrointestinal tract.

Nevertheless, radical surgical resection of the carcinoma and surrounding lymphatic nodes so far remains the only potentially curative therapy in the early stage. Even in highly experienced surgical centres the risk associated with the surgery remains very high at about 5%.

Any radiation method with X-rays that is presently available is no satisfactory alternative. X-rays being a “shoot-through” method, the healthy tissue is exposed to a multiple of the dose - up to five times the tumour dose - in front of and behind the tumour.

Limitations of radiotherapy

Surgery is, in cases where the cancer is located in the so called head of the pancreas close to the duodenum, one of the most extensive abdominal surgeries possible: the “Whipple operation” named after its developer.

Chemotherapy

Pancreas surgery

Clinical symptoms such as jaundice caused by a compression of the biliary duct, which runs through the pancreas, often occur only at such a late stage that a cure of this cancer is no longer possible. More than 80% of these cases cannot be healed; therapy merely prolongs life for a few months.

These include image-guided examinations in the context of targeted screenings or unrelated examinations of the upper abdomen such as magnetic resonance imaging, computed tomography or sonography, which in some cases is capable of an analysis of the pancreas.

Radiation technology with X-rays has advanced rapidly over the past years. With the help of intensity modulated radio therapy (IMRT), tomotheraphy, or stereotactic ARC irradiation it is possible to better adapt the radiation dose distribution to the respective tumour shape.

However, regardless of which x-ray radiation method is chosen, or from how many different directions the tumour is irradiated, the parts of the small intestine in front of the pancreas are always irradiated with a high dose.

In the case of radiation with X-rays, there is also a high radiation exposure of other organs such as liver, kidneys, stomach or spinal cord. In order not to exceed the maximum acceptable dose to these critical organs, the dose which can be applied to the pancreatic tumour is limited.

Advantages of proton therapy

Proton therapy provides a three-times better concentration of radiation within the tumour compared to radiotherapy

See our page on proton therapy

For more details see the Rinecker Proton Therapy Center quarterly report for December 2011 showing the results of recent studies.

Review coutesy of Rinecker Proton Therapy Center, Munich

The absence of any radiation beyond the tumor (in the direction of the beam) and a dose in front of the tumor which is far lower than with X-rays means that it is finally possible to irradiate pancreatic carcinomas with a curative dose.

Even though current surgery methods are highly advanced, only 10%-25% of the pancreatic carcinomas are primarily operable. Even then a total resection of the carcinoma without any tumour tissue remaining is possible in only 60% of cases.

MHL is always seeking out the latest and best treatments for pancreatic diseases and we feature a number of centers which offer advanced specialist or multidisciplinary treatment options. Conditions treated include pancreatic cancer, pancreas transplants, chronic pancreatitis, cystic tumors and pancreatic duct diseases.

Pancreas centers

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