Can radiation be given between finishing chemo and having Whipple?

I had 8 cycles of FOLFIRINOX and then was pushed by my Whipple surgeon to get radiation. My surgeon was at the Mayo, but I was doing the chemo at Stanford. The original radiation plan proposed by Stanford could have caused future complications down the road with problems like bowl obstructions. I found that they were recommending a radiation plan that they use as typical for 90% of the pancreatic cancer patients. But most of those patients do not qualify for Whipple surgery and so the radiation plan was more aggressive. In the end the Mayo advised the Stanford radiation oncologist on a less aggressive radiation plan which I underwent.

A different doctor friend of mine was speculating—and this is just speculation—that the surgeon wanted the radiation because it firmed up the tissue of the pancreas making it easier to work with for the Whipple.

Steveron, that’s going to be a personal choice by you relative to yes or no on radiation. Drs seem to have different attitudes about it. I’m with UCLA and even when I asked about HIPEC radiation their response was a “no” as they felt the intention behind it was out of date. Many others on this thread have received it and it can be achieved with success in some cases in keeping one cancer free. I’m just not willing to take that particular risk especially since I have the KRAS12D, ATM, and TP53 genes which are a little harder to beat and the likelihood of cancer coming back is a bit higher. The question I would ask anyone with pancreatic cancer who has had (radiation) is how many years since and did the cancer come back? Personally and since I’m doing well on it, am sticking with my biweekly GAC chemo treatments until a worthy clinical trial comes along.

good to know. thanks and best wishes for continued good progress.

Marienewland, Thanks for the info. We are finding lots of different opinions. Best wishes for continued good progress.

@steveron , how much time are you looking at between chemo and Whipple? The norm seems to be a 4-week washout to let you recover and let blood counts return to normal. The Whipple can be tough on a patient, and radiation can be as well, so I don't know if they'd want you coming into surgery all beaten down by radiation -- it could make your recovery a good bit harder. Also, it seems common to co-administer Gemcitabine (oral chemo) with radiation to help sensitize tissue to it. I'm not sure if radiation without Gem would be effective enough to be worth the risk. I inquired about using the Tumor Treating Fields equipment between chemo and Whipple to provide some level of control, but got nowhere with it. From another perspective, I'd be curious about whether radiating the pancreas head before a Whipple could increase your chance of getting R0 resection (clean and possibly bigger margin) by killing microscopic disease that might exist and be undetectable beyond the margin. You could always ask, but I doubt you'll find any takers.

@marienewland99 : Off-topic, but one thing I just learned this week is that long-term GAC chemo can be pretty tough on the kidneys. When I get my biweekly blood tests, I normally don't look too closely at the trends of parameters that are coming back in normal range (obviously focusing on those that are high or low). But on my new treatment this week, blood tests have shown abnormal levels of Creatinine, EGFR, and BUN (signs of underfunctioning kidneys). When I looked at all the historical data from starting 15 months of biweekly GAC to the present, those levels all went from the good end of normal to the bad end of normal -- downhill in almost perfectly straight lines; i.e., they never raised a red flag in 15 months, but all fell into the bad range this week, which is keeping me tied to a hydration IV pole 24/7. Hydration definitely improves the numbers. Just something to keep an eye on the longer you stay on GAC. Hope that's all continuing to go well!

I am a patient of Dr Mark Truty at Mayo, and he definitely is a fan of chemo, then radiation, before surgery. Not sure about Whipple in particular as I had a total pancreatectomy with vascular reconstruction. I did 28 days of radiation along with weekly Gemcitabine infusion. Then had a 4 week washout period before surgery. I was told it was time to let my body heal in preparation for such an extensive surgery. I had complete path response with no evidence of tumor at surgery. I do remember my local radiation oncologist discussing 2 approaches to radiation. One with surgery in the plan, and the other without. I honestly cannot remember which approach I took, but nonetheless, it appeared to work well for me. I am currently 11 months post-op and NED.

I would add only that one should discuss radiation with several sources. And do ask about the long term effects of radiation if you are stage IV and realistically will face reoccurrence. Radiation in some areas can limit treatments later. I am keeping it in my back pocket for sure but not rushing towards it.

@markymarkfl -you make such a good point! We need to be watching our numbers. Doctors are typically reacting only once we leave “normal range”. Trends are very important and can allow us to take proactive measures. We need to bring these to the attention of our doctors and not wait for them to alert-they often have many other patients that are in worse shape than us.

ashley2235
That’s very good news regarding NED. Did you have the BRCA2 gene? Sounds like a plan outside of the typical protocol that worked! My niece
Went to same Mayo Clinic for thyroid cancer and it was a complete success for her which is about 10 yrs ago now.

Hi. I don't have any genetic mutations that they have found.

markymarkfl thank you for your very in-depth information regarding radiation. Hoping you are feeling well, other than the situation you mention; being diabetics we have to be monitoring our kidney function at the same time. I watch every blood test I get prior to chemo like a hawk; always have even before chemo in spite of some medical staff being annoyed when I ask questions ha ha. The kidney blood tests that you mention in my case are a bit low or below the lower limit and I’m told that means my kidneys are functioning better than average (I hope that’s right). Thank you for the advice and waiting to see how you are doing with current treatment and hoping for complete success!