There are surgeons that specialize in vascular involvement. Dr Mark Truty at Mayo Rochester. Dr Douglas Evans in Wisconsin. The others are slipping my mind right now. I would highly recommend a second opinion from one of these highly experienced PC surgeons.
Yes, there are options! There is chemotherapy that has had success in shrinking tumors from the area. I second the advice to get to Dr Truty at Mayo, Dr Evans in Wisconsin, or Dr Abdalla in Atlanta. All are highly qualified surgeons focused on the pancreas at National Centers of Excellence. 2nd and 3rd opinions are a must!
In addition to the surgeons mentioned that take on the more complex cases involving vasculature, John Chabot MD who is Chief of Surgery at Columbia Presbyterian Medical Center Pancreas Program and and has performed close to 2800 Whipples in his long and distinguished career and Christopher Wolfgang MD PhD, at NYU-Langone Medical Center also in NYC, who trained under esteemed surgeon John Cameron at John’s Hopkins when he was in practice there.
Colleen Young, Connect Director | @colleenyoung | Jul 29 3:46pm
Hi @steveron, that must've come as a shock to have your surgery deemed incomplete when they discovered superior mesenteric vein (SMV) involvement. I believe you already had chemotherapy prior to being scheduled for Whipple surgery. Did you also have radiation prior, too?
Hi @steveron, that must've come as a shock to have your surgery deemed incomplete when they discovered superior mesenteric vein (SMV) involvement. I believe you already had chemotherapy prior to being scheduled for Whipple surgery. Did you also have radiation prior, too?
My Whipple was also aborted due to vascular involvement. Highly reputable surgeon so that’s not the case. Oncology just wants to wait and see with mine as it is not spreading yet. When it does start growing, I will be back on 5-FU infusions. I am open to hearing other Options as well.
My Whipple was also aborted due to vascular involvement. Highly reputable surgeon so that’s not the case. Oncology just wants to wait and see with mine as it is not spreading yet. When it does start growing, I will be back on 5-FU infusions. I am open to hearing other Options as well.
Background:
To clarify: my wife is the patient, I am the researcher.
Our research discovered a clinical trial entitled "Stereotactic MR-guided on-table adaptive radiation therapy (SMART) for borderline resectable and locally advanced pancreatic cancer: A multi-center, open-label phase 2 study". Here is the link: https://www.thegreenjournal.com/article/S0167-8140(23)09371-4/fulltext
I am not a doctor, so the following is my layperson's understanding. SMART radiation uses real-time MRI imaging to adjust the beam as the patient's body moves for any number of reasons, such as during breathing. or muscle contraction. This is an improvement on traditional radiation which essentially takes a CT on Day 1 and uses that image for treatment on Day 2. Since this does not account for patient or tumor movement, the beam accuracy is reduced and more of the tumor is missed and other tissues are radiated. SMART provides more accuracy and therefore allows higher dosage. SMART takes two weeks. Week 1 Day 1 is consult to plan the treatment. There are 5 days of radiation in Week 2 followed by recovery.
Here is a link to Dr. Michael Chuong at Miami Baptist Health, who was the study leader: https://baptisthealth.net/doctors/michael-d-chuong/869551
We traded emails and spoke with him at length by phone. He was easy to speak with and answered all our questions. He said his treatment was specifically applicable to unresectable tumors because resectable patients would have Whipple surgery. We did not proceed with him as we thought Whipple surgery would be successful.
Background:
To clarify: my wife is the patient, I am the researcher.
Our research discovered a clinical trial entitled "Stereotactic MR-guided on-table adaptive radiation therapy (SMART) for borderline resectable and locally advanced pancreatic cancer: A multi-center, open-label phase 2 study". Here is the link: https://www.thegreenjournal.com/article/S0167-8140(23)09371-4/fulltext
I am not a doctor, so the following is my layperson's understanding. SMART radiation uses real-time MRI imaging to adjust the beam as the patient's body moves for any number of reasons, such as during breathing. or muscle contraction. This is an improvement on traditional radiation which essentially takes a CT on Day 1 and uses that image for treatment on Day 2. Since this does not account for patient or tumor movement, the beam accuracy is reduced and more of the tumor is missed and other tissues are radiated. SMART provides more accuracy and therefore allows higher dosage. SMART takes two weeks. Week 1 Day 1 is consult to plan the treatment. There are 5 days of radiation in Week 2 followed by recovery.
Here is a link to Dr. Michael Chuong at Miami Baptist Health, who was the study leader: https://baptisthealth.net/doctors/michael-d-chuong/869551
We traded emails and spoke with him at length by phone. He was easy to speak with and answered all our questions. He said his treatment was specifically applicable to unresectable tumors because resectable patients would have Whipple surgery. We did not proceed with him as we thought Whipple surgery would be successful.
SBRT has been recommended S a next step for me so I have spent time with interventional radiologist to understand the process. I chose to enter a clinical trial first, but do feel this is a good back up plan.
SBRT has been recommended S a next step for me so I have spent time with interventional radiologist to understand the process. I chose to enter a clinical trial first, but do feel this is a good back up plan.
Hi gamaryanne- how is your clinical trial going? What is the name of it? I’m considering it. Ive been on a chemo vacation for 2 weeks and my ca19-9 went from 19 to 91, so not happy about the results. The CT I had just days before the vacay showed nothing new and in fact shrinkage of the existing liver lesions. I hope it’s going well for you.
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There are surgeons that specialize in vascular involvement. Dr Mark Truty at Mayo Rochester. Dr Douglas Evans in Wisconsin. The others are slipping my mind right now. I would highly recommend a second opinion from one of these highly experienced PC surgeons.
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1 ReactionI have also read a bit on nanoknife (IRE) being an option for some. Perhaps research that as well.
Yes, there are options! There is chemotherapy that has had success in shrinking tumors from the area. I second the advice to get to Dr Truty at Mayo, Dr Evans in Wisconsin, or Dr Abdalla in Atlanta. All are highly qualified surgeons focused on the pancreas at National Centers of Excellence. 2nd and 3rd opinions are a must!
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Helpful -
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1 Reactionthanks for the great advice!
In addition to the surgeons mentioned that take on the more complex cases involving vasculature, John Chabot MD who is Chief of Surgery at Columbia Presbyterian Medical Center Pancreas Program and and has performed close to 2800 Whipples in his long and distinguished career and Christopher Wolfgang MD PhD, at NYU-Langone Medical Center also in NYC, who trained under esteemed surgeon John Cameron at John’s Hopkins when he was in practice there.
Hi @steveron, that must've come as a shock to have your surgery deemed incomplete when they discovered superior mesenteric vein (SMV) involvement. I believe you already had chemotherapy prior to being scheduled for Whipple surgery. Did you also have radiation prior, too?
What treatment is being recommended for you now?
My Whipple was also aborted due to vascular involvement. Highly reputable surgeon so that’s not the case. Oncology just wants to wait and see with mine as it is not spreading yet. When it does start growing, I will be back on 5-FU infusions. I am open to hearing other Options as well.
-
Like -
Helpful -
Hug
2 ReactionsBackground:
To clarify: my wife is the patient, I am the researcher.
Our research discovered a clinical trial entitled "Stereotactic MR-guided on-table adaptive radiation therapy (SMART) for borderline resectable and locally advanced pancreatic cancer: A multi-center, open-label phase 2 study". Here is the link:
https://www.thegreenjournal.com/article/S0167-8140(23)09371-4/fulltext
I am not a doctor, so the following is my layperson's understanding. SMART radiation uses real-time MRI imaging to adjust the beam as the patient's body moves for any number of reasons, such as during breathing. or muscle contraction. This is an improvement on traditional radiation which essentially takes a CT on Day 1 and uses that image for treatment on Day 2. Since this does not account for patient or tumor movement, the beam accuracy is reduced and more of the tumor is missed and other tissues are radiated. SMART provides more accuracy and therefore allows higher dosage. SMART takes two weeks. Week 1 Day 1 is consult to plan the treatment. There are 5 days of radiation in Week 2 followed by recovery.
Here is a link to Dr. Michael Chuong at Miami Baptist Health, who was the study leader:
https://baptisthealth.net/doctors/michael-d-chuong/869551
We traded emails and spoke with him at length by phone. He was easy to speak with and answered all our questions. He said his treatment was specifically applicable to unresectable tumors because resectable patients would have Whipple surgery. We did not proceed with him as we thought Whipple surgery would be successful.
Dr. Percy Lee at City of Hope Los Angeles was also on the study team. We have a consultation with him on 8-14 as he is closer to our San Diego home than Miami and was recommended by Dr. Chuong. Here is his link:
https://www.cityofhope.org/percy-lee
Here is one patient's story:
https://baptisthealth.net/baptist-health-news/she-defeated-pancreatic-cancer-via-most-advanced-radiation-therapy-at-miami-cancer-institute
SCINTIX uses PET imaging, but not yet for PC.
https://scintixtherapy.com/education/
Clinical trials may be available, but we haven't investigated them in detail yet.
Let us know what you discover. Best wishes for success.
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3 ReactionsIf I may ask, how is this different from SBRT?
SBRT has been recommended S a next step for me so I have spent time with interventional radiologist to understand the process. I chose to enter a clinical trial first, but do feel this is a good back up plan.
-
Like -
Helpful -
Hug
2 ReactionsHi gamaryanne- how is your clinical trial going? What is the name of it? I’m considering it. Ive been on a chemo vacation for 2 weeks and my ca19-9 went from 19 to 91, so not happy about the results. The CT I had just days before the vacay showed nothing new and in fact shrinkage of the existing liver lesions. I hope it’s going well for you.
-
Like -
Helpful -
Hug
1 Reaction