Surgical options for borderline resectable/locally advanced tumors
My mom was diagnosed with pancreatic cancer in July 2022. She was not eligible for surgery at the time due to SMA encasement, so she was recommended to start chemotherapy. She just had her 12th infusion and will have her 13th and last infusion in about two weeks. Fortunately, her CA 19-9 numbers peaked at around 480 and have since come down to 18. We are heading up to Mayo Clinic in less than a month to see Dr. Truty, but I am super anxious about the consult. I am trying to focus on the fact that her CA 19-9 numbers have come back down to normal and her past two CT scans have shown shrinkage, but there is still SMA encasement, so I'm very worried. What if they tell us she's not eligible for surgery after all planned exploratory surgery? What options do we have after?
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I am still in progress with chemo, 4 treatments. I was advised by the surgeon that if the vascular involvement did not improve to the point where surgery was possible, they could offer a high dose targeted radiotherapy. I saw Dr. William Jarnigan at Memorial Sloan Kettering Cancer Center in New York City. It sounds like the high dose targeted radiotherapy is also being done at Mayo Clinic. Being at a pancreatic cancer center of excellence should be very good as you will hear about all the latest treatments. Good luck with your treatment. I have had two previous cancers and I found that uncertainty about the right thing to do was the hardest part for me.
I had PDAC in head to neck in 2019. I had 180’ encasement of Portal Vein and severe narrowing of SMA. Originally graded as 2b-3. The tumor shrunk after 12 cycles of FOLIRINOX and then also after 28 days of chemo-radiation. Had Whipple 3/2020 and the tumor had shrunk from max diameter of 4.8 to <1.5cm. There was only a few tiny cells of cancer seen in the very small tumor then. The SMV was clear and my Portal Vein was able to be reconstructed by stretching it (no jugular vein donation was needed!) I had no positive lymph nodes at surgery.
My oncologist and I decided to have me do some adjuvant chemo that summer and I had 6 cycles of Gemara and Zeloda. I was tired, but was glad I did it as I feel it gave me some extra “power” to kill any possible rogue cells. My scans since then have been NED💜 It was all worth it and I’m so thankful for all my doctors and everyone who supported me and my decisions. Every day is something I never take for granted anymore! Good luck to your mother and God Bless. I’m so happy she has you to help navigate her journey☺️
Hello, is the adjuvant chemo you did a part of a trial? Not sure I have heard of that for pancreatic cancer. Do you mind sharing where your doctors are located?
Thanks for sharing your story. I learned a lot and am inspired by the way you hung in with your treatment. Hope you continue to well. I try not to be either an optimist or pessimist, just a realist. Hearing the range of experiences helps me to live in each day, realizing that there are wide ranges of outcomes in pancreatic cancer.
Not a trial- just what my oncologist and surgeon decided.
My surgeon was Dr Mark Talamonti in Evanston, IL. He is the head of the dept at North Shore and used to be the head ar Northwestern Univ. He is absolutely wonderful. My oncologist is in Elgin (closer to home) but worked with Dr T and the North Shore oncology team to determine the best adjuvant chemo to use. I highly recommend North Shore… they are one of the top 2 in the Chicago area for the number of Whipple surgeries they perform. Everyone at that hospital was fantastic!
Hi, your mother’s diagnosis sounds very similar to my own. I was diagnosed last August, and also ineligible for surgery because of atrial encasement. I am being treated at the University of Iowa Hospitals and Clinic. So far I have received 7 chemo treatments of a planned 8. Then I’ll start chemo/radiation. The tumor had shrunk from 3.4 cm to 2.6 cm on Dec. 6th, and I have a new scan coming up in a couple of weeks. My CA 19-9 is down to 29. The surgeon believes Whipple surgery would be too risky because of the encasement and recommends the NanoKnife procedure (irreversible electroporation). It seems to be my best option, but the tumor will have to shrink a bit more for me to be eligible. It’s difficult to decide the path that will have the most favorable outcome. I hope your mom’s consultation goes well, and she’s able to have the surgery at Mayo! Best of luck!!
Not familiar with the NanoKnife, can you give more information?
As it was explained to me, electrical probes (usually 2 or 4) are inserted surrounding the tumor. The probes then send electrical pulses into the tumor, essentially punching holes in the cancer cell membranes. The cancer cells then die, but the cells of the healthy tissue surrounding the tumor survive. I’m sure this is a very simplified explanation of a very complex procedure, but it’s basically what happens as I understand it.
Wow, you and my mom are really on the same boat! May I ask why your oncologist only wants you to do 8 chemo sessions? Typically people go for 12. Have you contacted Dr. Truty at Mayo? We were also introduced to the Nanoknife and will pursue it if that’s our only option. There is a surgeon in Kentucky that speaks very highly of it, so it seems promising.