Radiotherapy and chemoradiotherapy for pancreatic cancer

Chemoradiation or chemoradiotherapy is where chemotherapy is combined with radiotherapy to treat cancer. Both treatments destroy cancer cells. Radiotherapy uses high-energy rays and chemotherapy uses drugs. You may be treated just with chemotherapy or just with radiotherapy. Use of chemotherapy is a lot more common for pancreatic cancer than radiotherapy.
Combining the two treatments can work better than using one by itself. Chemotherapy can make cancer cells more likely to be affected by the radiotherapy.
One or both may be used:
  • Before surgery to try to shrink or slow the growth of the cancer.
  • After surgery to try to stop the cancer coming back.
  • To slow down the growth of the cancer if surgery isnt possible.
  • To help to relieve symptoms such as pain.
CyberKnife stereotactic ablative radiotherapy might also be used.

A consultant explains why the use of radiotherapy in pancreatic cancer is controversial.

View profile

The use of radiotherapy in pancreatic cancer is controversial. Some of this arose as a result of, a surprising result in the ESPAC one study, performed in the late nineteen nineties, where patients who have radiotherapy following resection of pancreatic cancer actually did not so well as those that did not have the radiotherapy.

On the other side of the Atlantic in America, however, there is a groundswell of opinion that using a multi-modal approach of chemotherapy, radiotherapy plus or minus surgery is the mainstay of their treatment programmes. And within the UK there are a number of studies looking at the role of radiotherapy in the patient who has not presented early enough to consider surgery, so in a palliative setting. At present, there is insufficient evidence to be dogmatic as to whether radiotherapy is the correct type of treatment to be used in pancreatic cancer but it’s certainly an area where a lot of work is being done on at present.

Embed Print Transcript
Elaine had surgery followed by radiotherapy. Her doctor had ‘persuaded’ her to have the treatment to try to stop the cancer coming back.

After her surgery Elaine had radiotherapy. She felt a bit nauseated and tired but had no other…

Age at interview 73

Gender Female

Age at diagnosis 59

View profile

Do you mind just saying a little bit more about your experience of radiotherapy?

I don’t mind at all. You know, it, it’s not really, as long as they’ve done the mapping properly and everything else. I had it done from there, there, I’ve got three, three little
Stencils?

Stencils. And I had to go and, you know, usually the appointments were not too long. This is all N-, NHS, needless to say. I mean from the start to the finish it was all NHS, and they, and then they’re very good with, with serious things, I think. And you just lie on the table and these great big things come and it goes that way first or that way first through the splenetic area, then straight down and this way. And it didn’t actually bother me very much. But the radiotherapist was passing by one day and he said, quite late on in the treatment, and he said, Oh, you know, you seem to be standing up to the treatment quite well. You’re not exactly fading away, Elaine And I said, No, I don’t do fade away [laugh]. And so even though I was nauseated, it didn’t seem to affect me very much. Because apparently it, going through the liver in particular is, it can be quite unpleasant for some people. But I just sort of thought, Well, it’s part of the figh and
And you had that every day?

Do you know, again one forgets. did get more tired. And I’d find, it was in the summer and I was sitting on the, on the veranda and I’d find myself fast asleep.

Embed Print Transcript
Other we spoke to who’d had radiotherapy had also had chemotherapy at the same time. One man had it to try to shrink his tumour in order to make surgery possible. Others had it after surgery to try to stop it coming back. A few people were unable to have surgery so had chemoradiation to slow the growth of the cancer.
People had different chemotherapy drugs.

Steve had neo-adjuvant chemoradiotherapy. His doctors wanted to shrink his tumour, hoping to make…

Age at interview 47

Gender Male

Age at diagnosis 47

View profile

So in a very short space of time, just a matter of a week or so I was able to speak with the oncologist who recommended a treatment of, it’s actually called cisplatin, which is a chemotherapy drug which is administered through a drip and that was done, and it happens over the course of a whole day, you go into a day ward and you have the cisplatin through an infusion. And also an oral chemotherapy drug, one that I would have, I think it was three times a day with a meal, you’d swallow this big tablet. And at the same time each weekday I would go for radiotherapy. So that regime was outlined and that was over I think it was five or six weeks, this regime would take place.
So around yes six weeks after returning to the UK, I started this regime of chemo and radiotherapy and all the time in the back of my mind is, I wonder if this Whipple’s operation is going to be a possibility The things on my mind to do with that were, I knew I had read that the, the prognosis for pancreatic cancer is very grim. The statistics say that you only have a two or three percent possibility of living beyond five years. That the headline statistics tell us that. Everybody’s different, so fortunately some people will live much longer than that. Others, their condition may have been caught quite late, and they may only have a matter of months, maybe even weeks to live. And I didn’t know which category I fell in of course.

Embed Print Transcript

After her surgery Alison had adjuvant chemotherapy. Then she had adjuvant chemoradiotherapy. She…

Age at interview 44

Gender Female

Age at diagnosis 41

View profile

I’d gone six months, so we’re now into March. And I had a month off, and we went away on holiday. And came back from that and I was referred to a consultant clinical oncologist. And he prescribed for me roughly six weeks’ worth of chemoradiotherapy. Now that involved having a, a drug called 5FU in a pump which was attached to what’s called a Groshong line, which is a c-, a central line that, that goes into your chest and it delivers the chemotherapy on a 24/7 basis. So you’ve got the pump with you continually. And that was changed once a week in clinic. So, which actually I decided to do myself, because I couldn’t be bothered [laugh] to go back up to the, to the, the clinic to do, and I was given all the kit to do that in a sterile environment. But, yes, and, and included in that was daily sessions of radiotherapy, which are, which are actually done at the NHS unit locally, but as a private patient.

What was the radiotherapy like?

It wasn’t painful at all. Beforehand I had to go in for some scans, so that they can perfectly align where they were going to focus the beam. And I had to have some mini tattoos put on me. And the radiotherapy went in three sides, so the middle and then the two sides. And I’ve got three nice little dots to show them where they were going to line the machine up. So it’s, it’s not quite a, a dragon or a butterfly or anything like that. And it, you certainly don’t notice it now. But the process itself, it was only for ten minutes but I had, I had to lie very, very still. And it’s amazing, when you’re trying to lie still you think about not moving and you can’t wait to move. And it’s, it’s really difficult. And, you know, it, it, it doesn’t hurt at all. And you just hear sort of the zapping and the clunking of the machine and, as it’s rotating around you. And that I found worse than the chemotherapy regime I’d been on. The side effects of that were mainly exhaustion.

Embed Print Transcript

Anthonys wife, Martine, had inoperable pancreatic cancer. After the diagnosis she started…

Age at interview 65

Gender Male

Age at diagnosis 56

View profile

I think after that things moved fairly fast in that we were handed over to, from the surgeon to a radiologist, oncologist. And they said straightaway, We’re going to move you to two things, you’re going to start a course of chemotherap, I think there’s a, there’s a drug that’s always used for, and called gemcitabine, and also you’ll go onto radiotherap.

And then we learnt all about the process of having planning, I think it’s called, where she had to go and have these little marks, little tattoos put on her. First when the word tattoo was used, we had visions of great big marks on her body, which she was a bit worried about, but they were only just dots actually.

And then she went for the planning and she had these tattoo marks so that when she was lying on the, the big machine with the radiotherapy, whatever it is, the gun, they knew exactly where to focus it so it was straight on the tumour, on the pancreas.

And she never felt anything, during the sessions of radiotherapy. As the radiotherapy went on she got tireder and tireder, but how much was from the radiotherapy and how much was from the chemotherapy, we don’t know because it was joint.

Embed Print Transcript

People usually have radiotherapy as an outpatient. Treatment is painless, but Michael said he found the massive machine ‘rather intimidating’. Peter found it difficult to lie still on the table because it was uncomfortable as he had become very thin. He also felt disorientated after treatment.

Richard had inoperable cancer. He had chemoradiotherapy. He described what it was like to have…

Age at interview 59

Gender Male

Age at diagnosis 58

View profile

And so with radiotherapy, the way in which that worked was again every Monday morning I would go in and receive a small dose of gemcitabine, in the hospital intravenously.

Then each day I had, from Monday to Friday, I had to attend the hospital for my radiotherapy. In preparation I had a special scan done which located the tumour precisely, and worked out the as it were the various angles in which it was going to be attacked by the x-rays. And my body was marked in various critical positions which became like the daily target so that when I lay on the x-ray machine I was able to be lined up precisely to the millimetre, exactly to, to receive my radiotherapy.

And I had five weeks and three days, so I had 28 individual treatments. And each treatment only lasts about five minutes, but you in, in order to get the treatment you had to get undressed, and then get dressed. And I have to say it was very well organised. I was rarely kept waiting for more than ten/fifteen minutes, and sometimes I would sort of arrive on time for my appointment and almost go straight in. So I certainly couldn’t complain about my, my treatment at all there.

Embed Print Transcript
People experienced various side effects. It was not always clear which were from the chemotherapy and which were from the radiotherapy.