New Pancreatic Cancer Treatment guidelines

Pictured: Conjoint Professor David Goldstein

New surgery guidelines have been developed by a team of leading Australian pancreatic cancer experts, who hope this detail will be a major step forward to improved survival rates over the next five years.

A report, published today in the Medical Journal of Australia, notes pancreatic cancer is fast becoming one of the top three death cancers in Australia, with only 7% of patients surviving five years.

But report authors noted there had been “a lack of consistent and widely agreed definitions of operability in pancreatic cancer”, which has led to either insufficient or unnecessary surgery for some patients.

One of the report authors, Sydney based Conjoint Professor David Goldstein, said that in 80% of cases, pancreatic cancer is not operable, but only 20% of operable patients will go into remission following surgery and additional  treatment like chemotherapy.

“There has been a lack of standardisation in our approach to pancreatic cancer management with variations between States and internationally,” he said.

“We can’t change a cancer’s biology at present but we can change the way we deal with it. These guidelines will assist us to standardise care, so for the first time in Australia, there are very clear guidelines on when to operate.  We are confident that via this review and consensus, we have begun the process of improving care and eventually, outcomes for this difficult to manage disease.”

The report outlines Australian consensus definitions to:

  • provide an overview of local and international guidelines which define operability and R0 resection (microscopic clear margins);
  • develop a consensus statement that defines when a patient is clearly operable, borderline and locally advanced inoperable;
  • develop an understanding of the circumstances around the use of neo-adjuvant therapies and chemotherapy and in some centres pre-operative radiation; and
  • provide an understanding of the use of multidisciplinary tumour groups to set treatment plans.

The report has emanated from the Pancreatic Cancer Surgical Guidelines Workshop, which was convened by the Australasian Gastro-Intestinal Trials Group along with the Avner Pancreatic Cancer Foundation.

The workshop brought together medical experts from around Australia, including surgeons, medical oncologists, radiologists, pathologists, gastroenterologists and consumers.

The Workshop Report was developed by the Workshop Steering Committee: Conjoint Professor David Goldstein, Associate Professor Andrew Barbour, Associate Professor Jaswinder Samra, Dr Koroush Haghighi, Dr Mehrad Nikfarjam and Professor James Kench with the assistance of Dr Susan Williamson and was co-authored by Dr Payal Saxena. The MJA summary was led by Dr Robert Gandy together with the above authors.