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Thread: Diagnosed with Stage 3 Inoperable.

  1. #1
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    Diagnosed with Stage 3 Inoperable.

    Gen was diagnosed yesterday with Stage 3 PC. Doctor wants to start with Chemo this coming Tuesday which she will do. Last night I called her three sisters to let them know the status of her condition. As can be expected they were very upset. I also recieved an email from one of them @ 2:45 am. This sounds very intriguing and hopeful. I will look into this more. Just wondering has anyone herd of this treatment and surgery. Stoneybrook is a a teaching hospital did not know they have a cancer center. Will here it goes pretty long.

    Minnesota Man with Pancreatic Cancer Has Renewed Hope after Surgery at StonyBrook


    Dr. Kevin T. Watkins Performs Procedure to Remove Tumor Previously Deemed
    Inoperable


    Marc Breton, the hopeful patient, with wife Teri and Dr. Kevin T. Watkins,
    following his surgery at Stony Brook earlier this month.
    The picture of good health - that is how Teri Breton, wife of Marc Breton,
    53, of St. Paul, MN, describes her husband of 10 years. All that changed on
    September 29, 2011, when doctors in Minnesota told him about a tumor they
    discovered in his pancreas via a CT scan. Marc had lost a significant amount
    of weight only a few short weeks before that time and had become jaundiced.
    During the next two months, Marc's options seemed very limited. Surgeons in
    Minnesota determined that the tumor was inoperable, mainly because it was
    wrapped around a major artery and vein. He underwent chemotherapy, which did
    not appear to shrink the tumor to any significant degree, and he experienced
    other complications, such as a large abscess on his liver.

    As a program manager for ISEEK.org, a Minnesota career, education, and job
    resource, Marc is savvy on the computer. He and his family members searched
    frantically for newer and innovative pancreatic cancer treatment options.

    In their search, they discovered that our renowned surgical oncologist,
    Kevin T. Watkins, MD, chief of upper gastrointestinal and general oncologic
    surgery, is a pioneer using irreversible electroporation (IRE), a technique
    that selectively kills cancer by using electrical fields to generate pores
    in tumor cells, to remove pancreatic tumors.

    Today, the patient is coming back to Stony Brook for his first follow-up
    visit with Dr. Watkins - with renewed hope.

    Dr. Watkins was the first surgeon in the world to use IRE technology to
    treat pancreatic cancer. In the past two years he has treated more than 20
    patients with pancreatic cancer at Stony Brook University Hospital with IRE,
    some who traveled thousands of miles to Stony Brook for the surgery. The
    treatment is a last-hope option for patients who have run out of other
    options, and whose cancer has not spread to other areas of the body.


    The IRE procedure kills tumor cells without causing collateral damage to
    adjacent tissue.
    Marc, a non-smoker and father of two, approached his oncologist, Steven E.
    McCormack, MD, about the IRE procedure and Dr. Watkins. Dr. McCormack agreed
    that IRE may be his best chance for extended survival and quality of life
    with pancreatic cancer. After a consult with Dr. Watkins, Marc was scheduled
    for surgery on January 11 of this year.

    To remove the entire tumor, Dr. Watkins used a combination of surgical
    methods - the standard open Whipple procedure to excise cancerous tissue on
    the pancreas and remove parts of surrounding organs, which are then
    reattached; and the IRE procedure for the tumor surrounding the vessels.

    "To incorporate both surgical methods is unusual, and this approach enabled
    me to obtain a complete resection of Marc's tumor," says Dr. Watkins.

    On January 18, Marc's pathology reports indicated that not only were the
    tumor margins negative but all of his lymph node tissue was negative for
    cancer - results which Dr. Watkins refers to as "a best case scenario."
    Before surgery Marc's chance of beating pancreatic cancer was virtually
    zero, but now, according to Dr. Watkins, it is about 25%.

    "At the time my tumor was detected my prognosis was grim," says Marc. "But
    now my prospects for longer-term survival appear much better, and I have a
    lot more hope."

    Marc recovered quickly from his surgery and went home. He is back on Long
    Island now, and today he is returning to Stony Brook University Hospital for
    his first follow-up visit with Dr. Watkins.

  2. #2
    Plenty of examples / stories out there where first diagnosis is "inoperable" and then either after neoadjuvant chemo to knock it back or a 2nd opinion / different approach considered, surgery occurs. Check your private messages too.

    You don't get into too many specifics about why it's considered "inoperable" and not being a doctor I myself couldn't split hairs on the conclusion anyway.

  3. #3
    Moderator Senior User ddessert's Avatar
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    Usually inoperable (aka unresectable) is determined by how much of the Superior Mesenteric Artery (MSA) is wrapped by the tumor. MD Anderson would not touch mine when it was >180 degrees around the artery, but subsequent chemotherapy reduced the tumor and allowed me to have the conventional Whipple surgery. It is rare for this to happen.

    IRE has been used to effect in pancreatic cancer patients, usually not in conjunction with the Whipple.

    I would ask point-blank what his success rate is. What you are probably interested in is:
    • What are his surgical statistics (hospitalization stay, blood lost, hours in surgery, infection rates, mortality rate, etc)?
    • How many Whipples has he performed? How often?
    • % patients that remain cancer-free? How long?
    • Of those whose tumors return, what is the time range?
    • Of those whose tumors return, what is the median time to recurrence?

    There have been a lot of studies to show that Whipple success rates are higher at high-volume cancer centers. Fewer complications, shorter hospital stays, less blood lost, lower recurrence, etc. If you have a choice of places to do IRE with a Whipple, you should check them out. I've talked to several Whipple surgeons who are surprised at the questions their patients do not ask. If they were under the knife, you can bet that they would not hesitate to ask these question.

    Here is a very different outcome from the same doctor and surgery. Perhaps the posting and follow-on discussion will give you some things to ask the surgeon.

    Here is a published paper by Dr. Kevin Watkins detailing his results of IRE on unresectable lung malignancies. Both patient's tumors returned within six months after the procedure.

    Your curative alternative to this procedure is starting a chemotherapy program, hoping it is successful, and having the regular Whipple procedure. Surgery is the only sure-fire cure for this cancer and even it also is often ultimately unsuccessful.

    Best of Luck,

    David
    BRCA2 3398del5
    Dec 2010 - back/abd pain
    May 2011 - Unresectable stage III, 2.5cm tumor
    Jun-Aug 2011 - Gem/Cis, 9 rounds
    Oct-Nov 2011 - Radiation+Xeloda, 25 days in 5 weeks
    Oct 2011-Sep 2012 - shrinking tumor
    Feb 2012 - National Familial Pancreatic Study
    Aug 2012 - Downgraded to stage IA, PGP
    Sep 2012 - Whipple, 0.5cm tumor, no lymph nodes
    Dec 2012 - Quebec PanCan Study
    Sep 2012-May 2014 - Cancer Free
    Mar 2013 - NCT01088789
    Twitter @pancanology

  4. #4
    Moderator Senior User ddessert's Avatar
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    The answers I received about why a tumor fully wrapping the SMA is inoperable are:
    • The SMA cannot be cut out and a new section spliced back in. The organs provided blood by this artery will quickly die (30 seconds?) without a blood supply. Not enough time to perform the procedure.
    • Once the tumor gets into the SMA, it rapidly travels up and down the artery. I was told the tumor really likes the arterial environment.

    David
    BRCA2 3398del5
    Dec 2010 - back/abd pain
    May 2011 - Unresectable stage III, 2.5cm tumor
    Jun-Aug 2011 - Gem/Cis, 9 rounds
    Oct-Nov 2011 - Radiation+Xeloda, 25 days in 5 weeks
    Oct 2011-Sep 2012 - shrinking tumor
    Feb 2012 - National Familial Pancreatic Study
    Aug 2012 - Downgraded to stage IA, PGP
    Sep 2012 - Whipple, 0.5cm tumor, no lymph nodes
    Dec 2012 - Quebec PanCan Study
    Sep 2012-May 2014 - Cancer Free
    Mar 2013 - NCT01088789
    Twitter @pancanology

  5. #5
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    Great information David. Joe had his whipple that was not operable in January done in August after 6 months of Folfox chemo. Every one reacts different to the different chemo. Joe was lucky the Folfox did reduce the size of his tumor enough for surgery and clean margins. Joe was also considered stage three. not sure what his staging would be now or if it ever changes.
    73 Year old Husband has/had:
    1-23-13 Mass on pancreas. Stent placed. Adenocarcinoma suspected and biopsy diagnosed Jan 31,2013. Stage three due to non operable.
    2-18-13 Port placed.
    2-19-13-First Folfox round. Folfox rounds reduced after third and tenth through 7-26-13.
    8-2-13 CT scan Mass strands have moved away from SMV.
    8-14-13 Whipple surgery preformed. Pathology clean margins no lymph involvement. Hospitalized 24 days. Long slow recovery. Lost 20 pounds.
    11-5-13 Scheduled to see oncologist for follow up chemo and radiation as needed.
    Still too weak after surgery and pneumonia for chemo and radiation
    12-4-13-CT scan and blood work
    12-10-13-CT scan clear NED Blood work Ca 19-9 35 No chemo or radiation at this time.
    2-26-14 Next CT scan and Blood work Still NED Doing great so far.
    5-29-14 Next CT scan
    6-3-14 CT Scan still NED Ca 19-9 31.5
    8-26-14-CT Scan and blood work Ca 19-9 31.4 and Still NED

  6. #6
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    That PC sad story was with a "nanoknife"; is that the same as IRE?
    4/13: hubby to er w/ 7 cm mass on pancreas, total bilirubin 7.1 Temporary biliary drain.
    4/13: Unable to perform biopsy using ERCP, Rad. Int. took needle/brush biopsy; referred to Mayo Clinic in Phoenix AZ
    5/13: Mayo. Stage 3, borderline resectable. SMA/SMV are "involved", recommend reduce with Folfirinox, return in 3 cycles to reassess. whipple is goal.
    5/13: Mayo installed a 10 French Stent.
    5/22/13: first Folfirinox administered, no side affects
    6/5/13: Received a final report from Mayo team, after 3rd round they want to look and see if he is a candidate for radiation/chemo.
    7/13: CT scan showed not change to tumor after round 3 was completed.
    7/13: going on round 5, pain and tiredness are taking over his body. About 10 days before he can get off couch after chemo.
    8/13: round 8 this week then a chemo vacation! PET and CT at end of Sept.
    9/13: Mayo, biliary stent blocked and Ascites began. ERCP, ascites pending testing, hoping for great news.

  7. #7
    Moderator Senior User ddessert's Avatar
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    NanoKnife as used in that link is the same as IRE. Essentially, they run short pulses of electrical current between (up to) six small probes placed around the tumor that causes tumor cells to be destroyed, but not normal tissue. The body naturally gets rid of the dead cells.

    There is this clinical trial in Italy for NanoKnife being sponsored by the manufacturer of the machine. They are not recruiting participants.

    This clinical trial in the Netherlands for NanoKnife is open to non-metastatic, resectable pancreatic cancer patients.

    Be forewarned that the Wikipedia link for nanoknife is something completely different.

    David
    Last edited by ddessert; 10-31-2013 at 02:46 PM. Reason: Add link, fix another one
    BRCA2 3398del5
    Dec 2010 - back/abd pain
    May 2011 - Unresectable stage III, 2.5cm tumor
    Jun-Aug 2011 - Gem/Cis, 9 rounds
    Oct-Nov 2011 - Radiation+Xeloda, 25 days in 5 weeks
    Oct 2011-Sep 2012 - shrinking tumor
    Feb 2012 - National Familial Pancreatic Study
    Aug 2012 - Downgraded to stage IA, PGP
    Sep 2012 - Whipple, 0.5cm tumor, no lymph nodes
    Dec 2012 - Quebec PanCan Study
    Sep 2012-May 2014 - Cancer Free
    Mar 2013 - NCT01088789
    Twitter @pancanology

 
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