Radiation Treatment Advances Offer New Options for Pancreatic Cancer Patients

Through research and the use of groundbreaking radiation treatment, Miami Cancer Institute is providing hope — and potentially longer lifespans — for patients with inoperable pancreatic cancer.

The Institute, part of Baptist Health Cancer Care, has been at the international forefront of using MRI-guided technology to safely deliver precisely targeted doses of radiation to pancreatic tumors, using a condensed treatment period of five outpatient sessions or less.

“Within the last few years, we’ve seen dramatic advances in the technologies that allow us to give extremely high doses of radiation that can completely obliterate or eradicate tumors,” says Michael Chuong, M.D., medical director of Miami Cancer Institute’s Department of Radiation Oncology.

Michael Chuong, M.D., medical director of the Department of Radiation Oncology.at Baptist Health Miami Cancer Institute

“This is something that has not become available at most cancer centers throughout the United States, or even internationally,” he says. “We here at Miami Cancer Institute have been one of the early pioneers of this technology that allows us to offer exceptionally sophisticated treatments for even the most complex cancer and have much higher success rates.”

Pancreatic cancer remains a challenge to treat because symptoms, which can mimic other health problems, rarely occur until tumors are at an advanced stage. Because the vast majority of cases aren’t caught early, treatment options are limited and most patients are not candidates for potentially curative surgery by the time they are diagnosed.

When surgery is impossible, radiation can provide an alternative. In 2018, Miami Cancer Institute was the second center in the U.S. to treat patients with the MRIdian Linac, the first FDA-approved MR-guided radiation therapy system.

Since then, the Institute has become one of the most experienced centers treating inoperable pancreas cancer and other challenging cancers with this advanced device. The Institute also is a leader in research aimed at defining novel clinical indications and best treatment techniques for MRIdian Linac. Institute physician-researchers contributed to new international guidelines on radiation dosing and targeting strategies recently published in the International Journal of Radiation Oncology, Biology, Physics.

Dr. Chuong, the lead physician for the MRI-guided radiation program at Miami Cancer Institute, co-led an international multicenter trial for patients with inoperable pancreatic cancer. In the Phase II SMART trial, physicians used noninvasive MRI technology to deliver very high ablative radiation doses for advanced pancreatic tumors in only five outpatient sessions. The study investigators published encouraging results that 53.6 percent of patients with inoperable pancreatic cancer were still alive after two years. In comparison, just 20 percent of patients who receive chemotherapy and standard radiation therapy are expected to live two years after diagnosis.

“This is now emerging as a new standard of care, and much of the adoption of this type of technology and the techniques that other centers are using have been influenced by what we at Miami Cancer Institute have published,” Dr. Chuong says. “We're really excited by the outcomes that we've seen, and by being able to help patients not only get through treatment in a relatively short period of time, but do so with excellent quality of life, with minimal side effects and the potential to live longer.”

The MRIdian Linac system “marries” the technology used for radiation treatments with an MRI, allowing real-time monitoring as therapy is administered. Combining radiation with real-time visualization allows oncologists to define very tight treatment margins, avoiding radiation exposure to other nearby organs. The system is so advanced it even adapts for movement when a patient breathes.

“It allows us to deliver pinpoint radiation to tumors in the abdomen in such a way that has never been possible before,” Dr. Chuong says. “Not only are we treating patients with much higher doses than can be safely delivered with the standard radiation machine, but this can potentially result in tumor eradication and potentially prolong patients’ lives.”

When combined with chemotherapy, targeted medications and immunotherapy, radiation therapy can have a profound effect on the future pancreatic cancer treatment, Dr. Chuong says.

“We've seen dramatic outcomes from this combination in patients who were initially not thought to be potentially curable because they have stage 4 cancer, but who have had complete eradication of their tumors and have had sustained responses over many years,” Dr. Chuong says. “While surgery is still the gold standard today and is still the only known curative type of treatment for pancreas cancer, the data that we and other institutions have published on high dose ablative radiation can provide potentially long-term survival.”