Treatment for patients with pancreatic cancer in a super-aging society

Abstract

Pancreatic cancer is a disease that is more likely to affect older adults and is therefore on the rise in Japan's hyper-aged society. In older patients with pancreatic cancer, surgical resection may not be indicated even when the disease is still oncologically speaking resectable, because surgical resection is too invasive to tolerate. Recently, minimally invasive procedures such as laparoscopic pancreatectomy have been developed and are expected to become more and more popular forms of surgical resection in older patients. Radiotherapy may be indicated even in older patients with pancreatic cancer because of its safety, but its efficacy is limited. Techniques that increase the radiation dose to the tumor while reducing the dose to normal tissue by irradiating from multiple directions, as well as proton beam and carbon-iron beam radiotherapy, are expected to have more efficacy while maintaining safety. Systemic chemotherapy can be applied for older patients using gemcitabine plus nab-paclitaxel, gemcitabine alone, and S-1 alone. The indication for any of these treatment modalities should be based on a geriatric assessment that includes not only age but also major organ function and comorbidities.