Ultimate Guide to Oncosil Pancreatic Care

Overview

In pancreatic head cancers, Oncosil-supported multidisciplinary treatment refers to a comprehensive therapeutic approach in which, in addition to standard methods such as surgery, chemotherapy, and/or radiotherapy, Oncosil a local radiotherapy implant containing radioactive phosphorus-32 administered intratumorally is used.

The aim of this method is to deliver localized radiation directly targeting the tumor to reduce tumor volume, increase the likelihood of surgical resection, and enhance the effectiveness of systemic therapies.

Objective

Surgical resection remains the only potentially curative treatment for pancreatic cancer. However, in advanced stages of the disease, chemotherapy and radiotherapy have also been shown to provide survival benefits.

Unfortunately, the 5-year relative survival in pancreatic cancer remains poor:

• Localized disease (confined to the pancreas):  44%
• Regional disease (spread to nearby tissues or lymph nodes): 16%
• Distant metastasis: 3%
• Overall average across all stages: ~13%

At diagnosis, nearly 80% of pancreatic head cancers are deemed unresectable. A subset of these may be considered borderline resectable due to their close proximity to or invasion of critical blood vessels, including the superior mesenteric vein, portal vein, or neighboring arteries. In such scenarios, achieving surgical removal of the tumor—particularly an R0 resection, which leaves no residual disease—is often not possible.

Although neoadjuvant therapy (treatment before surgery) has not yet definitively proven to improve overall survival in borderline resectable cases, it has been shown to:
Increase the chance of surgical resection,
Improve R0 resection rates,
And prolong disease-free survival.
While neoadjuvant or adjuvant therapies in pancreatic cancer are becoming more standardized, external beam radiation therapy may still cause unintended damage to surrounding tissues before reaching the tumor.

Oncosil, a radioactive phosphorus-32 (P-32) microsphere, can be injected directly into the tumor via endoscopic ultrasound (EUS) or during surgery. This technique delivers localized radiotherapy with minimal exposure to adjacent healthy tissues.

• Half-life of P-32: 14.27 days
• 98% of the radiation is absorbed by the tissue within 81 days

By integrating OncoSil-based internal radiotherapy with systemic chemotherapy, our goals are:

• To prolong overall survival,
• To convert selected patients to surgical candidates,
• And to offer individualized treatment under a robust multidisciplinary framework.

Method

1. Multidisciplinary Evaluation

• Disciplines involved: Surgery, Medical Oncology, Nuclear Medicine, Interventional Radiology, Gastroenterology
• Every case will be reviewed by a dedicated tumor board.

2. OncoSil Application

• The intratumoral injection of P-32 radioactive microspheres can be performed either endoscopically using endoscopic ultrasound (EUS) under general anesthesia, or during surgery. The primary objective of this procedure is to decrease tumor volume and metabolic activity.

• Primary goal: Tumor volume and activity reduction

3. Systemic Therapy

• Standard regimens such as FOLFIRINOX or nab-paclitaxel + gemcitabine, administered concurrently or sequentially

4. Surgical Reevaluation

• A minimum of three months of treatment is required before reassessment. At that time, patients will undergo comprehensive re-staging, including PET/CT, MRI, and evaluation of tumor markers. Individuals who show a favorable response may then be considered for potentially curative surgery.

• Re-staging with PET/CT, MRI, and tumor markers
• Patients showing favorable response may undergo curative surgery

Who is Eligible For This Treatment?

• • Adults (age 18 and older) with pancreatic head adenocarcinoma
  • Patients with borderline resectable or unresectable (locally advanced) tumors
  • Individuals able to tolerate standard FOLFIRINOX chemotherapy
  • Karnofsky Performance Score ≥70 (able to perform self-care but not work)
  • Not planning pregnancy during or soon after treatment
  • Also suitable for those with locally advanced or recurrent disease for palliative purposes

• Those with borderline resectable or unresectable (locally advanced) tumors
• Patients able to tolerate standard FOLFIRINOX chemotherapy
• Karnofsky Performance Score ≤70 (can perform self-care but not work)
• Patients not planning pregnancy during or shortly after treatment
• Age ≥18
• Also applicable in locally advanced or recurrent cases for palliative purposes

Who is not Eligible?

• Patients with distant metastases
• Tumors involving multiple regions of the pancreas
• Cases where endoscopic access to the tumor is not possible
• History of another cancer within the past 5 years
• Pregnant or breastfeeding women
• Severe comorbidities that preclude the procedure

Why Oncosil?

• Targets tumor cells while sparing surrounding healthy tissue

• • Can offer a survival benefit even for patients who are not surgical candidates
  • May work synergistically with chemotherapy to improve treatment outcomes
  • All treatment decisions are tailored to the individual by an experienced multidisciplinary team

• Potential for synergy with chemotherapy
• Treatment decisions are personalized by a multidisciplinary team

Center Highlights

• High-level surgical expertise with background in liver transplantation and HPB surgery
• Access to interventional radiology and nuclear medicine
• Research-friendly clinical setting
• Rapid and coordinated multidisciplinary decision-making process
• Patient-centered follow-up and side effect management system

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Frequently Asked Questions