Integration of Stereotactic Body Radiation Therapy into the Multidisciplinary Management of Pancreatic Cancer

Although most patients with pancreatic cancer die of metastatic disease, an autopsy study showed that up to one-third of patients die of predominantly local disease. This patient population stands to benefit the most from radiation, surgery, or both. Unfortunately, however, single-agent chemotherapy...

Full description

Saved in:
Bibliographic Details
Published inSeminars in radiation oncology Vol. 27; no. 3; pp. 256 - 267
Main Authors Rosati, Lauren M., BS, Kumar, Rachit, MD, Herman, Joseph M., MD, MSc
Format Journal Article
LanguageEnglish
Published United States Elsevier Inc 01.07.2017
Subjects
Chemoradiotherapy - methods
Disease Progression
Dose Fractionation
Hematology, Oncology and Palliative Medicine
Humans
Immunotherapy - methods
Pancreatic Neoplasms - therapy
Radiology
Radiosurgery - methods
Online AccessGet full text

Cover

More Information
Summary:Although most patients with pancreatic cancer die of metastatic disease, an autopsy study showed that up to one-third of patients die of predominantly local disease. This patient population stands to benefit the most from radiation, surgery, or both. Unfortunately, however, single-agent chemotherapy has had minimal benefit in pancreatic cancer, and most patients progress distantly before receiving radiation therapy (RT). With the addition of multiagent chemotherapy, patients are living longer, and RT has emerged as an important modality in preventing local progression. Standard chemoradiation delivered over 5-6 weeks has been shown to improve local control, but this approach delays full-dose systemic therapy and increases toxicity when compared to chemotherapy alone. Stereotactic body RT (SBRT) delivered in 3-5 fractions can be used to accurately target the pancreatic tumor with small margins and limited acute treatment-related toxicity. Given the favorable toxicity profile, SBRT can easily be integrated with other therapies in all stages of pancreatic cancer. However, future studies are necessary to determine optimal dose or fractionation regimens and sequencing with targeted therapies and immunotherapy. The purpose of this review is to discuss our current understanding of SBRT in the multidisciplinary management of patients with pancreatic cancer and future implications.
ISSN:1053-4296
1532-9461
DOI:10.1016/j.semradonc.2017.02.005