ESTRO ACROP guidelines for target volume definition in pancreatic cancer

Abstract

Despite of the predominant role of chemotherapy and surgery in pancreatic ductal adenocarcinoma (PDAC), radiotherapy (RT) still has a place in multimodal management of this disease where local tumour sequelae are fatal in about 40% of the patients. RT (chemoradiotherapy and stereotactic body radiotherapy) is used and investigated in the non-metastatic setting as part of definitive treatment strategies, in (neo)adjuvant settings and for locally recurrent disease. The ACROP committee was delegated by ESTRO to recommend target volume delineation for these clinical situations. The guidelines of this document are a result of a structured evaluation of the best available evidence by a panel of international experts in the field. Guidance for treatment planning including diagnostic imaging is provided. Recommendations are given for GTV delineation. The role and the definition of CTV volumes are critically discussed. Aspects of motion management and patient positioning are taken into account for PTV definition. Furthermore, aspects of delineation of organs at risk and of dose constraints are described in both, standard and hypofractionated, settings. This guideline has the purpose to support standardised and optimised processes of RT treatment planning for both, clinical practice and prospective studies.

The timing and design of stereotactic radiotherapy approaches as a part of neoadjuvant therapy in pancreatic cancer: Is it time for change?

“…Areas of clinical microscopic risk, including nodal regions, around the celiac trunk and superior mesenteric artery should be included based on patterns of failure [22,32]. ESTRO guidelines support the consideration of elective nodal irradiation (ENI) for resectable tumors, as the importance of local control increases in the context of surgery [33]. Further, single institution data has suggested rare out of field failures with five fraction regimens mandating ENI [34].…”

Investigate the Dosimetric and Potential Clinical Benefits Utilizing Stereotactic Body Radiation Therapy With Simultaneous Integrated Boost Technique for Locally Advanced Pancreatic Cancer: A Comparison Between Photon and Proton Beam Therapy

“…The patient groups were divided by the location of the tumor (head: 13 patients, body: 6 patients). Gross tumor volume (GTV) includes primary tumor and clinically apparent lymph nodes but does not include elective nodal regions ( 16 ). GTV to CTV uniform expansions of 0.5 cm were based on ESTRO guidelines ( 16 ).…”

“…Gross tumor volume (GTV) includes primary tumor and clinically apparent lymph nodes but does not include elective nodal regions ( 16 ). GTV to CTV uniform expansions of 0.5 cm were based on ESTRO guidelines ( 16 ). For photon therapy, PTV was the CTV plus a 0.5-cm uniform margin.…”

Current understanding of ferroptosis in the progression and treatment of pancreatic cancer

“…In the multimodal treatment of pancreatic cancer, particularly to treat locally advanced or recurrent pancreatic tumours, radiotherapy remains a critical component [83].…”