Radiotherapy in Pancreatic Cancer: To Whom, When, and How?

Abstract

The diagnosis rate of pancreatic cancer is steadily increasing. The average age of onset is close to 70 years. In most cases, the disease is diagnosed at an advanced stage. The indications for and techniques of radiotherapy are changing over time. The aim of this thesis is to present the role and possibilities of radiotherapy from the perspective of radiation oncologist. The most common cause of treatment failure in pancreatic cancer remains generalisation. The implementation of new systemic treatment regimens contributes to improved treatment outcomes regardless of the stage of the disease. With improved treatment outcomes in terms of the incidence of distant metastases, the impact of local curability on the length and quality of life of patients increases. Modern radiotherapy offers the opportunity to achieve high local cure rates. Postoperative radiotherapy in combination with chemotherapy seems justified in the group of postoperative pancreatic cancer patients with pT3 and pN+ features. In the group of patients with borderline resectable pancreatic cancer, the impact of radiotherapy in combination with the latest chemotherapy regimens is difficult to define clearly. In the setting of a diagnosis of advanced pancreatic cancer, radiotherapy, especially stereotactic radiotherapy, in combination with chemotherapy, contributes to improved local curability and allows to achieve a significantly reduced level of pain.

New avenues for the treatment of immunotherapy-resistant pancreatic cancer

“…Radiotherapy has been incorporated into neoadjuvant, adjuvant, and first-line treatment regimens for patients with metastatic and advanced PC[ 59 ]. While chemoradiotherapy in neoadjuvant and adjuvant settings has demonstrated a marginal increase in patient survival, the majority of diagnoses occur at an advanced disease stage.…”

“…While chemoradiotherapy in neoadjuvant and adjuvant settings has demonstrated a marginal increase in patient survival, the majority of diagnoses occur at an advanced disease stage. Consequently, the use of chemotherapy and radiotherapy as first-line treatments becomes imperative[ 59 , 60 ]. Nevertheless, the application of radiotherapy in the treatment of patients with metastatic PC yields conflicting data and falls short of anticipated effectiveness.…”