Review and current state of radiation therapy for locally advanced pancreatic adenocarcinoma

Abstract

Pancreatic cancer is characterized by a high rate of metastatic spread and overall poor prognosis. Yet 30% of patients have progressive local disease at the time of death, and local progression can cause significant morbidity. Approximately 30-40% of patients present with locally advanced pancreatic cancer (LAPC) that is not surgically resectable, and the optimal treatment for these patients continues to evolve. The role of radiation in the management of LAPC is an area of controversy, and the recent LAP07 randomized trial reported no survival benefit of radiation following gemcitabine plus or minus erlotinib. However, the efficacy of modern systemic regimens has improved since the design of the LAP07 study, and radiation therapy may be of greater benefit in the context of more effective systemic therapy. Advances in radiation delivery including the increasing use of stereotactic body radiation therapy (SBRT) have the potential to improve outcomes through dose escalation and better treatment tolerability. In addition, the combination of radiation therapy and immune therapy is an area of promising research. These advances suggest that radiation therapy will continue to play an integral role in the management of LAPC.

Benefitial role of electrochemotherapy in locally advanced pancreatic cancer – radiological perspective

“…The less common complications are seen in hypofraction ated treatment in compared to single fraction SBRT [31].…”

Novel Anticancer and Treatment Sensitizing Compounds against Pancreatic Cancer

“…Technical advances in radiotherapy have resulted in a reduction of damage to organs at risk and overall improvement in the survival outcomes for radiotherapy patients. Recent advances include intensity or volumetric modulated radiation therapy (IMRT) or (VMAT), stereotactic body radiation therapy (SRBT) and proton therapy [35][36][37][38][39] These modalities allow for specific tumor targeting, protecting organs at risk, and allow for higher dose escalation [30,[35][36][37][38][39]. Moreover, strategies to target hypoxia-induced resistance to radiotherapy have developed over the past few decades.…”

Monozentrische Erfahrungen mit stereotaktischer Bestrahlung (SBRT) beim fortgeschrittenen hepatozellulären Karzinom im Stadium BCLC-C

“…In einer retrospektiv durchgeführten Propensity-Score-Analyse wurden 122 Patienten, die mittels SBRT behandelt worden sind, mit Patienten unter Sorafenib-Therapie verglichen. Die Ergebnisse deuteten auf ein verbessertes mittleres Gesamtüberleben von 17,0 Monaten (10,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)2) im Vergleich zu den mit Sorafenib behandelten Patienten von 9,6 Monaten (8,6-10,7) hin [36]. Trotz der vielversprechenden Ergebnisse sind jedoch das retrospektive Studiendesign der Studie und die limitierte Anzahl an Patienten zu beachten, sodass Ergebnisse von prospektiven Studien abzuwarten sind.…”

“…Damit kann die Behandlung mit hohen Einzeldosen in nur wenigen Sitzungen sicher erfolgen. Stereotaktische Bestrahlungen werden bei unterschiedlichen Tumorentitäten bereits erfolgreich eingesetzt [19][20][21]. Auch beim HCC gibt es vielversprechende erste Daten zur SBRT in verschiedenen Stadien der Erkrankung [18].…”