Stereotactic radiotherapy for unresectable adenocarcinoma of the pancreas

Chang, Daniel T.; Schellenberg, Devin; Shen, John; Kim, Jeff; Goodman, Karyn A.; Fisher, George A.; Ford, James M.; Desser, Terry S.; Quon, Andrew; Koong, Albert C.

doi:10.1002/cncr.24059

Cited by 349 publications

(282 citation statements)

References 23 publications

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“…28 Numerous other published trials have also looked at the role of SBRT in the treatment of locally advanced pancreatic cancer. [29][30][31][32][33][34][35][36] In Table 1, we present a selected number of studies addressing this topic.…”

Section: Clinical Outcomes In Patients Treated With Sbrtmentioning

confidence: 99%

Pancreatic cancer and SBRT: A new potential option?

Hajj

Goodman

2015

Reports of Practical Oncology & Radiotherapy

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a b s t r a c tLocal control remains a major issue for patients with unresectable, locally advanced pancreatic cancer (LAPC). The role of radiation therapy in the management of LAPC represents an area of some controversy. Stereotactic body radiotherapy is an emerging treatment option for LAPC as it can provide a therapeutic benefit with significant advantages for patients' quality of life over standard conventional chemoradiation. The objective of this review is to present the rationale for stereotactic body radiotherapy in LAPC, as well as to discuss the potential limitations and caveats of the currently available studies.

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Section: Clinical Outcomes In Patients Treated With Sbrtmentioning

confidence: 99%

Pancreatic cancer and SBRT: A new potential option?

Hajj

Goodman

2015

Reports of Practical Oncology & Radiotherapy

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“…The first studies of pancreatic SBRT were conducted in patients with locally advanced disease and attempted to define the optimal radiation dose and delivery method to maximize tumor control while minimizing gastrointestinal toxicity. An early study of 77 patients treated with SBRT (25 Gy in a single fraction) resulted in a 1-year OS of 21% and locoregional control of approximately 90% [88]. Using this high dose of radiation, the late >grade 3 toxicity rate was 9% and consisted mainly of gastrointestinal ulceration and bleeding.…”

Section: • Neoadjuvant Chemoradiation For Borderline Resectable Diseasementioning

confidence: 99%

The Role of Neoadjuvant Therapy in Pancreatic Cancer: A Review

et al. 2016

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Controversy remains regarding neoadjuvant approaches in the treatment of pancreatic cancer. Neoadjuvant therapy has several potential advantages over adjuvant therapy including earlier delivery of systemic treatment, in vivo assessment of response, increased resectability rate in borderline resectable patients and increased margin-negative resection rate. At present, there are no randomized data favoring neoadjuvant over adjuvant therapy and multiple neoadjuvant approaches are under investigation. Combination chemotherapy regimens including 5-fluorouracil, irinotecan and oxaliplatin, gemcitabine with or without abraxane, or docetaxel and capecitabine have been used in the neoadjuvant setting. Radiation and chemoradiation have also been incorporated into neoadjuvant strategies, and delivery of alternative fractionation regimens is being explored. This review provides an overview of neoadjuvant therapies for pancreatic cancer. KEYWORDS• 5-fluorouracilPancreatic adenocarcinoma is considered one of the most aggressive malignancies. Most patients are diagnosed with advanced stage disease and only 15-20% of patients are considered candidates for curative resection. An additional 5-10% is diagnosed with borderline resectable or locally advanced disease. Although surgical resection is considered the only potentially curative treatment, resection alone results in low cure rates with median overall survival (OS) rates of approximately 20 months [1,2]. Pancreatic cancer is biologically aggressive and lacks therapeutic agents that are effective against micrometastases. Even in patients who undergo complete surgical resection followed by adjuvant chemotherapy with or without radiation, the risk for systemic recurrence can be as high as 77%, and may be either locoregional or distant in nature [3].Response rates to adjuvant therapies are variable and there is no reliable method to identify which patients will respond to treatment. Nonetheless, some randomized studies demonstrate OS and disease-free survival advantages associated with adjuvant therapies for resectable pancreatic cancer [4,5].Unlike adjuvant therapy, a neoadjuvant treatment approach potentially allows for in vivo assessment of tumor response. In addition, the use of early systemic therapy prior to surgery allows treatment of radiographically undetectable metastatic disease in some patients. It has been reported that 670REviEW Russo, Ammori, Eads & Dorth future science group disease progression occurs in 45-74% following neoadjuvant chemoradiation [6][7][8][9] and 30-78% following neoadjuvant chemotherapy [10] . Noncurative surgery and its associated risks can be avoided in patients who demonstrate disease progression following n eoadjuvant therapy.Neoadjuvant treatment also has the potential to improve compliance [11] as adjuvant therapy is frequently delayed due to recovery from surgery. It is estimated that approximately 25% of patients undergoing curative resection for pancreatic cancer do not receive the planned postoperative treatment due to surgical co...

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“…Amennyiben a beteg állapota ezt nem engedi, vagy metasztázisra gyanús eltérések jelenléte igazolható, illetve a reszekálhatóság erősen kérdéses, érdemes 2-6 kemoterápiás ciklussal kezdeni. Ha a tumor a kezelés után sem operálható, fenntartó kemoterápia indokolt [33,34].…”

Section: Sugárterápia 81unclassified

Pancreatic cancer.Evidence based management guidelines of the Hungarian Pancreatic Study Group

et al. 2015

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A pancreasrák gyakran későn diagnosztizált kórkép, amely a legrosszabb kórlefolyású betegségek csoportjába sorolható, ezért a szűrése, diagnosztikája, kezelése és palliációja korszerű és bizonyítékokon alapuló útmutatót igényel. A Magyar Hasnyálmirigy Munkacsoport célul tűzte ki, hogy a jelenleg elérhető nemzetközi irányvonalakat, illetve evidenciákat alapul véve a pancreasrák kezelésének kulcskérdései vonatkozásában bizonyíték alapú irányelveket fogalmazzon meg. A Magyar Hasnyálmirigy Munkacsoport által kijelölt előkészítő és konzulens munkacsoport lefordí-totta, és ahol szükségesnek találta, kiegészítette és/vagy módosította a nemzetközi irányelveket. Összesen 10 téma-körben (Rizikófaktorok és genetika, Szűrés, Diagnózis, Staging, Sebészi kezelés, Patológiai feldolgozás, Szisztémás kezelés, Sugárterápia, Palliáció és szupportív kezelés, Utánkövetés és rekurrencia) 37 releváns irányelv került össze-állításra. Az evidencia osztályozása a National Comprehensive Cancer Network (NCCN) rendszere alapján került meghatározásra. Az összeállított irányelvek a 2014. szeptember 12-ei konszenzustalálkozón kerültek bemutatásra és megvita tásra. A résztvevők 15 irányelvet teljes (95% feletti) egyetértéssel, míg 22 irányelvet erős (70% feletti) egyetértéssel fogadtak el. A Magyar Hasnyálmirigy Munkacsoport kezelési irányelvei az első, bizonyíték alapján készült pancreasrák-kezelési útmutató hazánkban. Az irányelv komoly segítséget nyújthat a pancreasrák oktatásához, a mindennapi betegellátáshoz és a megfelelő fi nanszírozás kialakításához. Ezért a szerzők bíznak abban, hogy ezen irányelvek minél szélesebb körben alapreferenciaként fognak szolgálni Magyarországon.

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Stereotactic radiotherapy for unresectable adenocarcinoma of the pancreas

Cited by 349 publications

References 23 publications

Pancreatic cancer and SBRT: A new potential option?

Pancreatic cancer and SBRT: A new potential option?

The Role of Neoadjuvant Therapy in Pancreatic Cancer: A Review

Pancreatic cancer.Evidence based management guidelines of the Hungarian Pancreatic Study Group

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