The Evolving Field of Stereotactic Body Radiation Therapy in Pancreatic Cancer

Abstract

Pancreatic cancer remains a devastating disease with dismal outcomes despite the development of novel chemotherapeutic regimens and radiation techniques. Stereotactic body radiation therapy (SBRT) offers an advantage both in image guidance and radiation dose delivery to direct ablative doses to tumors with acceptable toxicity compared to conventional techniques. Recent literature is clustered with data pertaining to SBRT in patients with resectable, borderline resectable and locally advanced pancreatic tumors. We here present a summary of the current data and highlight the limitations and potential for future growth. Further clinical study in the form of multi-institutional trials is warranted to establish the role of SBRT in combination with new chemotherapeutic agents as well as a non-invasive alternative to surgery.

Added Value of Radiotherapy Following Neoadjuvant FOLFIRINOX for Resectable and Borderline Resectable Pancreatic Cancer: A Systematic Review and Meta-Analysis

“…SBRT is a new development in the field of radiotherapy. 43 By applying image guidance, the tumor can be followed during the radiation (tracking), or radiation can be interrupted when the tumor moves out of the beam (gating). This allows high doses of radiation in a very short period of time with less toxicity than conventional chemoradiotherapy.…”

Radioactive 125I seed implantation for pancreatic cancer with unexpected liver metastasis: A preliminary experience with 26 patients

“…125 I seeds can continuously release a low dose of γ-ray when they are implanted into tumor tissue. It can damage the DNA of tumor cells and induce apoptosis of tumor cells, so as to kill the proliferative cancer cells[ 17 , 18 ]. The advantages of 125 I seeds in the treatment of pancreatic cancer are local adaptation and low dose continuous therapy[ 19 - 21 ].…”

Neoadjuvant Radiotherapy is Associated With Improved Pathologic Outcomes and Survival in Resected Stage II-III Pancreatic Adenocarcinoma Treated With Multiagent Neoadjuvant Chemotherapy in the Modern Era

“…24 A previous NCDB analysis (data from 1998-2012) demonstrated that SBRT was associated with a 1.4-month survival benefit as compared to conventionally fractionated radiotherapy among patients with locally advanced unresectable PDAC. 25 Stereotactic body has several theoretical advantages over EBRT worth highlighting. Stereotactic body delivers higher doses of radiation administered over a smaller number of fractions, with improved tumor localization.…”