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State of the Art in Radiation Therapy for Pancreas Cancer

  • Aaron C. Spalding
  • Edgar Ben-Josef
Part of the M. D. Anderson Solid Tumor Oncology Series book series (MDA)

Despite an extraordinary tendency for metastatic spread, radiotherapy may have an important role in the management of locally advanced unresectable cancer of the pancreas. Local control remains a significant clinical problem. In patients with unresectable disease, failure to control local disease is virtually uniform, and in patients undergoing curative resection, the rate of local relapse is 50–85% (1). Failure to control the primary is associated with symptoms such as pain, gastric outlet, and duodenal obstruction, and upper gastrointestinal ulceration and bleeding. Palliation of symptoms with radiotherapy (as the sole modality) is accomplished in nearly half of patients (2). It is almost certain that modern day combined-modality therapy provides even better palliation, but unfortunately solid data on symptom control and quality of life associated with such therapy are not available.

Improved local control not only provides a palliative benefit, but may also impact on survival. Chemotherapy can extend survival of patients with advanced disease by 2–3 months to a median of 5–6 months ( 3, 4 ) and it has been suggested that radiotherapy can also extend survival ( 5 ). The Gastrointestinal Tumor Study Group (GITSG) conducted a prospective phase III trial comparing SMF (streptozotocin, mitomycin, and 5-fluorouracil) chemotherapy alone to SMF plus external-beam radiotherapy to a dose of 54 Gy. They reported a significant benefit in median survival (9.7 months versus 7.4 months) in favor of the combined modality arm. Patients with unresectable disease who are rendered resectable by chemoradiotherapy and undergo surgery, appear to have a survival similar to patients who are surgical candidates at presentation ( 10 ), suggesting that aggressive local therapy may have an impact on survival. Like other fields of oncology (breast cancer and lymphoma, for instance), with the advent of more effective systemic agents, the need for local control and the impact of local control on survival are likely to become more evident.

Keywords

Pancreatic Cancer Planning Target Volume Dose Distribution Radiat Oncol Biol Phys Intensity Modulate Radiotherapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer Science + Business Media, LLC 2008

Authors and Affiliations

  • Aaron C. Spalding
    • 1
  • Edgar Ben-Josef
    • 1
  1. 1.Department of Radiation OncologyUniversity of MichiganAnn ArborUSA

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