Novel Approaches in Chemoradiation for Localized Pancreas Cancer
Attempts to improve results of chemoradiotherapy in patients with pancreatic cancer by either increasing the total dose of radiation or chemotherapy or by changing cytotoxic drugs have not been very successful. Additionally, some combinations have been associated with a high rate of unacceptable treatment-related morbidity, underscoring the need for new treatment strategies to combine with radiation to improve the therapeutic ratio of such treatment. Gemcitabine has stood the test of time as a systemic agent in advanced and early disease but was not widely adopted as a radiosensitizer in pancreatic cancer. Single-arm clinical trials that initially explored gemcitabine as a radiosensitizer in locally advanced pancreatic cancer demonstrated the potential for significant toxicity without dramatic improvements in efficacy. Subsequent studies showed marked improvement in patient tolerance with the refinements of delivery of radiation. Recent strategies include radiosensitization by the incorporation of targeted agents and continued improvement in delivery of radiation through novel means such as steriotactic radiotherapy. This chapter focuses on data evaluating the incorporation of targeted agents with radiation therapy in the context of a multidisciplinary approach for the treatment of localized pancreatic cancer.
KeywordsEpidermal Growth Factor Receptor Pancreatic Cancer Rectal Cancer Clin Oncol Radiat Oncol Biol Phys
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