Skip to main content
SpringerLink
Log in

Role of Radiation for Locally Advanced Pancreatic Cancer

  • Chapter
  • First Online:
Management of Localized Pancreatic Cancer

  • 460 Accesses

Abstract

Given the propensity for locally advanced pancreatic cancer (LAPC) to metastasize, the role of radiation in treatment of this challenging disease is questioned. Given the location of the pancreas in the upper abdomen, the use of radiation in this location is technically challenging. Identification of the patients who will benefit from this treatment is pivotal, as is the expertise to execute radiation to defined targets at the required high doses in the upper abdomen. This chapter will explore these challenges.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Bibliography

  1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin. 2017;67(1):7–30.

    Article  PubMed  Google Scholar 

  2. Schrag D. Optimizing treatment for locally advanced pancreas cancer: progress but no precision. JAMA. 2016;315(17):1837–8.

    Article  CAS  PubMed  Google Scholar 

  3. Evans DB, George B, Tsai S. Non-metastatic pancreatic cancer: resectable, borderline resectable, and locally advanced-definitions of increasing importance for the optimal delivery of multimodality therapy. Ann Surg Oncol. 2015;22(11):3409–13.

    Article  PubMed  Google Scholar 

  4. Huguet F, Andre T, Hammel P, Artru P, Balosso J, Selle F, et al. Impact of chemoradiotherapy after disease control with chemotherapy in locally advanced pancreatic adenocarcinoma in GERCOR phase II and III studies. J Clin Oncol. 2007;25(3):326–31.

    Article  CAS  PubMed  Google Scholar 

  5. Krishnan S, Rana V, Janjan NA, Varadhachary GR, Abbruzzese JL, Das P, et al. Induction chemotherapy selects patients with locally advanced, unresectable pancreatic cancer for optimal benefit from consolidative chemoradiation therapy. Cancer. 2007;110(1):47–55.

    Article  PubMed  Google Scholar 

  6. Hammel P, Huguet F, van Laethem JL, Goldstein D, Glimelius B, Artru P, et al. Effect of chemoradiotherapy vs chemotherapy on survival in patients with locally advanced pancreatic cancer controlled after 4 months of gemcitabine with or without erlotinib: the LAP07 randomized clinical trial. JAMA. 2016;315(17):1844–53.

    Article  CAS  PubMed  Google Scholar 

  7. Iacobuzio-Donahue CA, Fu B, Yachida S, Luo M, Abe H, Henderson CM, et al. DPC4 gene status of the primary carcinoma correlates with patterns of failure in patients with pancreatic cancer. J Clin Oncol. 2009;27(11):1806–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Ben-Josef E, Lawrence TS. Chemoradiotherapy for unresectable pancreatic cancer. Int J Clin Oncol. 2008;13(2):121–6.

    Article  PubMed  Google Scholar 

  9. Murphy JD, Adusumilli S, Griffith KA, Ray ME, Zalupski MM, Lawrence TS, et al. Full-dose gemcitabine and concurrent radiotherapy for unresectable pancreatic cancer. Int J Radiat Oncol Biol Phys. 2007;68(3):801–8.

    Article  CAS  PubMed  Google Scholar 

  10. Shinchi H, Takao S, Noma H, Matsuo Y, Mataki Y, Mori S, et al. Length and quality of survival after external-beam radiotherapy with concurrent continuous 5-fluorouracil infusion for locally unresectable pancreatic cancer. Int J Radiat Oncol Biol Phys. 2002;53(1):146–50.

    Article  CAS  PubMed  Google Scholar 

  11. Huguet F, Girard N, Guerche CS, Hennequin C, Mornex F, Azria D. Chemoradiotherapy in the management of locally advanced pancreatic carcinoma: a qualitative systematic review. J Clin Oncol. 2009;27(13):2269–77.

    Article  CAS  PubMed  Google Scholar 

  12. Ben-Josef E, Schipper M, Francis IR, Hadley S, Ten-Haken R, Lawrence T, et al. A phase I/II trial of intensity modulated radiation (IMRT) dose escalation with concurrent fixed-dose rate gemcitabine (FDR-G) in patients with unresectable pancreatic cancer. Int J Radiat Oncol Biol Phys. 2012;84(5):1166–71.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Crane CH. Improving long-term survival in patients with locally advanced pancreatic cancer via the delivery of definitive radiotherapy doses. Oncology (Williston Park). 2015;29(8):561–2, 6.

    Google Scholar 

  14. Crane CH. Hypofractionated ablative radiotherapy for locally advanced pancreatic cancer. J Radiat Res. 2016;57(Suppl 1):i53–i7.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hammel PHF, Van Laethem JL, et al. Comparison of chemoradiotherapy (CRT) and chemotherapy (CT) in patients with a locally advanced pancreatic cancer (LAPC) controlled after 4 months of gemcitabine with or without erlotinib: final results of the international phase III LAP07 study. J Clin Oncol. 2013;31:LBA4003.

    Article  Google Scholar 

  16. Jani A, Horowitz DP. Radiation therapy deviations in trial of locally advanced pancreatic cancer [corrected]. JAMA. 2016;316(13):1409.

    Article  PubMed  Google Scholar 

  17. Loehrer PJ Sr, Feng Y, Cardenes H, Wagner L, Brell JM, Cella D, et al. Gemcitabine alone versus gemcitabine plus radiotherapy in patients with locally advanced pancreatic cancer: an Eastern Cooperative Oncology Group trial. J Clin Oncol. 2011;29(31):4105–12.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Mukherjee S, Hurt CN, Bridgewater J, Falk S, Cummins S, Wasan H, et al. Gemcitabine-based or capecitabine-based chemoradiotherapy for locally advanced pancreatic cancer (SCALOP): a multicentre, randomised, phase 2 trial. Lancet Oncol. 2013;14(4):317–26.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Hurt CN, Falk S, Crosby T, McDonald A, Ray R, Joseph G, et al. Long-term results and recurrence patterns from SCALOP: a phase II randomised trial of gemcitabine- or capecitabine-based chemoradiation for locally advanced pancreatic cancer. Br J Cancer. 2017;116(10):1264–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Conroy T, Desseigne F, Ychou M, Bouche O, Guimbaud R, Becouarn Y, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011;364(19):1817–25.

    Article  CAS  PubMed  Google Scholar 

  21. Christians KK, Tsai S, Mahmoud A, Ritch P, Thomas JP, Wiebe L, et al. Neoadjuvant FOLFIRINOX for borderline resectable pancreas cancer: a new treatment paradigm? Oncologist. 2014;19(3):266–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Badiyan SN, Olsen JR, Lee AY, Yano M, Menias CO, Khwaja S, et al. Induction chemotherapy followed by concurrent full-dose gemcitabine and intensity-modulated radiation therapy for borderline resectable and locally advanced pancreatic adenocarcinoma. Am J Clin Oncol. 2016;39(1):1–7.

    Article  CAS  PubMed  Google Scholar 

  23. Katz MH, Shi Q, Ahmad SA, Herman JM, Marsh Rde W, Collisson E, et al. Preoperative modified FOLFIRINOX treatment followed by capecitabine-based chemoradiation for borderline resectable pancreatic cancer: alliance for clinical trials in oncology trial A021101. JAMA Surg. 2016;151(8):e161137.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Faris JE, Blaszkowsky LS, McDermott S, Guimaraes AR, Szymonifka J, Huynh MA, et al. FOLFIRINOX in locally advanced pancreatic cancer: the Massachusetts General Hospital Cancer Center experience. Oncologist. 2013;18(5):543–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Chatzizacharias NA, Tsai S, Griffin M, Tolat P, Ritch P, George B, et al. Locally advanced pancreas cancer: staging and goals of therapy. Surgery. 2018;163:1053.

    Article  PubMed  Google Scholar 

  26. Paulson ES, Erickson B, Schultz C, Allen LX. Comprehensive MRI simulation methodology using a dedicated MRI scanner in radiation oncology for external beam radiation treatment planning. Med Phys. 2015;42(1):28–39.

    Article  PubMed  Google Scholar 

  27. Heerkens HD, Hall WA, Li XA, Knechtges P, Dalah E, Paulson ES, et al. Recommendations for MRI-based contouring of gross tumor volume and organs at risk for radiation therapy of pancreatic cancer. Pract Radiat Oncol. 2017;7(2):126–36.

    Article  CAS  PubMed  Google Scholar 

  28. Heerkens HD, van Vulpen M, van den Berg CA, Tijssen RH, Crijns SP, Molenaar IQ, et al. MRI-based tumor motion characterization and gating schemes for radiation therapy of pancreatic cancer. Radiother Oncol. 2014;111(2):252–7.

    Article  PubMed  Google Scholar 

  29. Reese AS, Lu W, Regine WF. Utilization of intensity-modulated radiation therapy and image-guided radiation therapy in pancreatic cancer: is it beneficial? Semin Radiat Oncol. 2014;24(2):132–9.

    Article  PubMed  Google Scholar 

  30. Huguet F, Goodman KA, Azria D, Racadot S, Abrams RA. Radiotherapy technical considerations in the management of locally advanced pancreatic cancer: American-French consensus recommendations. Int J Radiat Oncol Biol Phys. 2012;83(5):1355–64.

    Article  PubMed  Google Scholar 

  31. Bussels B, Goethals L, Feron M, Bielen D, Dymarkowski S, Suetens P, et al. Respiration-induced movement of the upper abdominal organs: a pitfall for the three-dimensional conformal radiation treatment of pancreatic cancer. Radiother Oncol. 2003;68(1):69–74.

    Article  PubMed  Google Scholar 

  32. Li XA, Liu F, Tai A, Ahunbay E, Chen G, Kelly T, et al. Development of an online adaptive solution to account for inter- and intra-fractional variations. Radiother Oncol. 2011;100(3):370–4.

    Article  PubMed  Google Scholar 

  33. Tai A, Liang Z, Erickson B, Li XA. Management of respiration-induced motion with 4-dimensional computed tomography (4DCT) for pancreas irradiation. Int J Radiat Oncol Biol Phys. 2013;86(5):908–13.

    Article  PubMed  Google Scholar 

  34. Taniguchi CM, Murphy JD, Eclov N, Atwood TF, Kielar KN, Christman-Skieller C, et al. Dosimetric analysis of organs at risk during expiratory gating in stereotactic body radiation therapy for pancreatic cancer. Int J Radiat Oncol Biol Phys. 2013;85(4):1090–5.

    Article  PubMed  Google Scholar 

  35. Cattaneo GM, Passoni P, Sangalli G, Slim N, Longobardi B, Mancosu P, et al. Internal target volume defined by contrast-enhanced 4D-CT scan in unresectable pancreatic tumour: evaluation and reproducibility. Radiother Oncol. 2010;97(3):525–9.

    Article  PubMed  Google Scholar 

  36. Prokesch RW, Chow LC, Beaulieu CF, Bammer R, Jeffrey RB Jr. Isoattenuating pancreatic adenocarcinoma at multi-detector row CT: secondary signs. Radiology. 2002;224(3):764–8.

    Article  PubMed  Google Scholar 

  37. Arvold ND, Niemierko A, Mamon HJ, Fernandez-del Castillo C, Hong TS. Pancreatic cancer tumor size on CT scan versus pathologic specimen: implications for radiation treatment planning. Int J Radiat Oncol Biol Phys. 2011;80(5):1383–90.

    Article  PubMed  Google Scholar 

  38. Godfrey DJ, Patel BN, Adamson JD, Subashi E, Salama JK, Palta M. Triphasic contrast enhanced CT simulation with bolus tracking for pancreas SBRT target delineation. Pract Radiat Oncol. 2017;7(6):e489–e97.

    Article  PubMed  Google Scholar 

  39. Qiu H, Wild AT, Wang H, Fishman EK, Hruban RH, Laheru DA, et al. Comparison of conventional and 3-dimensional computed tomography against histopathologic examination in determining pancreatic adenocarcinoma tumor size: implications for radiation therapy planning. Radiother Oncol. 2012;104(2):167–72.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Hall WA, Mikell JL, Mittal P, Colbert L, Prabhu RS, Kooby DA, et al. Tumor size on abdominal MRI versus pathologic specimen in resected pancreatic adenocarcinoma: implications for radiation treatment planning. Int J Radiat Oncol Biol Phys. 2013;86(1):102–7.

    Article  PubMed  Google Scholar 

  41. Koong AC, Mehta VK, Le QT, Fisher GA, Terris DJ, Brown JM, et al. Pancreatic tumors show high levels of hypoxia. Int J Radiat Oncol Biol Phys. 2000;48(4):919–22.

    Article  CAS  PubMed  Google Scholar 

  42. Von Hoff DD, Korn R, Mousses S. Pancreatic cancer – could it be that simple? A different context of vulnerability. Cancer Cell. 2009;16(1):7–8.

    Article  CAS  Google Scholar 

  43. Park MS, Klotz E, Kim MJ, Song SY, Park SW, Cha SW, et al. Perfusion CT: noninvasive surrogate marker for stratification of pancreatic cancer response to concurrent chemo- and radiation therapy. Radiology. 2009;250(1):110–7.

    Article  PubMed  Google Scholar 

  44. Goldstein SD, Ford EC, Duhon M, McNutt T, Wong J, Herman JM. Use of respiratory-correlated four-dimensional computed tomography to determine acceptable treatment margins for locally advanced pancreatic adenocarcinoma. Int J Radiat Oncol Biol Phys. 2010;76(2):597–602.

    Article  PubMed  Google Scholar 

  45. Gabata T, Matsui O, Kadoya M, et al. Small pancreatic adenocarcinomas: efficacy of MR imaging with fat supression and gadolinium enhancement. Radiology. 1994;193:683–8.

    Article  CAS  PubMed  Google Scholar 

  46. Semelka RC, Kelekis NL, Molina PL, Sharp TJ, Calvo B. Pancreatic masses with inconclusive findings on spiral CT: is there a role for MRI? J Magn Reson Imaging. 1996;6(4):585–8.

    Article  CAS  PubMed  Google Scholar 

  47. Semelka R, editor. Abdominal-pelvic MRI. 2nd ed. Hoboken: John Wiley & Sons, INc.; 2006.

    Google Scholar 

  48. Ichikawa T, Erturk SM, Motosugi U, Sou H, Iino H, Araki T, et al. High-b value diffusion-weighted MRI for detecting pancreatic adenocarcinoma: preliminary results. AJR Am J Roentgenol. 2007;188(2):409–14.

    Article  PubMed  Google Scholar 

  49. Barral M, Taouli B, Guiu B, Koh DM, Luciani A, Manfredi R, et al. Diffusion-weighted MR imaging of the pancreas: current status and recommendations. Radiology. 2015;274(1):45–63.

    Article  PubMed  Google Scholar 

  50. Cuneo KC, Chenevert TL, Ben-Josef E, Feng MU, Greenson JK, Hussain HK, et al. A pilot study of diffusion-weighted MRI in patients undergoing neoadjuvant chemoradiation for pancreatic cancer. Transl Oncol. 2014;7(5):644–9.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Dalah E, Erickson B, Oshima K, Schott D, Hall WA, Paulson E, et al. Correlation of ADC with pathological treatment response for radiation therapy of pancreatic cancer. Transl Oncol. 2018;11(2):391–8.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Ueno M, Niwa T, Ohkawa S, Amano A, Masaki T, Miyakawa K, et al. The usefulness of perfusion-weighted magnetic resonance imaging in advanced pancreatic cancer. Pancreas. 2009;38(6):644–8.

    Article  PubMed  Google Scholar 

  53. Akisik MF, Sandrasegaran K, Bu G, Lin C, Hutchins GD, Chiorean EG. Pancreatic cancer: utility of dynamic contrast-enhanced MR imaging in assessment of antiangiogenic therapy. Radiology. 2010;256(2):441–9.

    Article  PubMed  Google Scholar 

  54. Cui Y, Song J, Pollom E, Alagappan M, Shirato H, Chang DT, et al. Quantitative analysis of (18)F-Fluorodeoxyglucose positron emission tomography identifies novel prognostic imaging biomarkers in locally advanced pancreatic cancer patients treated with stereotactic body radiation therapy. Int J Radiat Oncol Biol Phys. 2016;96(1):102–9.

    Article  PubMed  Google Scholar 

  55. Chang JS, Choi SH, Lee Y, Kim KH, Park JY, Song SY, et al. Clinical usefulness of (1)(8)F-fluorodeoxyglucose-positron emission tomography in patients with locally advanced pancreatic cancer planned to undergo concurrent chemoradiation therapy. Int J Radiat Oncol Biol Phys. 2014;90(1):126–33.

    Article  PubMed  Google Scholar 

  56. Schellenberg D, Quon A, Minn AY, Graves EE, Kunz P, Ford JM, et al. 18Fluorodeoxyglucose PET is prognostic of progression-free and overall survival in locally advanced pancreas cancer treated with stereotactic radiotherapy. Int J Radiat Oncol Biol Phys. 2010;77(5):1420–5.

    Article  PubMed  Google Scholar 

  57. Hall WA, Heerkens HD, Paulson ES, Meijer GJ, Kotte AN, Knechtges P, et al. Pancreatic gross tumor volume contouring on computed tomography (CT) compared with magnetic resonance imaging (MRI): results of an international contouring conference. Pract Radiat Oncol. 2018;8(2):107–15.

    Article  PubMed  Google Scholar 

  58. Yamazaki H, Nishiyama K, Tanaka E, Koiwai K, Shikama N, Ito Y, et al. Dummy run for a phase II multi-institute trial of chemoradiotherapy for unresectable pancreatic cancer: inter-observer variance in contour delineation. Anticancer Res. 2007;27(4C):2965–71.

    PubMed  Google Scholar 

  59. Dalah E, Moraru I, Paulson E, Erickson B, Li XA. Variability of target and normal structure delineation using multimodality imaging for radiation therapy of pancreatic cancer. Int J Radiat Oncol Biol Phys. 2014;89(3):633–40.

    Article  PubMed  Google Scholar 

  60. Ito Y, Okusaka T, Kagami Y, Ueno H, Ikeda M, Sumi M, et al. Evaluation of acute intestinal toxicity in relation to the volume of irradiated small bowel in patients treated with concurrent weekly gemcitabine and radiotherapy for locally advanced pancreatic cancer. Anticancer Res. 2006;26(5B):3755–9.

    CAS  PubMed  Google Scholar 

  61. Kelly P, Das P, Pinnix CC, Beddar S, Briere T, Pham M, et al. Duodenal toxicity after fractionated chemoradiation for unresectable pancreatic cancer. Int J Radiat Oncol Biol Phys. 2013;85(3):e143–9.

    Article  PubMed  Google Scholar 

  62. Krishnan S, Chadha AS, Suh Y, Chen HC, Rao A, Das P, et al. Focal radiation therapy dose escalation improves overall survival in locally advanced pancreatic cancer patients receiving induction chemotherapy and consolidative chemoradiation. Int J Radiat Oncol Biol Phys. 2016;94(4):755–65.

    Article  PubMed  Google Scholar 

  63. Bittner MI, Grosu AL, Brunner TB. Comparison of toxicity after IMRT and 3D-conformal radiotherapy for patients with pancreatic cancer – a systematic review. Radiother Oncol. 2015;114(1):117–21.

    Article  PubMed  Google Scholar 

  64. Prasad S, Cambridge L, Huguet F, Chou JF, Zhang Z, Wu AJ, et al. Intensity modulated radiation therapy reduces gastrointestinal toxicity in locally advanced pancreas cancer. Pract Radiat Oncol. 2016;6(2):78–85.

    Article  PubMed  Google Scholar 

  65. Singh AK, Tierney RM, Low DA, Parikh PJ, Myerson RJ, Deasy JO, et al. A prospective study of differences in duodenum compared to remaining small bowel motion between radiation treatments: implications for radiation dose escalation in carcinoma of the pancreas. Radiat Oncol. 2006;1:33.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Herman JM, Chang DT, Goodman KA, Dholakia AS, Raman SP, Hacker-Prietz A, et al. Phase 2 multi-institutional trial evaluating gemcitabine and stereotactic body radiotherapy for patients with locally advanced unresectable pancreatic adenocarcinoma. Cancer. 2015;121(7):1128–37.

    Article  CAS  PubMed  Google Scholar 

  67. Moraru IC, Tai A, Erickson B, Li XA. Radiation dose responses for chemoradiation therapy of pancreatic cancer: an analysis of compiled clinical data using biophysical models. Pract Radiat Oncol. 2014;4(1):13–9.

    Article  PubMed  Google Scholar 

  68. Chauffert B, Mornex F, Bonnetain F, Rougier P, Mariette C, Bouche O, et al. Phase III trial comparing intensive induction chemoradiotherapy (60 Gy, infusional 5-FU and intermittent cisplatin) followed by maintenance gemcitabine with gemcitabine alone for locally advanced unresectable pancreatic cancer. Definitive results of the 2000-01 FFCD/SFRO study. Ann Oncol. 2008;19(9):1592–9.

    Article  CAS  PubMed  Google Scholar 

  69. Ceha HM, van Tienhoven G, Gouma DJ, Veenhof CH, Schneider CJ, Rauws EA, et al. Feasibility and efficacy of high dose conformal radiotherapy for patients with locally advanced pancreatic carcinoma. Cancer. 2000;89(11):2222–9.

    Article  CAS  PubMed  Google Scholar 

  70. Chung SY, Chang JS, Lee BM, Kim KH, Lee KJ, Seong J. Dose escalation in locally advanced pancreatic cancer patients receiving chemoradiotherapy. Radiother Oncol. 2017;123(3):438–45.

    Article  PubMed  Google Scholar 

  71. Rudra S, Jiang N, Rosenberg SA, Olsen JR, Parikh PJ, Bassetti MF, et al. High dose adaptive MRI guided radiation therapy improves overall survival of inoperable pancreatic cancer. Int J Radiat Oncol Biol Phys. 2017;99(2):E184.

    Article  Google Scholar 

  72. de Geus SWL, Eskander MF, Kasumova GG, Ng SC, Kent TS, Mancias JD, et al. Stereotactic body radiotherapy for unresected pancreatic cancer: a nationwide review. Cancer. 2017;123(21):4158–67.

    Article  PubMed  CAS  Google Scholar 

  73. Petrelli F, Comito T, Ghidini A, Torri V, Scorsetti M, Barni S. Stereotactic body radiation therapy for locally advanced pancreatic cancer: a systematic review and pooled analysis of 19 trials. Int J Radiat Oncol Biol Phys. 2017;97(2):313–22.

    Article  PubMed  Google Scholar 

  74. Rosati LM, Kumar R, Herman JM. Integration of stereotactic body radiation therapy into the multidisciplinary management of pancreatic cancer. Semin Radiat Oncol. 2017;27(3):256–67.

    Article  PubMed  Google Scholar 

  75. Kavanagh BD, Pan CC, Dawson LA, Das SK, Li XA, Ten Haken RK, et al. Radiation dose-volume effects in the stomach and small bowel. Int J Radiat Oncol Biol Phys. 2010;76(3 Suppl):S101–7.

    Article  PubMed  Google Scholar 

  76. Prior P, Tai A, Erickson B, Li XA. Consolidating duodenal and small bowel toxicity data via isoeffective dose calculations based on compiled clinical data. Pract Radiat Oncol. 2014;4(2):e125–31.

    Article  PubMed  Google Scholar 

  77. Verma J, Sulman EP, Jhingran A, Tucker SL, Rauch GM, Eifel PJ, et al. Dosimetric predictors of duodenal toxicity after intensity modulated radiation therapy for treatment of the para-aortic nodes in gynecologic cancer. Int J Radiat Oncol Biol Phys. 2014;88(2):357–62.

    Article  PubMed  Google Scholar 

  78. Xu KM, Rajagopalan MS, Kim H, Beriwal S. Extended field intensity modulated radiation therapy for gynecologic cancers: is the risk of duodenal toxicity high? Pract Radiat Oncol. 2015;5(4):e291–7.

    Article  PubMed  Google Scholar 

  79. Poorvu PD, Sadow CA, Townamchai K, Damato AL, Viswanathan AN. Duodenal and other gastrointestinal toxicity in cervical and endometrial cancer treated with extended-field intensity modulated radiation therapy to paraaortic lymph nodes. Int J Radiat Oncol Biol Phys. 2013;85(5):1262–8.

    Article  PubMed  Google Scholar 

  80. Murphy JD, Christman-Skieller C, Kim J, Dieterich S, Chang DT, Koong AC. A dosimetric model of duodenal toxicity after stereotactic body radiotherapy for pancreatic cancer. Int J Radiat Oncol Biol Phys. 2010;78(5):1420–6.

    Article  PubMed  Google Scholar 

  81. Bae SH, Kim MS, Cho CK, Kang JK, Lee SY, Lee KN, et al. Predictor of severe gastroduodenal toxicity after stereotactic body radiotherapy for abdominopelvic malignancies. Int J Radiat Oncol Biol Phys. 2012;84(4):e469–74.

    Article  PubMed  Google Scholar 

  82. Nakamura A, Shibuya K, Matsuo Y, Nakamura M, Shiinoki T, Mizowaki T, et al. Analysis of dosimetric parameters associated with acute gastrointestinal toxicity and upper gastrointestinal bleeding in locally advanced pancreatic cancer patients treated with gemcitabine-based concurrent chemoradiotherapy. Int J Radiat Oncol Biol Phys. 2012;84(2):369–75.

    Article  PubMed  Google Scholar 

  83. Huang J, Robertson JM, Ye H, Margolis J, Nadeau L, Yan D. Dose-volume analysis of predictors for gastrointestinal toxicity after concurrent full-dose gemcitabine and radiotherapy for locally advanced pancreatic adenocarcinoma. Int J Radiat Oncol Biol Phys. 2012;83(4):1120–5.

    Article  CAS  PubMed  Google Scholar 

  84. Cattaneo GM, Passoni P, Longobardi B, Slim N, Reni M, Cereda S, et al. Dosimetric and clinical predictors of toxicity following combined chemotherapy and moderately hypofractionated rotational radiotherapy of locally advanced pancreatic adenocarcinoma. Radiother Oncol. 2013;108(1):66–71.

    Article  PubMed  Google Scholar 

  85. Liu X, Ren G, Li L, Xia T. Predictive dosimetric parameters for gastrointestinal toxicity with hypofractioned radiotherapy in pancreatic adenocarcinoma. Onco Targets Ther. 2016;9:2489–94.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  86. Combs SE, Habermehl D, Kessel K, Bergmann F, Werner J, Brecht I, et al. Intensity modulated radiotherapy as neoadjuvant chemoradiation for the treatment of patients with locally advanced pancreatic cancer. Outcome analysis and comparison with a 3D-treated patient cohort. Strahlenther Onkol. 2013;189(9):738–44.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, The Medical College of Wisconsin, Milwaukee, WI, USA

    Beth A. Erickson & William A. Hall

Authors
  1. Beth A. Erickson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. William A. Hall
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Beth A. Erickson .

Editor information

Editors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, The Medical College of Wisconsin, Milwaukee, WI, USA

    Susan Tsai

  2. Division of Medical Oncology, Department of Medicine, The Medical College of Wisconsin, Milwaukee, WI, USA

    Paul S. Ritch

  3. Department of Radiation Oncology, The Medical College of Wisconsin, Milwaukee, WI, USA

    Beth A. Erickson

  4. Department of Surgery, The Medical College of Wisconsin, Milwaukee, WI, USA

    Douglas B. Evans

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Erickson, B.A., Hall, W.A. (2019). Role of Radiation for Locally Advanced Pancreatic Cancer. In: Tsai, S., Ritch, P., Erickson, B., Evans, D. (eds) Management of Localized Pancreatic Cancer . Springer, Cham. https://doi.org/10.1007/978-3-319-98944-0_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-98944-0_11

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-98943-3

  • Online ISBN: 978-3-319-98944-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation