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Gastrointestinal Cancer: Pancreas

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Alternate Fractionation in Radiotherapy

Part of the book series: Medical Radiology ((Med Radiol Radiat Oncol))

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Abstract

Radiotherapy plays a significant role in the management of pancreatic cancer. In combination with surgical resection and chemotherapy, radiation provides local control and is utilized to reduce morbidity and mortality from local disease progression. Radiation can be utilized definitively in unresectable disease, but also in the neoadjuvant and adjuvant setting in conjunction with surgery and chemotherapy. While radiotherapy in pancreatic cancer has traditionally been administered using conventional dose regimens, hypofractionated radiation is an emerging treatment option. In this chapter we review the role of radiotherapy in the current management of pancreatic cancer, as well as the data and practical aspects of stereotactic body radiotherapy.

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References

  • American Cancer Society (2009) Pancreas cancer staging, AJCC staging manual, 7th edn. p 1

    Google Scholar 

  • American Cancer Society (2016) Cancer facts & figures 2016. pp 1–72

    Google Scholar 

  • Balaban EP, Mangu PB, Khorana AA et al (2016) Locally advanced, unresectable pancreatic cancer: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 34:2654–2668. doi:10.1200/JCO.2016.67.5561

    Article  PubMed  Google Scholar 

  • Balcom JH, Rattner DW, Warshaw AL et al (2001) Ten-year experience with 733 pancreatic resections: changing indications, older patients, and decreasing length of hospitalization. Arch Surg 136:391–398

    Article  PubMed  Google Scholar 

  • Ben-Josef E, Shields AF, Vaishampayan U et al (2004) Intensity-modulated radiotherapy (IMRT) and concurrent capecitabine for pancreatic cancer. Int J Radiat Oncol Biol Phys 59:454–459. doi:10.1016/j.ijrobp.2003.11.019

    Article  CAS  PubMed  Google Scholar 

  • Bilimoria KY, Bentrem DJ, Ko CY et al (2007) Validation of the 6th edition AJCC pancreatic cancer staging system: report from the National Cancer Database. Cancer 110:738–744. doi:10.1002/cncr.22852

    Article  PubMed  Google Scholar 

  • Breslin TM, Hess KR, Harbison DB et al (2001) Neoadjuvant chemoradiotherapy for adenocarcinoma of the pancreas: treatment variables and survival duration. Ann Surg Oncol 8:123–132. doi:10.1007/s10434-001-0123-4

    Article  CAS  PubMed  Google Scholar 

  • Butturini G, Stocken DD, Wente MN et al (2008) Influence of resection margins and treatment on survival in patients with pancreatic cancer: meta-analysis of randomized controlled trials. Arch Surg 143:75–83. doi:10.1001/archsurg.2007.17

    Article  PubMed  Google Scholar 

  • Cameron JL, Pitt HA, Yeo CJ et al (1993) One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg 217:430–435. discussion 435–438

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Cameron JL, Riall TS, Coleman J et al (2006) One thousand consecutive pancreaticoduodenectomies. Ann Surg 244:10–15. doi:10.1097/01.sla.0000217673.04165.ea

    Article  PubMed  PubMed Central  Google Scholar 

  • Ceha HM, van Tienhoven G, Gouma DJ et al (2000) Feasibility and efficacy of high dose conformal radiotherapy for patients with locally advanced pancreatic carcinoma. Cancer 89:2222–2229. doi:10.1002/1097-0142(20001201)89:11<2222::AID-CNCR10>3.0.CO;2-V

    Article  CAS  PubMed  Google Scholar 

  • Chang DT, Schellenberg D, Shen J et al (2009) Stereotactic radiotherapy for unresectable adenocarcinoma of the pancreas. Cancer 115:665–672. doi:10.1002/cncr.24059

    Article  PubMed  Google Scholar 

  • Chauffert B, Mornex F, Bonnetain F et al (2008) 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 19:1592–1599. doi:10.1093/annonc/mdn281

    Article  CAS  PubMed  Google Scholar 

  • Chuong MD, Springett GM, Freilich JM et al (2013) Stereotactic body radiation therapy for locally advanced and borderline resectable pancreatic cancer is effective and well tolerated. Int J Radiat Oncol Biol Phys 86:516–522. doi:10.1016/j.ijrobp.2013.02.022

    Article  PubMed  Google Scholar 

  • Corsini MM, Miller RC, Haddock MG et al (2008) Adjuvant radiotherapy and chemotherapy for pancreatic carcinoma: the Mayo Clinic experience (1975–2005). J Clin Oncol 26(21):3511–3516. doi:10.1200/JCO.2007.15.8782;wgroup:string:Publication

    Article  PubMed  Google Scholar 

  • Coveler AL, Herman JM, Simeone DM et al (2016) Localized pancreatic cancer: multidisciplinary management. Am Soc Clin Oncol Educ Book 35:e217–e226. doi:10.14694/EDBK_160827

    Article  PubMed  Google Scholar 

  • Crane CH (2016) Hypofractionated ablative radiotherapy for locally advanced pancreatic cancer. J Radiat Res 57(Suppl 1):i53–i57. doi:10.1093/jrr/rrw016

    Article  PubMed  PubMed Central  Google Scholar 

  • Dagoglu N, Callery M, Moser J et al (2016) Stereotactic body radiotherapy (SBRT) reirradiation for recurrent pancreas cancer. J Cancer 7:283–288. doi:10.7150/jca.13295

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Dholakia AS, Kumar R, Raman SP et al (2013a) Mapping patterns of local recurrence after pancreaticoduodenectomy for pancreatic adenocarcinoma: a new approach to adjuvant radiation field design. Int J Radiat Oncol Biol Phys 87:1007–1015. doi:10.1016/j.ijrobp.2013.09.005

    Article  PubMed  PubMed Central  Google Scholar 

  • Dholakia AS, Hacker-Prietz A, Wild AT et al (2013b) Resection of borderline resectable pancreatic cancer after neoadjuvant chemoradiation does not depend on improved radiographic appearance of tumor-vessel relationships. J Radiat Oncol 2:413–425. doi:10.1007/s13566-013-0115-6

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Evans DB, Hess KR, Pisters P (2002) ESPAC-1 trial of adjuvant therapy for resectable adenocarcinoma of the pancreas. Ann Surg 236:694., author reply 694–696. doi:10.1097/01.SLA.0000037256.09376.FC

    Article  PubMed  PubMed Central  Google Scholar 

  • Franke AJ, Rosati LM, Pawlik TM et al (2015) The role of radiation therapy in pancreatic ductal adenocarcinoma in the neoadjuvant and adjuvant settings. Semin Oncol 42:144–162. doi:10.1053/j.seminoncol.2014.12.013

    Article  PubMed  Google Scholar 

  • Gastrointestinal Tumor Study Group (1985) Radiation therapy combined with Adriamycin or 5-fluorouracil for the treatment of locally unresectable pancreatic carcinoma. Cancer 56:2563–2568. doi:10.1002/1097-0142(19851201)56:11<2563::AID-CNCR2820561104>3.0.CO;2-0

    Article  Google Scholar 

  • Gastrointestinal Tumor Study Group (1988) Treatment of locally unresectable carcinoma of the pancreas: comparison of combined-modality therapy (chemotherapy plus radiotherapy) to chemotherapy alone. JNCI 80:751–755. doi:10.1093/jnci/80.10.751

    Article  Google Scholar 

  • Geer RJ, Brennan MF (1993) Prognostic indicators for survival after resection of pancreatic adenocarcinoma. Am J Surg 165:68–72. discussion 72–73

    Article  CAS  PubMed  Google Scholar 

  • Gillen S, Schuster T, zum Büschenfelde CM, et al Neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages, PLoS Med 7 (2010) e1000267. doi:10.1371/journal.pmed.1000267.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Goodman KA (2016) Stereotactic body radiation therapy for pancreatic cancer. Cancer J 22:290–295. doi:10.1097/PPO.0000000000000206

    Article  PubMed  Google Scholar 

  • Goyal K, Einstein D, Ibarra RA et al (2012) Stereotactic body radiation therapy for nonresectable tumors of the pancreas. J Surg Res 174:319–325. doi:10.1016/j.jss.2011.07.044

    Article  PubMed  Google Scholar 

  • Griffin JF, Smalley SR, Jewell W et al (1990) Patterns of failure after curative resection of pancreatic carcinoma. Cancer 66:56–61. doi:10.1002/1097-0142(19900701)66:1<56::AID-CNCR2820660112>3.0.CO;2-6

    Article  CAS  PubMed  Google Scholar 

  • Gurka M, Collins SP, Slack R et al (2013) Stereotactic body radiation therapy with concurrent full-dose gemcitabine for locally advanced pancreatic cancer: a pilot trial demonstrating safety. Radiat Oncol 8:44. doi:10.1186/1748-717X-8-44

    Article  PubMed  PubMed Central  Google Scholar 

  • Hammel P, Huguet F, van Laethem JL et al (2016) 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 315:1844–1853. doi:10.1001/jama.2016.4324

    Article  CAS  PubMed  Google Scholar 

  • Herman JM, Swartz MJ, Hsu CC et al (2008) Analysis of fluorouracil-based adjuvant chemotherapy and radiation after pancreaticoduodenectomy for ductal adenocarcinoma of the pancreas: results of a large, prospectively collected database at the Johns Hopkins Hospital. J Clin Oncol 26(21):3503–3510. doi:10.1200/JCO.2007.15.8469;page:string:Article/Chapter.

    Article  PubMed  Google Scholar 

  • Herman JM, Chang DT, Goodman KA et al (2015a) Phase 2 multi-institutional trial evaluating gemcitabine and stereotactic body radiotherapy for patients with locally advanced unresectable pancreatic adenocarcinoma. Cancer 121:1128–1137. doi:10.1002/cncr.29161

    Article  CAS  PubMed  Google Scholar 

  • Herman JM, Crane CH, Iacobuzio-Donahue C, Abrams RA (2015b). Pancreatic cancer. In: Gunderson LL, Tepper JE (eds) Clinical radiation oncology, 4th edn. Elsevier Health Sciences, pp 934–959

    Google Scholar 

  • Hoyer M, Roed H, Sengelov L et al (2005) Phase-II study on stereotactic radiotherapy of locally advanced pancreatic carcinoma. Radiother Oncol 76:48–53. doi:10.1016/j.radonc.2004.12.022

    Article  PubMed  Google Scholar 

  • Hsu CC, Herman JM, Corsini MM et al (2010) Adjuvant chemoradiation for pancreatic adenocarcinoma: the Johns Hopkins Hospital—Mayo Clinic Collaborative Study. Ann Surg Oncol 17:981–990. doi:10.1245/s10434-009-0743-7

    Article  PubMed  PubMed Central  Google Scholar 

  • Iacobuzio-Donahue CA, Fu B, Yachida S et al (2009) DPC4 gene status of the primary carcinoma correlates with patterns of failure in patients with pancreatic cancer. J Clin Oncol 27:1806–1813. doi:10.1200/JCO.2008.17.7188

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Jones WE, Suh WW, Abdel-Wahab M et al (2017) ACR appropriateness criteria® resectable pancreatic cancer. Am J Clin Oncol 40:109–117. doi:10.1097/COC.0000000000000370

    Article  PubMed  Google Scholar 

  • Kalser MH, Ellenberg SS (1985) Pancreatic cancer. Adjuvant combined radiation and chemotherapy following curative resection. Arch Surg 120:899–903

    Article  CAS  PubMed  Google Scholar 

  • Kang MJ, Jang JY, Chang YR et al (2014) Revisiting the concept of lymph node metastases of pancreatic head cancer: number of metastatic lymph nodes and lymph node ratio according to N stage. Ann Surg Oncol 21:1545–1551. doi:10.1245/s10434-013-3473-9

    Article  PubMed  Google Scholar 

  • Katz MH, Pisters P, Evans DB et al (2008) Borderline resectable pancreatic cancer: the importance of this emerging stage of disease. J Am Coll Surg 206:833–846. doi:10.1016/j.jamcollsurg.2007.12.020

    Article  PubMed  PubMed Central  Google Scholar 

  • Katz MH, Fleming JB, Bhosale P et al (2012) Response of borderline resectable pancreatic cancer to neoadjuvant therapy is not reflected by radiographic indicators. Cancer 118:5749–5756. doi:10.1002/cncr.27636

    Article  PubMed  Google Scholar 

  • Katz MH, Shi Q, Ahmad SA et al (2016) Preoperative modified FOLFIRINOX treatment followed by capecitabine-based chemoradiation for borderline resectable pancreatic cancer: Alliance for Clinical Trials in Oncology Trial A021101. JAMA Surg 151:e161137. doi:10.1001/jamasurg.2016.1137

    Article  PubMed  PubMed Central  Google Scholar 

  • Klaassen DJ, MacIntyre JM, Catton GE et al (1985) Treatment of locally unresectable cancer of the stomach and pancreas: a randomized comparison of 5-fluorouracil alone with radiation plus concurrent and maintenance 5-fluorouracil—an Eastern Cooperative Oncology Group study. J Clin Oncol 3:373–378. doi:10.1200/JCO.1985.3.3.373

    Article  CAS  PubMed  Google Scholar 

  • Klinkenbijl JH, Jeekel J, Sahmoud T et al (1999) Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase III trial of the EORTC gastrointestinal tract cancer cooperative group. Ann Surg 230:776

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Kooby DA, Gillespie TW, Liu Y et al (2013) Impact of adjuvant radiotherapy on survival after pancreatic cancer resection: an appraisal of data from the National Cancer Data Base. Ann Surg Oncol 20:3634–3642. doi:10.1245/s10434-013-3047-x

    Article  PubMed  PubMed Central  Google Scholar 

  • Koong AC, Le QT, Ho A et al (2004) Phase I study of stereotactic radiosurgery in patients with locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 58:1017–1021. doi:10.1016/j.ijrobp.2003.11.004

    Article  PubMed  Google Scholar 

  • Krishnan S, Chadha AS, Suh Y et al (2016) Focal radiotherapy dose escalation improves overall survival in locally advanced pancreatic cancer patients receiving induction chemotherapy and consolidative chemoradiation. Int J Radiat Oncol Biol Phys 94(4):755–765

    Article  PubMed  Google Scholar 

  • Liao WC, Chien KL, Lin YL et al (2013) Adjuvant treatments for resected pancreatic adenocarcinoma: a systematic review and network meta-analysis. Lancet Oncol 14:1095–1103. doi:10.1016/S1470-2045(13)70388-7

    Article  PubMed  Google Scholar 

  • Loehrer PJ, Feng Y, Cardenes H et al (2011) Gemcitabine alone versus gemcitabine plus radiotherapy in patients with locally advanced pancreatic cancer: an Eastern Cooperative Oncology Group trial. J Clin Oncol 29:4105–4112. doi:10.1200/JCO.2011.34.8904

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Lominska CE, Unger K, Nasr NM et al (2012) Stereotactic body radiation therapy for reirradiation of localized adenocarcinoma of the pancreas. Radiat Oncol 7:74. doi:10.1186/1748-717X-7-74

    Article  PubMed  PubMed Central  Google Scholar 

  • Lowenfels AB, Maisonneuve P (2006) Epidemiology and risk factors for pancreatic cancer. Best Pract Res Clin Gastroenterol 20:197–209. doi:10.1016/j.bpg.2005.10.001s

    Article  PubMed  Google Scholar 

  • Mahadevan A, Miksad R, Goldstein M et al (2011) Induction gemcitabine and stereotactic body radiotherapy for locally advanced nonmetastatic pancreas cancer. Int J Radiat Oncol Biol Phys 81:e615–e622. doi:10.1016/j.ijrobp.2011.04.045

    Article  CAS  PubMed  Google Scholar 

  • Michaud DS, Giovannucci E, Willett WC et al (2001) Physical activity, obesity, height, and the risk of pancreatic cancer. JAMA 286:921–929

    Article  CAS  PubMed  Google Scholar 

  • Moertel C (1969) Combined 5-flurouracil and supervoltage radiation therapy of locally unresectable gastrointestinal cancer. Lancet 294:865–867. doi:10.1016/S0140-6736(69)92326-5

    Article  Google Scholar 

  • Moertel C, Frytak S, Hahn RG et al (1981) Therapy of locally unresectable pancreatic carcinoma: a randomized comparison of high dose (6000 rads) radiation alone, moderate dose radiation (4000 rads + 5-fluorouracil), and high dose radiation + 5-fluorouracil. The Gastrointestinal Tumor Study Group. Cancer 48:1705–1710. doi:10.1002/1097-0142(19811015)48:8<1705::AID-CNCR2820480803>3.0.CO;2-4

    Article  CAS  PubMed  Google Scholar 

  • Moningi S, Walker AJ, Hsu CC et al (2015a) Correlation of clinical stage and performance status with quality of life in patients seen in a pancreas multidisciplinary clinic. J Oncol Pract 11:e216–e221. doi:10.1200/JOP.2014.000976

    Article  PubMed  PubMed Central  Google Scholar 

  • Moningi S, Dholakia AS, Raman SP et al (2015b) The role of stereotactic body radiation therapy for pancreatic cancer: a single-institution experience. Ann Surg Oncol 22:2352–2358. doi:10.1245/s10434-014-4274-5

    Article  PubMed  PubMed Central  Google Scholar 

  • Morganti AG, Falconi M, van Stiphout RG et al (2014) Multi-institutional pooled analysis on adjuvant chemoradiation in pancreatic cancer. Int J Radiat Oncol Biol Phys 90:911–917. doi:10.1016/j.ijrobp.2014.07.024

    Article  PubMed  Google Scholar 

  • Murphy JD, Christman-Skieller C, Kim J et al (2010) A dosimetric model of duodenal toxicity after stereotactic body radiotherapy for pancreatic cancer. Int J Radiat Oncol Biol Phys 78:1420–1426. doi:10.1016/j.ijrobp.2009.09.075

    Article  PubMed  Google Scholar 

  • Myrehaug S, Sahgal A, Russo SM et al (2016) Stereotactic body radiotherapy for pancreatic cancer: recent progress and future directions. Expert Rev Anticancer Ther 16:523–530. doi:10.1586/14737140.2016.1168698

    Article  CAS  PubMed  Google Scholar 

  • Neoptolemos JP, Stocken DD, Friess H et al (2009) A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 350:1200–1210. doi:10.1056/NEJMoa032295

    Article  Google Scholar 

  • Oettle H, Neuhaus P, Hochhaus A et al (2013) Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: The CONKO-001 Randomized Trial. JAMA 310:1473–1481. doi:10.1001/jama.2013.279201

    Article  CAS  PubMed  Google Scholar 

  • Pawlik TM, Laheru D, Hruban RH et al (2008) Evaluating the impact of a single-day multidisciplinary clinic on the management of pancreatic cancer. Ann Surg Oncol 15:2081–2088. doi:10.1245/s10434-008-9929-7

    Article  PubMed  PubMed Central  Google Scholar 

  • Polistina F, Costantin G, Casamassima F et al (2010) Unresectable locally advanced pancreatic cancer: a multimodal treatment using neoadjuvant chemoradiotherapy (gemcitabine plus stereotactic radiosurgery) and subsequent surgical exploration. Ann Surg Oncol 17:2092–2101. doi:10.1245/s10434-010-1019-y

    Article  PubMed  Google Scholar 

  • Poplin E, Feng Y, Berlin J et al (2016) Phase III, randomized study of gemcitabine and oxaliplatin versus gemcitabine (fixed-dose rate infusion) compared with gemcitabine (30-minute infusion) in patients with pancreatic carcinoma E6201: a trial of the Eastern Cooperative Oncology Group. J Clin Oncol 27(23):3778–3785. doi:10.1200/JCO.2008.20.9007;subPage:string:Abstract;website:website:asco-site;issue:issue:10.1200/JCO.2009.24.27.issue-23;wgroup:string:Publication

    Article  Google Scholar 

  • Porta M, Fabregat X, Malats N et al (2005) Exocrine pancreatic cancer: symptoms at presentation and their relation to tumour site and stage. Clin Transl Oncol 7:189–197

    Article  PubMed  Google Scholar 

  • Redmond KJ, Wolfgang CL, Sugar EA et al (2010) Adjuvant chemoradiation therapy for adenocarcinoma of the distal pancreas. Ann Surg Oncol 17:3112–3119. doi:10.1245/s10434-010-1200-3

    Article  PubMed  PubMed Central  Google Scholar 

  • Regine WF, Winter KW, Abrams R et al (2011) Fluorouracil-based chemoradiation with either gemcitabine or fluorouracil chemotherapy after resection of pancreatic adenocarcinoma: 5-year analysis of the U.S. Intergroup/RTOG 9704 phase III trial. Ann Surg Oncol 18:1319–1326. doi:10.1245/s10434-011-1630-6

    Article  PubMed  PubMed Central  Google Scholar 

  • Ren F, YC X, Wang HX et al (2012) Adjuvant chemotherapy, with or without postoperative radiotherapy, for resectable advanced pancreatic adenocarcinoma: continue or stop? Pancreatology 12:162–169. doi:10.1016/j.pan.2012.02.002

    Article  CAS  PubMed  Google Scholar 

  • Rose JB, Rocha FG, Alseidi A et al (2014) Extended neoadjuvant chemotherapy for borderline resectable pancreatic cancer demonstrates promising postoperative outcomes and survival. Ann Surg Oncol 21:1530–1537. doi:10.1245/s10434-014-3486-z

    Article  PubMed  Google Scholar 

  • Rwigema JC, Heron DE, Parikh SD et al (2012) Adjuvant stereotactic body radiotherapy for resected pancreatic adenocarcinoma with close or positive margins. J Gastrointest Cancer 43:70–76. doi:10.1007/s12029-010-9203-7

    Article  PubMed  Google Scholar 

  • Schellenberg D, Goodman KA, Lee F et al (2008) Gemcitabine chemotherapy and single-fraction stereotactic body radiotherapy for locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 72:678–686. doi:10.1016/j.ijrobp.2008.01.051

    Article  CAS  PubMed  Google Scholar 

  • Schellenberg D, Kim J, Christman-Skieller C et al (2011) Single-fraction stereotactic body radiation therapy and sequential gemcitabine for the treatment of locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 81:181–188. doi:10.1016/j.ijrobp.2010.05.006

    Article  PubMed  Google Scholar 

  • Small W, Hayes JP, Suh WW et al (2016) Expert panel on radiation oncology-gastrointestinal, ACR appropriateness criteria® borderline and unresectable pancreas cancer. Oncology 30:619–624. 627–632

    PubMed  Google Scholar 

  • Spitz FR, Abbruzzese JL, Lee JE et al (2016) Preoperative and postoperative chemoradiation strategies in patients treated with pancreaticoduodenectomy for adenocarcinoma of the pancreas. J Clin Oncol. doi:10.1200/JCO.1997.15.3.928;issue:issue:10.1200/jco.1997.15.3.15.issue-3;page:string:Article/Chapter.

    Google Scholar 

  • Stocken DD, Büchler MW, Dervenis C et al (2005) Meta-analysis of randomized adjuvant therapy trials for pancreatic cancer. Br J Cancer 92:1372–1381. doi:10.1038/sj.bjc.6602513

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Stolzenberg-Solomon RZ, Adams K, Leitzmann KM et al (2008) Adiposity, physical activity, and pancreatic cancer in the National Institutes of Health-AARP Diet and Health Cohort. Am J Epidemiol 167:586–597. doi:10.1093/aje/kwm361

    Article  PubMed  Google Scholar 

  • Tempero MA (2016) Pancreatic adenocarcinoma, The emperor of all pancreatic cancer maladies. J Oncol Pract 1:29–30. doi:10.1200/jop.2015.009753

    Article  Google Scholar 

  • Tepper J, Nardi G, Suit H (1976) Carcinoma of the pancreas: review of MGH experience from 1963 to 1973—analysis of surgical failure and implications for radiation therapy. Cancer 37:1519–1524. doi:10.1002/1097-0142(197603)37:3<1519::AID-CNCR2820370340>3.0.CO;2-O

    Article  CAS  PubMed  Google Scholar 

  • Tozzi A, Comito T, FAlongi F et al (2013) SBRT in unresectable advanced pancreatic cancer: preliminary results of a mono-institutional experience. Radiat Oncol 8:148. doi:10.1186/1748-717X-8-148

    Article  PubMed  PubMed Central  Google Scholar 

  • Ueno H, Ioka T, Ikeda M et al (2016) Randomized phase III study of gemcitabine plus S-1, S-1 alone, or gemcitabine alone in patients with locally advanced and metastatic pancreatic cancer in Japan and Taiwan: GEST study. J Clin Oncol 31(13):1640–1648. doi:10.1200/JCO.2012.43.3680;page:string:Article/Chapter

    Article  Google Scholar 

  • Valle JW, Palmer D, Jackson R et al (2014) Optimal duration and timing of adjuvant chemotherapy after definitive surgery for ductal adenocarcinoma of the pancreas: ongoing lessons from the ESPAC-3 study. J Clin Oncol 32:504–512. doi:10.1200/JCO.2013.50.7657

    Article  PubMed  Google Scholar 

  • Wild AT, Hiniker SM, Chang DT et al (2013) Re-irradiation with stereotactic body radiation therapy as a novel treatment option for isolated local recurrence of pancreatic cancer after multimodality therapy: experience from two institutions. J Gastrointest Oncol 4:343–351

    PubMed  PubMed Central  Google Scholar 

  • Wolfgang CL, Herman JM, Laheru DA et al (2013) Recent progress in pancreatic cancer. CA Cancer J Clin 63:318–348. doi:10.3322/caac.21190

    Article  PubMed  PubMed Central  Google Scholar 

  • Yang W, Reznik WR, Fraass BA et al (2015) Dosimetric evaluation of simultaneous integrated boost during stereotactic body radiation therapy for pancreatic cancer. Med Dosim 40:47–52. doi:10.1016/j.meddos.2014.09.001

    Article  PubMed  Google Scholar 

  • Ychou M, Desseigne F, Guimbaud R (2007) Randomized phase II trial comparing folfirinox (5FU/leucovorin [LV], irinotecan [I] and oxaliplatin [O]) vs gemcitabine (G) as first-line treatment for metastatic pancreatic adenocarcinoma (MPA). First results of the ACCORD 11 trial. J Clin Oncol 25(18):4516

    Google Scholar 

  • Yeo CJ, Cameron JL, Lillemoe KD et al (1995) Pancreaticoduodenectomy for cancer of the head of the pancreas. 201 patients. Ann Surg 221:721–731. discussion 731–733

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Yeo CJ, Cameron JL, Sohn TA et al (1997) Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 226:248–257. discussion 257–260

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Linda Chen & Lauren M. Rosati

  2. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Joseph M. Herman

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  1. Linda Chen
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  2. Lauren M. Rosati
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  3. Joseph M. Herman
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Editors and Affiliations

  1. Allegheny General Hospital Allegheny Health Network Cancer Institute, Drexel University College of Medicine, Pittsburgh, PA, USA

    Mark Trombetta

  2. Radiation Oncology Department, Erasmus University Medical Center, Rotterdam, The Netherlands

    Jean-Philippe Pignol

  3. Allegheny Health Network, Temple University School of Medicine, Pittsburgh Campus, Pittsburgh, PA, USA

    Paolo Montemaggi

  4. Hylda Cohn/American Cancer Society, Drexel University College of Medicine, Philadelphia, PA, USA

    Luther W. Brady

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Chen, L., Rosati, L.M., Herman, J.M. (2017). Gastrointestinal Cancer: Pancreas. In: Trombetta, M., Pignol, JP., Montemaggi, P., Brady, L.W. (eds) Alternate Fractionation in Radiotherapy. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/174_2017_97

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  • DOI: https://doi.org/10.1007/174_2017_97

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-51197-9

  • Online ISBN: 978-3-319-51198-6

  • eBook Packages: MedicineMedicine (R0)

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