Conformal Radiation Therapy in Pancreatic Cancer

Summary

We are still learning how to best combine radiation with chemotherapy. Concurrent regimens with newer sensitizers have led to increased toxicity. One way of improving the therapeutic ratio is to reduce the toxicity of treatment. New radiation techniques allow improved localization of the radiation dose and a reduction in the volume of normal tissue irradiated. This could lead to reduced toxicity of treatment and possibly to radiation-dose escalation. The appropriate volume of irradiation with the concurrent use of newer, more toxic radiosensitizers in pancreatic cancer is controversial. Treatment of the regional lymphatics increases toxicity, but may be important. Concerns of toxicity have led some investigators to use smaller fields and to rely on chemotherapy for high-risk nodal areas. Newer radiotherapy techniques, such as 3DCRT and IMRT, improve the radiation-dose distribution and thus offer a theoretical advantage that may translate into a clinical benefit in this new era of more toxic combinations of radiation and chemotherapy Improved radiation targeting may have a role in reducing toxicity and may allow escalation of the radiation dose, or the inclusion of additional cytotoxic agents into current regimens.