The role of imaging in the clinical practice of radiation oncology for pancreatic cancer
Advances in technology have enabled the delivery of high doses of radiation therapy for pancreatic ductal adenocarcinoma (PDAC) with low rates of toxicity. Although the role of radiation for pancreatic cancer continues to evolve, encouraging results with newer techniques indicate that radiation may benefit selected patient populations. Imaging has been central to the modern successes of radiation therapy for PDAC. Here, we review the role of diagnostic imaging, imaging-based planning, and image guidance in radiation oncology practice for PDAC.
KeywordsPancreatic cancer Image guidance Radiotherapy Stereotactic body radiation therapy
Compliance with ethical standards
This study was funded by the National Institutes of Health (NIH U54CA210181-01, U54CA143837 and U01CA196403), the Pancreatic Cancer Action Network (14-20-25-KOAY), and the Radiological Society of North America (RSD1429). We gratefully acknowledge partial support from the Andrew Sabin Family Fellowship, Center for Radiation Oncology Research, the Sheikh Ahmed Center for Pancreatic Cancer Research, institutional funds from The University of Texas MD Anderson Cancer Center, GE Healthcare, Philips Healthcare, and Cancer Center Support (Core) Grant CA016672 from the National Cancer Institute to MD Anderson.
Conflict of interest
Eugene Koay has received research grants from Philips Healthcare and GE. Eugene Koay has received a speaker honorarium from Philips Healthcare. The authors have no relevant conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- 3.Attiyeh MA, Fernandez-Del Castillo C, Al Efishat M, Eaton AA, Gonen M, Batts R, et al. (2016) Development and validation of a multi-institutional preoperative nomogram for predicting grade of dysplasia in intraductal papillary mucinous neoplasms (IPMNs) of the pancreas: a report from the pancreatic surgery consortium. Ann SurgGoogle Scholar
- 10.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(17):1844–1853CrossRefPubMedGoogle Scholar
- 12.Hammel P, Huguet F, Laethem JL, Goldstein D, Glimelius B, Artru P, et al. (2013) Comparison of chemoradiotherapy and chemotherapy in patients with a locally advanced pancreatic cancer controlled after 4 months of gemcitabine with or without erlotinib: final results of the international phase III LAP 07 study. J Clin Oncol suppl; abstr LBA4003Google Scholar
- 26.Dholakia AS, Chaudhry M, Leal JP, et al. (2014) Baseline metabolic tumor volume and total lesion glycolysis are associated with survival outcomes in patients with locally advanced pancreatic cancer receiving stereotactic body radiation therapy. Int J Radiat Oncol Biol Phys 89(3):539–546CrossRefPubMedPubMedCentralGoogle Scholar
- 29.Katz MH, Ou FS, Herman JM, et al. (2017) Alliance for Clinical Trials in Oncology (ALLIANCE) Trial A021501: preoperative extended chemotherapy vs. chemotherapy plus hypofractionated radiation therapy for borderline resectable adenocarcinoma of the head of the pancreas. BMC Cancer (accepted)Google Scholar
- 32.Murimwa G, Mellon EA, Frankes JM, et al. (2017) Impact of duodenal invasion on outcomes in patients with pancreatic cancer treated with stereotactic body radiotherapy. J Clin Oncol (no. 4 suppl):408Google Scholar