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Essential role of radiation therapy for the treatment of pancreatic cancer

Novel study concepts and established treatment recommendations

Essenzielle Rolle der Strahlentherapie in der Behandlung des Pankreaskarzinoms

Neuartige Studienmodelle und etablierte Therapieempfehlungen

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Strahlentherapie und Onkologie Aims and scope Submit manuscript

Abstract

Background

Pancreatic cancer is one of the most aggressive human tumors and the incidence has increased over the last 6 years. In the majority of cases the disease is already in an advanced stage at the time of diagnosis where surgery, the only curative treatment, is no longer an option and explains the still abysmal overall survival. The role of radiation therapy as treatment option for patients with pancreatic cancer is controversially discussed although radiation oncology has emerged as a central pillar in the combined oncological treatment.

Purpose

The present manuscript gives an overview of advanced radiotherapeutic strategies in the context of chemotherapy and surgery according to the current American Society of Clinical Oncology (ASCO) guidelines in comparison with the German guidelines and to elucidate the role of radiation therapy for the treatment of pancreatic cancer.

Conclusion

Advanced modern radiotherapeutic techniques in combination with individualized high-precision radiation concepts are new therapeutic approaches for pancreatic cancer in a multimodal setting with tolerable side effects. Several clinical studies together with experimental approaches are in process, to deliver further evidence and ultimately allow true personalized medicine.

Zusammenfassung

Hintergrund

Das Pankreaskarzinom gehört zu den aggressivsten menschlichen Tumoren und verzeichnete in den letzten 6 Jahren eine steigende Inzidenz. Die Diagnose wird meist erst im fortgeschrittenen Stadium gestellt; dies schließt häufig eine primär kurative Intervention mithilfe der chirurgischen Resektion aus und bedingt die hohe Mortalität. Obwohl die Strahlentherapie im multimodalen Therapieansatz des Pankreaskarzinoms eine zentrale Säule darstellt, wird die Rolle der Strahlentherapie in der Literatur kontrovers diskutiert.

Zielsetzung

Der vorliegende Beitrag bietet eine Übersicht moderner Bestrahlungsstrategien im interdisziplinären Konzept gemäß der Leitlinien der American Society of Clinical Oncology (ASCO) im Vergleich zu den deutschen Leitlinien für Patienten mit Pankreaskarzinom und verdeutlicht dabei die Rolle der Strahlentherapie.

Schlussfolgerung

Innovative Bestrahlungstechniken in Kombination mit individualisierten Hochpräzisionsbestrahlungskonzepten stellen neue Behandlungsansätze des Pankreaskarzinoms im multimodalen Therapieansatz mit einem tolerablen Nebenwirkungsprofil dar. Verschiedene klinische Studien und experimentelle Ansätze werden derzeit evaluiert, um weitere Evidenz zu schaffen und eine echte personalisierte Medizin zu ermöglichen.

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References

  1. Hidalgo M (2010) Pancreatic cancer. N Engl J Med 362(17):1605–1617. https://doi.org/10.1056/NEJMra0901557

    Article  CAS  PubMed  Google Scholar 

  2. Beg MS, Gupta A, Sher D, Ali S, Khan S, Gao A, Stewart T, Ahn C, Berry J, Mortensen EM (2017) Impact of concurrent medication use on pancreatic cancer survival-SEER-medicare analysis. Am J Clin Oncol. https://doi.org/10.1097/COC.0000000000000359

  3. Jemal A, Siegel R, Xu J, Ward E (2010) Cancer statistics, 2010. CA Cancer J Clin 60(5):277–300. https://doi.org/10.3322/caac.20073

    Article  PubMed  Google Scholar 

  4. Baumgartner JM, Krasinskas A, Daouadi M, Zureikat A, Marsh W, Lee K, Bartlett D, Moser AJ, Zeh HJ 3rd (2012) Distal pancreatectomy with en bloc celiac axis resection for locally advanced pancreatic adenocarcinoma following neoadjuvant therapy. J Gastrointest Surg 16(6):1152–1159. https://doi.org/10.1007/s11605-012-1839-0

    Article  PubMed  Google Scholar 

  5. Callery MP, Chang KJ, Fishman EK, Talamonti MS, Traverso WL, Linehan DC (2009) Pretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensus statement. Ann Surg Oncol 16(7):1727–1733. https://doi.org/10.1245/s10434-009-0408-6

    Article  PubMed  Google Scholar 

  6. Evans DB, George B, Tsai S (2015) Non-metastatic pancreatic cancer: resectable, borderline resectable, and locally advanced-definitions of increasing importance for the optimal delivery of multimodality therapy. Ann Surg Oncol 22(11):3409–3413. https://doi.org/10.1245/s10434-015-4649-2

    Article  PubMed  Google Scholar 

  7. Seufferlein T, Bachet JB, Van Cutsem E, Rougier P, Group EGW (2012) Pancreatic adenocarcinoma: ESMO-ESDO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 23(Suppl 7):vii33–vii40. https://doi.org/10.1093/annonc/mds224

    Article  PubMed  Google Scholar 

  8. Campbell F, Smith RA, Whelan P, Sutton R, Raraty M, Neoptolemos JP, Ghaneh P (2009) Classification of R1 resections for pancreatic cancer: the prognostic relevance of tumour involvement within 1 mm of a resection margin. Histopathology 55(3):277–283. https://doi.org/10.1111/j.1365-2559.2009.03376.x

    Article  PubMed  Google Scholar 

  9. Hazel JJ, Thirlwell MP, Huggins M, Maksymiuk A, MacFarlane JK (1981) Multi-drug chemotherapy with and without radiation for carcinoma of the stomach and pancreas: a prospective randomized trial. J Can Assoc Radiol 32(3):164–165

    CAS  PubMed  Google Scholar 

  10. Neoptolemos JP, Palmer D, Ghaneh P et al (2016) ESPAC-4: a multicenter, international, open-label randomized controlled phase III trial of adjuvant combination chemotherapy of gemcitabine and capecitabine versus monotherapy gemcitabine in patients with resected pancreatic ductal adenocarcinoma. ASCO Annual Meeting Abstract LBA4006, 06.6.2016.

    Google Scholar 

  11. Hosein PJ, Macintyre J, Kawamura C, Maldonado JC, Ernani V, Loaiza-Bonilla A, Narayanan G, Ribeiro A, Portelance L, Merchan JR, Levi JU, Rocha-Lima CM (2012) A retrospective study of neoadjuvant FOLFIRINOX in unresectable or borderline-resectable locally advanced pancreatic adenocarcinoma. BMC Cancer. https://doi.org/10.1186/1471-2407-12-199

    PubMed  PubMed Central  Google Scholar 

  12. Teague A, Lim KH, Wang-Gillam A (2015) Advanced pancreatic adenocarcinoma: a review of current treatment strategies and developing therapies. Ther Adv Med Oncol 7(2):68–84. https://doi.org/10.1177/1758834014564775

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Peitzsch C, Kurth I, Kunz-Schughart L, Baumann M, Dubrovska A (2013) Discovery of the cancer stem cell related determinants of radioresistance. Radiother Oncol 108(3):378–387. https://doi.org/10.1016/j.radonc.2013.06.003

    Article  PubMed  Google Scholar 

  14. Wu X, Tang W, Marquez RT, Li K, Highfill CA, He F, Lian J, Lin J, Fuchs JR, Ji M, Li L, Xu L (2016) Overcoming chemo/radio-resistance of pancreatic cancer by inhibiting STAT3 signaling. Oncotarget 7(10):11708–11723. https://doi.org/10.18632/oncotarget.7336

    PubMed  PubMed Central  Google Scholar 

  15. Hazard L, Tward JD, Szabo A, Shrieve DC (2007) Radiation therapy is associated with improved survival in patients with pancreatic adenocarcinoma: results of a study from the Surveillance, Epidemiology, and End Results (SEER) registry data. Cancer 110(10):2191–2201. https://doi.org/10.1002/cncr.23047

    Article  PubMed  Google Scholar 

  16. Prasad S, Cambridge L, Huguet F, Chou JF, Zhang Z, Wu AJ, O’Reilly EM, Allen PJ, Goodman KA (2016) Intensity modulated radiation therapy reduces gastrointestinal toxicity in locally advanced pancreas cancer. Pract Radiat Oncol 6(2):78–85. https://doi.org/10.1016/j.prro.2015.09.006

    Article  PubMed  Google Scholar 

  17. Ma NY, Tinganelli W, Maier A, Durante M, Kraft-Weyrather W (2013) Influence of chronic hypoxia and radiation quality on cell survival. J Radiat Res 54(Suppl 1):i13–i22. https://doi.org/10.1093/jrr/rrs135

    Article  PubMed  PubMed Central  Google Scholar 

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

    Article  PubMed  PubMed Central  Google Scholar 

  19. Brunner TB, Nestle U, Adebahr S, Gkika E, Wiehle R, Baltas D, Grosu AL (2016) Simultaneous integrated protection: a new concept for high-precision radiation therapy. Strahlenther Onkol 192(12):886–894. https://doi.org/10.1007/s00066-016-1057-x

    Article  PubMed  PubMed Central  Google Scholar 

  20. Crane CH, Willett CG (2009) Stereotactic radiotherapy for pancreatic cancer? Cancer 115(3):468–472. https://doi.org/10.1002/cncr.24069

    Article  PubMed  Google Scholar 

  21. Schellenberg D, Goodman KA, Lee F, Chang S, Kuo T, Ford JM, Fisher GA, Quon A, Desser TS, Norton J, Greco R, Yang GP, Koong AC (2008) Gemcitabine chemotherapy and single-fraction stereotactic body radiotherapy for locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 72(3):678–686. https://doi.org/10.1016/j.ijrobp.2008.01.051

    Article  CAS  PubMed  Google Scholar 

  22. Chuong MD, Springett GM, Freilich JM, Park CK, Weber JM, Mellon EA, Hodul PJ, Malafa MP, Meredith KL, Hoffe SE, Shridhar R (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(3):516–522. https://doi.org/10.1016/j.ijrobp.2013.02.022

    Article  PubMed  Google Scholar 

  23. Rajagopalan MS, Heron DE, Wegner RE, Zeh HJ, Bahary N, Krasinskas AM, Lembersky B, Brand R, Moser AJ, Quinn AE, Burton SA (2013) Pathologic response with neoadjuvant chemotherapy and stereotactic body radiotherapy for borderline resectable and locally-advanced pancreatic cancer. Radiat Oncol. https://doi.org/10.1186/1748-717x-8-254

    PubMed  PubMed Central  Google Scholar 

  24. Renz BW, Boeck S, Roeder F, Trumm C, Heinemann V, Werner J (2017) Oligometastatic Disease in Pancreatic Cancer—How to Proceed? Visc Med 33(1):36–41. https://doi.org/10.1159/000455027

    Article  PubMed  Google Scholar 

  25. Yeung R, Hamm J, Liu M, Schellenberg D (2017) Institutional analysis of stereotactic body radiotherapy (SBRT) for oligometastatic lymph node metastases. Radiat Oncol 12(1):105. https://doi.org/10.1186/s13014-017-0820-1

    Article  PubMed  PubMed Central  Google Scholar 

  26. Jingu K, Tanabe T, Nemoto K, Ariga H, Umezawa R, Ogawa Y, Takeda K, Koto M, Sugawara T, Kubozono M, Shimizu E, Abe K, Yamada S (2012) Intraoperative radiotherapy for pancreatic cancer: 30-year experience in a single institution in Japan. Int J Radiat Oncol Biol Phys 83(4):e507–e511. https://doi.org/10.1016/j.ijrobp.2012.01.024

    Article  PubMed  Google Scholar 

  27. Cai S, Hong TS, Goldberg SI, Fernandez-del Castillo C, Thayer SP, Ferrone CR, Ryan DP, Blaszkowsky LS, Kwak EL, Willett CG, Lillemoe KD, Warshaw AL, Wo JY (2013) Updated long-term outcomes and prognostic factors for patients with unresectable locally advanced pancreatic cancer treated with intraoperative radiotherapy at the Massachusetts General Hospital, 1978 to 2010. Cancer 119(23):4196–4204. https://doi.org/10.1002/cncr.28329

    Article  PubMed  PubMed Central  Google Scholar 

  28. Reni M, Panucci MG, Ferreri AJ, Balzano G, Passoni P, Cattaneo GM, Cordio S, Scaglietti U, Zerbi A, Ceresoli GL, Fiorino C, Calandrino R, Staudacher C, Villa E, Di Carlo V (2001) Effect on local control and survival of electron beam intraoperative irradiation for resectable pancreatic adenocarcinoma. Int J Radiat Oncol Biol Phys 50(3):651–658

    Article  CAS  PubMed  Google Scholar 

  29. Treece SJ, Mukesh M, Rimmer YL, Tudor SJ, Dean JC, Benson RJ, Gregory DL, Horan G, Jefferies SJ, Russell SG, Williams MV, Wilson CB, Burnet NG (2013) The value of image-guided intensity-modulated radiotherapy in challenging clinical settings. Br J Radiol 86(1021):20120278. https://doi.org/10.1259/bjr.20120278

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Pankreaskarzinom LOS-LE (2013) AWMF-Registernummer: 032/010OL. 1.0

  31. Li CP, Chao Y, Chi KH, Chan WK, Teng HC, Lee RC, Chang FY, Lee SD, Yen SH (2003) Concurrent chemoradiotherapy treatment of locally advanced pancreatic cancer: gemcitabine versus 5‑fluorouracil, a randomized controlled study. Int J Radiat Oncol Biol Phys 57(1):98–104

    Article  CAS  PubMed  Google Scholar 

  32. Loehrer PJ Sr., Feng Y, Cardenes H, Wagner L, Brell JM, Cella D, Flynn P, Ramanathan RK, Crane CH, Alberts SR, Benson AB 3rd (2011) Gemcitabine alone versus gemcitabine plus radiotherapy in patients with locally advanced pancreatic cancer: an Eastern Cooperative Oncology Group trial. J Clin Oncol 29(31):4105–4112. https://doi.org/10.1200/jco.2011.34.8904

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Huguet F, Andre T, Hammel P, Artru P, Balosso J, Selle F, Deniaud-Alexandre E, Ruszniewski P, Touboul E, Labianca R, de Gramont A, Louvet C (2007) Impact of chemoradiotherapy after disease control with chemotherapy in locally advanced pancreatic adenocarcinoma in GERCOR phase II and III studies. J Clin Oncol 25(3):326–331. https://doi.org/10.1200/JCO.2006.07.5663

    Article  CAS  PubMed  Google Scholar 

  34. al Huguet F et al (2014) Impact of chemoradiotherapy (CRT) on local control and time without treatment in patients with locally advanced pancreatic cancer (LAPC) included in the international phase III LAP 07 study. J Clin Oncol. https://doi.org/10.1200/jco.2014.32.15_suppl.4001

    Google Scholar 

  35. Hammel P, Huguet F, van Laethem JL, Goldstein D, Glimelius B, Artru P, Borbath I, Bouche O, Shannon J, Andre T, Mineur L, Chibaudel B, Bonnetain F, Louvet C, Group LAPT (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):1844–1853. https://doi.org/10.1001/jama.2016.4324

    Article  CAS  PubMed  Google Scholar 

  36. Mukherjee S, Hurt CN, Bridgewater J, Falk S, Cummins S, Wasan H, Crosby T, Jephcott C, Roy R, Radhakrishna G, McDonald A, Ray R, Joseph G, Staffurth J, Abrams RA, Griffiths G, Maughan T (2013) Gemcitabine-based or capecitabine-based chemoradiotherapy for locally advanced pancreatic cancer (SCALOP): a multicentre, randomised, phase 2 trial. Lancet Oncol 14(4):317–326. https://doi.org/10.1016/s1470-2045(13)70021-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Brunner T (2012) Gemcitabine in the chemoradiotherapy for locally advanced pancreatic cancer: a meta-analysis. Strahlenther Onkol 188(4):366–367. https://doi.org/10.1007/s00066-012-0079-2

    Article  CAS  PubMed  Google Scholar 

  38. Ikeda M, Ioka T, Ito Y, Yonemoto N, Nagase M, Yamao K, Miyakawa H, Ishii H, Furuse J, Sato K, Sato T, Okusaka T (2013) A multicenter phase II trial of S‑1 with concurrent radiation therapy for locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 85(1):163–169. https://doi.org/10.1016/j.ijrobp.2012.03.059

    Article  PubMed  Google Scholar 

  39. Chauffert B, Mornex F, Bonnetain F, Rougier P, Mariette C, Bouche O, Bosset JF, Aparicio T, Mineur L, Azzedine A, Hammel P, Butel J, Stremsdoerfer N, Maingon P, Bedenne L (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(9):1592–1599. https://doi.org/10.1093/annonc/mdn281

    Article  CAS  PubMed  Google Scholar 

  40. Rwigema JC, Parikh SD, Heron DE, Howell M, Zeh H, Moser AJ, Bahary N, Quinn A, Burton SA (2011) Stereotactic body radiotherapy in the treatment of advanced adenocarcinoma of the pancreas. Am J Clin Oncol 34(1):63–69. https://doi.org/10.1097/COC.0b013e3181d270b4

    Article  CAS  PubMed  Google Scholar 

  41. Idrees K, Parikh AA, McLendon L, Weber SM, Cho CS, Salem AI, Martin RCG et al (2016) Treatment of borderline resectable (BR) and locally advanced (LA) pancreatic cancer in the era of FOLFIRINOX and gemcitabine plus nab-paclitaxel: a multi-institutional study. J Clin Oncol 34(4_suppl):451

    Article  Google Scholar 

  42. Katz MH, Pisters PW, Evans DB, Sun CC, Lee JE, Fleming JB, Vauthey JN, Abdalla EK, Crane CH, Wolff RA, Varadhachary GR, Hwang RF (2008) Borderline resectable pancreatic cancer: the importance of this emerging stage of disease. J Am Coll Surg 206(5):833–846. https://doi.org/10.1016/j.jamcollsurg.2007.12.020 (discussion 846–838)

    Article  PubMed  Google Scholar 

  43. Oh TG, Chung MJ, Bang S, Park SW, Chung JB, Song SY, Seong J, Kang CM, Lee WJ, Park JY (2014) Validation of group B borderline resectable pancreatic cancer: retrospective analysis. Gut Liver 8(5):557–562. https://doi.org/10.5009/gnl13264

    Article  PubMed  PubMed Central  Google Scholar 

  44. Gillen S, Schuster T, Meyer Zum Buschenfelde C, Friess H, Kleeff J (2010) Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. PLoS Med 7(4):e1000267. https://doi.org/10.1371/journal.pmed.1000267

    Article  PubMed  PubMed Central  Google Scholar 

  45. Combs SE, Habermehl D, Kessel KA, Bergmann F, Werner J, Naumann P, Jager D, Buchler MW, Debus J (2014) Prognostic impact of CA 19–9 on outcome after neoadjuvant chemoradiation in patients with locally advanced pancreatic cancer. Ann Surg Oncol 21(8):2801–2807. https://doi.org/10.1245/s10434-014-3607-8

    Article  PubMed  Google Scholar 

  46. Combs SE, Habermehl D, Kessel K, Bergmann F, Werner J, Brecht I, Schirmacher P, Jager D, Buchler MW, Debus J (2013) 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 189(9):738–744. https://doi.org/10.1007/s00066-013-0391-5

    Article  CAS  PubMed  Google Scholar 

  47. Habermehl D, Kessel K, Welzel T, Hof H, Abdollahi A, Bergmann F, Rieken S, Weitz J, Werner J, Schirmacher P, Buchler MW, Debus J, Combs SE (2012) Neoadjuvant chemoradiation with Gemcitabine for locally advanced pancreatic cancer. Radiat Oncol 7:28. https://doi.org/10.1186/1748-717x-7-28

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Golcher H, Brunner TB, Witzigmann H, Marti L, Bechstein WO, Bruns C, Jungnickel H, Schreiber S, Grabenbauer GG, Meyer T, Merkel S, Fietkau R, Hohenberger W (2015) Neoadjuvant chemoradiation therapy with gemcitabine/cisplatin and surgery versus immediate surgery in resectable pancreatic cancer: results of the first prospective randomized phase II trial. Strahlenther Onkol 191(1):7–16. https://doi.org/10.1007/s00066-014-0737-7

    Article  PubMed  Google Scholar 

  49. Casadei R, Di Marco M, Ricci C, Santini D, Serra C, Calculli L, D’Ambra M, Guido A, Morselli-Labate AM, Minni F (2015) Neoadjuvant chemoradiotherapy and surgery versus surgery alone in resectable pancreatic cancer: a single-center prospective, randomized, controlled trial which failed to achieve accrual targets. J Gastrointest Surg 19(10):1802–1812. https://doi.org/10.1007/s11605-015-2890-4

    Article  PubMed  Google Scholar 

  50. Aristu J, Canon R, Pardo F, Martinez-Monge R, Martin-Algarra S, Ordonez MJ, Villafranca E, Moreno M, Cambeiro M, Azinovic I (2003) Surgical resection after preoperative chemoradiotherapy benefits selected patients with unresectable pancreatic cancer. Am J Clin Oncol 26(1):30–36

    Article  PubMed  Google Scholar 

  51. Evans DB, Varadhachary GR, Crane CH, Sun CC, Lee JE, Pisters PW, Vauthey JN, Wang H, Cleary KR, Staerkel GA, Charnsangavej C, Lano EA, Ho L, Lenzi R, Abbruzzese JL, Wolff RA (2008) Preoperative gemcitabine-based chemoradiation for patients with resectable adenocarcinoma of the pancreatic head. J Clin Oncol 26(21):3496–3502. https://doi.org/10.1200/JCO.2007.15.8634

    Article  CAS  PubMed  Google Scholar 

  52. Varadhachary GR, Wolff RA, Crane CH, Sun CC, Lee JE, Pisters PW, Vauthey JN, Abdalla E, Wang H, Staerkel GA, Lee JH, Ross WA, Tamm EP, Bhosale PR, Krishnan S, Das P, Ho L, Xiong H, Abbruzzese JL, Evans DB (2008) Preoperative gemcitabine and cisplatin followed by gemcitabine-based chemoradiation for resectable adenocarcinoma of the pancreatic head. J Clin Oncol 26(21):3487–3495. https://doi.org/10.1200/JCO.2007.15.8642

    Article  CAS  PubMed  Google Scholar 

  53. Roeder F, Timke C, Uhl M, Habl G, Hensley FW, Buechler MW, Krempien R, Huber PE, Debus J, Werner J (2012) Aggressive local treatment containing intraoperative radiation therapy (IORT) for patients with isolated local recurrences of pancreatic cancer: a retrospective analysis. BMC Cancer 12:295. https://doi.org/10.1186/1471-2407-12-295

    Article  PubMed  PubMed Central  Google Scholar 

  54. Balaban EP, Mangu PB, Khorana AA, Shah MA, Mukherjee S, Crane CH, Javle MM, Eads JR, Allen P, Ko AH, Engebretson A, Herman JM, Strickler JH, Benson AB 3rd, Urba S, Yee NS (2016) Locally advanced, unresectable pancreatic cancer: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 34(22):2654–2668. https://doi.org/10.1200/JCO.2016.67.5561

    Article  PubMed  Google Scholar 

  55. Neoptolemos JP, Cunningham D, Friess H, Bassi C, Stocken DD, Tait DM, Dunn JA, Dervenis C, Lacaine F, Hickey H, Raraty MG, Ghaneh P, Buchler MW (2003) Adjuvant therapy in pancreatic cancer: historical and current perspectives. Ann Oncol 14(5):675–692

    Article  CAS  PubMed  Google Scholar 

  56. Bassi C, Stocken DD, Olah A, Friess H, Buckels J, Hickey H, Dervenis C, Dunn JA, Deakin M, Carter R, Ghaneh P, Neoptolemos JP, Buchler MW, European Study Group for Pancreatic C (2005) Influence of surgical resection and post-operative complications on survival following adjuvant treatment for pancreatic cancer in the ESPAC-1 randomized controlled trial. Dig Surg 22(5):353–363. https://doi.org/10.1159/000089771

    Article  CAS  PubMed  Google Scholar 

  57. Wittekind C, Compton C, Quirke P, Nagtegaal I, Merkel S, Hermanek P, Sobin LH (2009) A uniform residual tumor (R) classification: integration of the R classification and the circumferential margin status. Cancer 115(15):3483–3488. https://doi.org/10.1002/cncr.24320

    Article  PubMed  Google Scholar 

  58. Liao WC, Chien KL, Lin YL, Wu MS, Lin JT, Wang HP, Tu YK (2013) Adjuvant treatments for resected pancreatic adenocarcinoma: a systematic review and network meta-analysis. Lancet Oncol 14(11):1095–1103. https://doi.org/10.1016/S1470-2045(13)70388-7

    Article  PubMed  Google Scholar 

  59. Kalser MH, Ellenberg SS (1985) Pancreatic cancer. Adjuvant combined radiation and chemotherapy following curative resection. Arch Surg 120(8):899–903

    Article  CAS  PubMed  Google Scholar 

  60. Klinkenbijl JH, Jeekel J, Sahmoud T, van Pel R, Couvreur ML, Veenhof CH, Arnaud JP, Gonzalez DG, de Wit LT, Hennipman A, Wils J (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(6):776–782 (discussion 782–774)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Hall WA, Colbert LE, Liu Y, Gillespie T, Lipscomb J, Hardy C, Kooby DA, Prabhu RS, Kauh J, Landry JC (2013) The influence of adjuvant radiotherapy dose on overall survival in patients with resected pancreatic adenocarcinoma. Cancer 119(12):2350–2357. https://doi.org/10.1002/cncr.28047

    Article  PubMed  PubMed Central  Google Scholar 

  62. Khorana AA, Mangu PB, Berlin J, Engebretson A, Hong TS, Maitra A, Mohile SG, Mumber M, Schulick R, Shapiro M, Urba S, Zeh HJ, Katz MH (2016) Potentially curable pancreatic cancer: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 34(21):2541–2556. https://doi.org/10.1200/JCO.2016.67.5553

    Article  PubMed  Google Scholar 

  63. Sohal DP, Mangu PB, Khorana AA, Shah MA, Philip PA, O’Reilly EM, Uronis HE, Ramanathan RK, Crane CH, Engebretson A, Ruggiero JT, Copur MS, Lau M, Urba S, Laheru D (2016) Metastatic pancreatic cancer: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 34(23):2784–2796. https://doi.org/10.1200/jco.2016.67.1412

    Article  PubMed  PubMed Central  Google Scholar 

  64. Dobiasch S, Kampfer S, Burkhardt R, Schilling D, Schmid TE, Wilkens JJ, Combs SE (2017) Use of the liquid fiducial marker BioXmark for high-precision radiotherapy of an orthotopic pancreatic tumor mouse model. Strahlenther Onkol. https://doi.org/10.1007/s00066-017-1193-y

    Google Scholar 

  65. Thorek DL, Kramer RM, Chen Q, Jeong J, Lupu ME, Lee AM, Moynahan ME, Lowery M, Ulmert D, Zanzonico P, Deasy JO, Humm JL, Russell J (2015) Reverse-contrast imaging and targeted radiation therapy of advanced pancreatic cancer models. Int J Radiat Oncol Biol Phys 93(2):444–453. https://doi.org/10.1016/j.ijrobp.2015.06.001

    Article  PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany

    Sophie Dobiasch &  Stephanie E. Combs

  2. Institute of Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany

    Stephanie E. Combs

  3. Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany

    Nicole L. Goerig & Rainer Fietkau

Authors
  1. Sophie Dobiasch
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  2. Nicole L. Goerig
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  3. Rainer Fietkau
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  4. Stephanie E. Combs
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Corresponding author

Correspondence to Stephanie E. Combs.

Additional information

These authors contributed equally to the manuscript: Sophie Dobiasch, Nicole L. Goerig

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Dobiasch, S., Goerig, N.L., Fietkau, R. et al. Essential role of radiation therapy for the treatment of pancreatic cancer. Strahlenther Onkol 194, 185–195 (2018). https://doi.org/10.1007/s00066-017-1227-5

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  • DOI: https://doi.org/10.1007/s00066-017-1227-5

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