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Radiation Therapy in Pancreatic Cancer

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Radiation Oncology

Abstract

Pancreatic adenocarcinoma is a neoplasm with very poor prognosis due to the biological aggressiveness of this tumor and to the frequently late diagnosis. In fact, in most patients, pancreatic cancer is diagnosed in locally advanced or metastatic stage. Therefore, in the majority of cases, the purpose of therapy is to prolong survival and improve quality of life.

In patients with resectable disease, the standard treatment is surgical resection followed by adjuvant chemotherapy which may eventually combined with postoperative chemoradiation. In locally advanced tumors, the treatment is mainly based on chemotherapy, eventually combined also in this case with concurrent chemoradiation.

Patients with locally advanced tumor undergoing chemoradiation should be accurately reassessed by imaging after the treatment and during the follow-up in order to identify patients who become eligible to surgery, taking into account that the rate of pathological response can improve after 10–20 weeks after radiochemotherapy.

Stereotactic radiotherapy is an emerging technique in locally advanced pancreatic cancer, by allowing satisfactory local control of the disease with very short treatment duration. In metastatic patients, palliative radiotherapy can be used to treat symptoms caused by metastases or primary tumors, again in combination with systemic treatments.

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References

  • Benedict SH, Yenice KM, Followill D, Galvin JM, Hinson W, Kavanagh B, Keall P, Lovelock M, Meeks S, Papiez L, Purdie T, Sadagopan R, Schell MC, Salter B, Schlesinger DJ, Shiu AS, Solberg T, Song DY, Stieber V, Timmerman R, Tomé WA, Verellen D, Wang L, Yin FF. Stereotactic body radiation therapy: the report of AAPM Task Group 101. Med Phys. 2010;37(8):4078–101.

    Article  PubMed  Google Scholar 

  • Bilimoria KY, et al. Multimodality therapy for pancreatic cancer in the U.S.: utilization, outcomes, and the effect of hospital volume. Cancer. 2007;110:1227–34.

    Article  PubMed  Google Scholar 

  • Chauffert B, Mornex F, Bonnetain F, 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 

  • Chen KT, Devarajan K, Milestone BN, Cooper HS, Denlinger C, Cohen SJ, Meyer JE, Hoffman JP. Neoadjuvant chemoradiation and duration of chemotherapy before surgical resection for pancreatic cancer: does time interval between radiotherapy and surgery matter? Ann Surg Oncol. 2014;21(2):662–9.

    Article  PubMed  Google Scholar 

  • Corsini MM, Miller RC, Haddock MG, et al. Adjuvant radiotherapy and chemotherapy for pancreatic carcinoma: the Mayo Clinic experience (1975–2005). J Clin Oncol. 2008;26(21):3511–6.

    Article  PubMed  Google Scholar 

  • Didolkar MS, Coleman CW, Brenner MJ, et al. Image guided stereotactic radiosurgery for locally advanced pancreatic adenocarcinoma results of first 85 patients. J Gastrointest Surg. 2010;14(10):1547–59.

    Article  PubMed  Google Scholar 

  • Evans DB, Varadhachary GR, Crane CH, et al. Preoperative gemcitabine-based chemoradiation for patients with resectable adenocarcinoma of the pancreatic head. J Clin Oncol. 2008;26(21):3496–502.

    Article  CAS  PubMed  Google Scholar 

  • Farnell MB, et al. A prospective randomized trial comparing standard pancreatectomy with pancreatectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma. Surgery. 2005;138:618–30.

    Article  PubMed  Google Scholar 

  • Gillen S, Schuster T, Meyer Zum Büschenfelde C, Friess H, Kleeff J. Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. PLoS Med. 2010;7:e1000267.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hall WA, Colbert LE, Liu Y, et al. The influence of adjuvant radiotherapy dose on overall survival in patients with resected pancreatic adenocarcinoma. Cancer. 2013;119(12):2350–7.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hammel P, Huguet F, van Laethem JL, et al. LAP07 Trial Group. 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  Google Scholar 

  • Hazard L, Tward JD, Szabo A, Shrieve DC. 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. 2007;110(10):2191–201.

    Article  PubMed  Google Scholar 

  • Herman JM, Swartz MJ, Hsu CC, et al. 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. 2008;26(21):3503–10.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hishinuma S, Ogata Y, Tomikawa M, Ozawa I, Hirabayashi K, Igarashi S. Patterns of recurrence after curative resection of pancreatic cancer, based on autopsy findings. J Gastrointest Surg. 2006;10(4):511–8.

    Article  PubMed  Google Scholar 

  • Hsu CC, Herman JM, Corsini MM, et al. Adjuvant chemoradiation for pancreatic adenocarcinoma: the Johns Hopkins Hospital-Mayo Clinic collaborative study. Ann Surg Oncol. 2010;17(4):981–90.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hurt CN, Mukherjee S, Bridgewater J, Falk S, Crosby T, McDonald A, Joseph G, Staffurth J, Abrams RA, Blazeby JM, Bridges S, Dutton P, Griffiths G, Maughan T, Johnson C. Health-related quality of life in SCALOP, a randomized phase 2 trial comparing chemoradiation therapy regimens in locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys. 2015;93(4):810–8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kalser MH, Ellenberg SS. Pancreatic cancer. Adjuvant combined radiation and chemotherapy following curative resection. Arch Surg. 1985;120(9):899–903.

    PubMed  CAS  Google Scholar 

  • Kayahara M, Nagakawa T, Ueno K, et al. An evaluation of radical resection for pancreatic cancer based on the mode of recurrence as determined by autopsy and diagnostic imaging. Cancer. 1993;72(7):2118–23.

    Article  CAS  PubMed  Google Scholar 

  • Khanna A, Walker GR, Livingstone AS, et al. Is adjuvant 5-FU-based chemoradiotherapy for resectable pancreatic adenocarcinoma beneficial? A meta-analysis of an unanswered question. J Gastrointest Surg. 2006;10(5):689–97.

    Article  PubMed  Google Scholar 

  • Kindler HL, et al. Gemcitabine plus bevacizumab compared to gemcitabine plus placebo in patients with advanced pancreatic cancer: phase III trial of Cancer and Leukemia Group B (CALBG 80303). J Clin Oncol. 2010;28:3617–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Klein AP, et al. Familial pancreatic cancer. Cancer J. 2001;7:266–73.

    PubMed  CAS  Google Scholar 

  • Klinkenbijl JH, Jeekel J, Sahmoud T, et al. 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. 1999;230(6):776–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Kooby DA, Gillespie TW, Liu Y, et al. Impact of adjuvant radiotherapy on survival after pancreatic cancer resection: an appraisal of data from the national cancer data base. Ann Surg Oncol. 2013;20(11):3634–42.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lim JE, Chien MW, Earle CC. Prognostic factors following curative resection for pancreatic adenocarcinoma: a population-based, linked database analysis of 396 patients. Ann Surg. 2003;237(1):74–85.

    Article  PubMed  PubMed Central  Google Scholar 

  • Loehrer PJ Sr, Feng Y, Cardenes H, Wagner L, Brell JM, Cella D, Flynn P, Ramanathan RK, Crane CH, Alberts SR, Benson AB 3rd. 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 

  • McDade TP, Hill JS, Simons JP, et al. A national propensity-adjusted analysis of adjuvant radiotherapy in the treatment of resected pancreatic adenocarcinoma. Cancer. 2010;116(13):3257–66.

    Article  PubMed  Google Scholar 

  • Merchant NB, Rymer J, Koehler EA, et al. Adjuvant chemoradiation therapy for pancreatic adenocarcinoma: who really benefits? J Am Coll Surg. 2009;208(5):829–38.

    Article  PubMed  PubMed Central  Google Scholar 

  • Morganti AG, Trodella L, Valentini V, et al. Pain relief with short-term irradiation in locally advanced carcinoma of the pancreas. J Palliat Care. 2003;19(4):258–62.

    PubMed  Google Scholar 

  • Morganti AG, Massaccesi M, La Torre G, et al. A systematic review of resectability and survival after concurrent chemoradiation in primarily unresectable pancreatic cancer. Ann Surg Oncol. 2010;17(1):194–205.

    Article  PubMed  Google Scholar 

  • Morganti AG, Falconi M, Van Stiphout RG, Mattiucci GC, Alfieri S, Calvo FA, Dubois JB, Fastner G, Herman JM, Maidment BW 3rd, Miller RC, Regine WF, Reni M, Sharma NK, Ippolito E, Valentini V. Multi-institutional pooled analysis on adjuvant chemotherapy in pancreatic cancer. Int J Radiat Oncol Biol Phys. 2014;90(4):911–7.

    Article  PubMed  Google Scholar 

  • National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology. Pancreatic adenocarcinoma version 2.2017. http://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf. Accessed June 2017.

  • Neoptolemos JP, Stocken DD, Friess H, et al. European Study Group for Pancreatic Cancer. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med. 2004;350(12):1200–10.

    Article  CAS  PubMed  Google Scholar 

  • Neoptolemos JP, Palmer DH, Ghaneh P, Psarelli EE, Valle JW, Halloran CM, Faluyi O, O’Reilly DA, Cunningham D, Wadsley J, Darby S, Meyer T, Gillmore R, Anthoney A, Lind P, Glimelius B, Falk S, Izbicki JR, Middleton GW, Cummins S, Ross PJ, Wasan H, McDonald A, Crosby T, Ma YT, Patel K, Sherriff D, Soomal R, Borg D, Sothi S, Hammel P, Hackert T, Jackson R, Büchler MW, European Study Group for Pancreatic Cancer. Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. Lancet. 2017;389:1011–24.

    Article  CAS  Google Scholar 

  • Palta M, Willett CG, Czito BG. Chapter 59, Pancreatic cancer. In: Halperin EC, et al., editors. Perez and Brady’s principles and practice of radiation oncology. 6th ed. Philadelphia: Lippincott Williams & Wilkins, a Wolters Kluwer Business; 2013. p. 1189–201.

    Google Scholar 

  • Philip PA, et al. Phase III study comparing gemcitabine plus cetuximab versus gemcitabine in patients with advanced adenocarcinoma pancreatic: Southwest Oncology Group-directed intergroup trial S0205. J Clin Oncol. 2010;28:3605–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Rahib L, Smith BD, Aizenberg R, Rosenzweig AB, Fleshman JM, Matrisian LM. Projecting cancer incidence and death to 2030: the unespected burden of thyroid, liver, and pancreas cancer in the United States. Cancer Res. 2014;74(11):2913–21.

    Article  CAS  Google Scholar 

  • Rwimega JC, Parikh SD, Heron DE, et al. Stereotactic body radiotherapy in the treatment of advanced adenocarcinoma of the pancreas. Am J Clin Oncol. 2011;24(1):63–9.

    Google Scholar 

  • Shen ZT, Wu XH, Li B, Wang L, Zhu XX. Preliminary efficacy of CyberKnife radiosurgery for locally advanced pancreatic cancer. Chin J Cancer. 2010;29(9):802–9.

    Article  PubMed  Google Scholar 

  • Takahashi H, Ohigashi H, Gotoh K, et al. Preoperative gemcitabine-based chemoradiation therapy for resectable and borderline resectable pancreatic cancer. Ann Surg. 2013;258(6):1040–50.

    Article  PubMed  Google Scholar 

  • Turrini O, Ychou M, Moureau-Zabotto L, et al. Neoadjuvant docetaxel-based chemoradiation for resectable adenocarcinoma of the pancreas: new neoadjuvant regimen was safe and provided an interesting pathologic response. Eur J Surg Oncol. 2010;36(10):987–92.

    Article  CAS  PubMed  Google Scholar 

  • Vanderveen KA, Chen SL, Yin D, et al. Benefit of postoperative adjuvant therapy for pancreatic cancer: a population-based analysis. Cancer. 2009;115(11):2420–9.

    Article  PubMed  PubMed Central  Google Scholar 

  • Yeo CJ, Abrams RA, Grochow LB, et al. Pancreaticoduodenectomy for pancreatic adenocarcinoma: postoperative adjuvant chemoradiation improves survival. A prospective, single-institution experience. Ann Surg. 1997;225(5):621–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Yovino S, Poppe M, Jabbour S, et al. Intensity-modulated radiation therapy significantly improves acute gastrointestinal toxicity in pancreatic and ampullary cancers. Int J Radiat Oncol Biol Phys. 2011;79(1):158–62.

    Article  PubMed  Google Scholar 

  • Zeng Y, Rucki AA, Che X, Zheng L. Shifting paradigm of developing biologics for the treatment of pancreatic adenocarcinoma. J Gastrointest Oncol. 2017;8:441–8.

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Alessio G. Morganti .

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Morganti, A.G., Siepe, G., Giaccherini, L. (2018). Radiation Therapy in Pancreatic Cancer. In: Wenz, F. (eds) Radiation Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-52619-5_43-1

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  • DOI: https://doi.org/10.1007/978-3-319-52619-5_43-1

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