Patterns of Failure Following Neoadjuvant SBRT or Fractionated Chemoradiation in Resectable and Borderline Resectable Pancreatic Cancer

Barrord, Michelle; Ahmad, Saya; Olowokure, Olugbenga; Sussman, Jonathan; Esslinger, Hope; Latif, Tahir; Gupta, Anamika; Smith, Mary Stoker; Poreddy, Sampath; Kharofa, Jordan

doi:10.1016/j.ijrobp.2018.07.409

Cited by 1 publication

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“…The oncologic disadvantage of this modality is that it can address only a small target containing gross disease and is unable to safely deliver meaningful dose to regional lymph nodes at high risk of harboring microscopic disease. This theoretical shortcoming of SBRT has recently been demonstrated by in the literature[17,18] where it is reported that patients undergoing pancreatectomy after SBRT demonstrate a high risk of disease recurrence in regional lymphatics that would have been irradiated by a conventionally fractionated course of preoperative radiotherapy with X-rays or protons. As such, we would argue that SBRT should not be considered an oncologically appropriate intervention in the setting of resectable or borderline resectable disease.…”

Section: Limitations Of Stereotactic Body Radiotherapymentioning

confidence: 99%

Optimizing neoadjuvant radiotherapy for resectable and borderline resectable pancreatic cancer using protons

Nichols

Rutenberg

2019

WJGS

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Approximately 25% of patients diagnosed with pancreatic cancer present with non-metastatic resectable or borderline resectable disease. Unfortunately, the cure rate for these “curable” patients is only in the range of 20%. Local-regional failure rates may exceed 50% after margin-negative, node-negative pancreatectomy, but up to 80% of resections are associated with regional lymph node or margin positivity. While systemic drug therapy and chemotherapy may prevent or delay the appearance of distant metastases, it is unlikely to have a significant impact on local-regional disease control. Preoperative radiotherapy would represent a rational intervention to improve local-regional control. The barrier to preoperative radiotherapy is the concern that it could potentially complicate what is already a long and complicated operation. When the radiotherapy is delivered with X-rays (photons), the entire cylinder of the abdomen is irradiated; therefore, an operating surgeon may be reluctant to accept the associated risk of increased toxicity. When preoperative radiotherapy is delivered with protons, however, significant bowel and gastric tissue-sparing is achieved and clinical outcomes indicate that proton therapy does not increase the risk of operative complications nor extend the length of the procedure.

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Section: Limitations Of Stereotactic Body Radiotherapymentioning

confidence: 99%