Onkologie. 2016:10(4):185-188 | DOI: 10.36290/xon.2016.040

Radiotherapy in treatment of pancreatic adenocarcinoma

Vladimír Rak, Petr Pospíšil
Klinika radiační onkologie LF MU, Masarykův onkologický ústav, Brno

Pancreatic adenocarcinoma is one of the most feared oncological diagnoses and its incidence is on the rise. The main difficulty

is a lack of effective treatment options. Even when deploying all standard cancer treatments, long term survival is not a common

phenomenon. Surgery is a mainstay of treatment, there is hardly any doubt about it. It is still the only curable treatment modality.

Role of chemotherapy is also largely clear. Even in the early stage of disease, there is a certain risk of tumor dissemination and

chemotherapy is the only way how to deal with this issue. The role of radiotherapy is less clear. Large amount of scientific data was

published, disscusing the use of radiotherapy in pancreatic cancer, but results are still indeterminate. Further uncertainty about

appropriateness of treatment stems from anatomical localization of pancreas, which is surrounded by radiosensitive tissues. An

obvious example of this issue are different guidelines between Europe and America. The aim of this article is to summarize the

main studies and to discuss in which stages of pancreatic cancer is radiotherapy an appropriate treatment option.

Keywords: pancreatic adenocarcinoma, radiotherapy, chemotherapy

Published: August 1, 2016  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Rak V, Pospíšil P. Radiotherapy in treatment of pancreatic adenocarcinoma. Onkologie. 2016;10(4):185-188. doi: 10.36290/xon.2016.040.
Download citation

References

  1. Národní onkologický registr. [Online] [Citace: 10. 3 2016.] http://www.svod.cz/.
  2. Incidencia zhubných nádorov v Slovenskej republike 2009. [Online] [Citace: 10. 3 2016.] http://www.nczisk.sk/Documents/publikacie/analyticke/incidencia_zhubnych_nadorov_2009.pdf.
  3. Willett CG, Czito BG, Bendell JC, et al. J Clin Oncol. 2005; 23(20): 4538-4544. Go to original source...
  4. Gnerlich JL, Luka SR, Deshpande AD, et al. Microscopic margins and patterns of treatment failure in resected pancreatic adenocarcinoma. Arch Surg. 2012; 147(8): 753-760. Go to original source... Go to PubMed...
  5. Neoptolemos JP, Stocken DD, Friess H, et al. A Randomized Trial of Chemoradiotherapy and Chemotherapy after Resection of Pancreatic Cancer. N Engl J Med. 2004; 350(12): 1200-1210. Go to original source...
  6. Kaiser MH, Ellenberg SS. Pancreatic cancer. Adjuvant combined radiation and chemotherapy following curative resection. Arch Surg. 1986; 120(8): 899-903. Go to original source...
  7. Vyzula R, et al. MODRÁ KNIHA ČESKÉ ONKOLOGICKÉ SPOLEČNOSTI. Brno: Masarykův onkologický ústav, 2015. 978-80-86793-38-2.
  8. Laethem JL, Hammel P, Mornex F, et al. Adjuvant Gemcitabine Alone Versus Gemcitabine-Based Chemoradiotherapy After Curative Resection for Pancreatic Cancer: A Randomized EORTC-40013-22012/FFCD-9203/GERCOR Phase II Study. J Clin Oncol. 2010; 28(29): 4450-4456. Go to original source... Go to PubMed...
  9. Morganti AG, Falconi M, van Stiphout R, Mattiucci GC, et al. Multi-institutional Pooled Analysis on Adjuvant Chemoradiation in Pancreatic Cancer. Int J Radiation Oncol Biol Phys. 2014; 90(4): 911-917. Go to original source...
  10. de Geus SW, Bliss LA, Eskander MF, et al. A Tale of Two Cities: Reconsidering Adjuvant Radiation in Pancreatic Cancer Care. J Gastrointest Surg. 20, 2016; 1: 85-92. Go to original source...
  11. Stocken DD, Büchler MW, Dervenis C, et al. Meta-analysis of randomised adjuvant therapy trials for pancreatic cancer. Br J Cancer. 92, 2005; 8: 1372-1381. Go to original source...
  12. Gillen S, Schuster T, Meyer Zum Büschenfelde C, et al. Preoperative/Neoadjuvant Therapy in Pancreatic Cancer: A Systematic Review and Meta-analysis of Response and Resection Percentages. PLoS Med. 2010; Sv. 7, 4. Go to original source...
  13. Moertel CG, Frytak S, Hahn RG, et al. Therapy of locally unresectable pancreatic carcinoma: a randomized comparison of high dose (6000 rads) radiation alone, moderate dose radiation (4000 rads + 5-fluorouracil), and high dose radiation + 5-fluorouracil: The Gastrointestinal Tumor Study Group. Cancer. 1981; Sv. 48, 8, 1705-1710. Go to original source...
  14. Loehrer JP, Feng Y, Cardenes H, et al. Gemcitabine Alone Versus Gemcitabine Plus Radiotherapy in Patients With Locally Advanced Pancreatic Cancer: An Eastern Cooperative Oncology Group Trial. J Clin Oncol. 2011; Sv. 29, 31, 4105-4112. Go to original source...
  15. 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. Ann Oncol. 2008; Sv. 19, 9, 1592-1599. Go to original source...
  16. Huguet F, Andre T, Hammel P, et al. Impact of chemoradiotherapy after disease control with chemotherapy in locally advanced pancreatic adenocarcinoma in GERCOR phase II and III studies. J Clin Oncol. 2007; Sv. 25, 3, 326-331. Go to original source... Go to PubMed...
  17. Hammel P, Huguet F, Laethem JL, et al. Comparison of chemoradiotherapy (CRT) and chemotherapy (CT) in patients with a locally advanced pancreatic cancer (LAPC) controlled after 4 months of gemcitabine with or without erlotinib: Final results of the international phase III LAP 07 study. J Clin Oncol. 2013; Sv. 31, suppl., s89. Go to original source...
  18. Russo S, Ammori J, Eads J, et al. The role of neoadjuvant therapy in pancreatic cancer: a review. Future Oncol. 2016; Sv. 12, 5. Go to original source...
  19. Conroy T, Desseigne F, Ychou M, et al. FOLFIRINOX versus Gemcitabine for Metastatic Pancreatic Cancer. N Engl J Med. 2011; Sv. 369, 18, 1817-1825. Go to original source...
  20. Hoff DD, Ervin T, Arena FP, et al. Increased Survival in Pancreatic Cancer with Nab-Paclitaxel plus Gemcitabine. N Engl J Med. 2013; Sv. 369, 18, 1691-1703. Go to original source... Go to PubMed...
  21. Shinchi H, Takao S, Noma H, et al. Length and Quality of Survival after External-Beam Radiotherapy with Concurrent Continuous 5-Fluorouracil Infusion for Locally Unresectable Pancreatic Cancer. Int J Radiat Oncol Biol Phys. 2002; Sv. 53, 1: 146-150. Go to original source...
  22. Iacobuzio-Donahue CA, Fu B, Yachida S, et al. DPC4 Gene Status of the Primary Carcinoma Correlates With Patterns of Failure in Patients With Pancreatic Cancer. J Clin Oncol. 2009; Sv. 27, 11: 1806-1813. Go to original source... Go to PubMed...
  23. Crane CH, Varadhachary GR, Yordy JS, et al. Phase II Trial of Cetuximab, Gemcitabine, and Oxaliplatin Followed by Chemoradiation With Cetuximab for Locally Advanced (T4) Pancreatic Adenocarcinoma: Correlation of Smad4(Dpc4) Immunostaining With Pattern of Disease Progression. J Clin Oncol. 2011; Sv. 29, 22: 3037-3043. Go to original source... Go to PubMed...
  24. Subramanian G, Schwarz RE, Higgins L, et al. Targeting Endogenous Transforming Growth Factor Receptor Signaling in SMAD4-Deficient Human Pancreatic Carcinoma Cells Inhibits Their Invasive Phenotype. Cancer Res. 2004; Sv. 64, 15: 5200-5211. Go to original source... Go to PubMed...
  25. Abrams RA, Regine WF, Goodman KA, et al. Consensus Panel Contouring Atlas for the Delineation of the Clinical Target Volume in the Postoperative Treatment of Pancreatic Cancer. [Online] [Citace: 6. 6 2016.] https://www.rtog.org/CoreLab/ContouringAtlases/PancreasAtlas.aspx.
  26. Nichols RC, Huh S, Li Z, Rutenberg M. Proton therapy for pancreatic cancer. World J Gastrointest Oncol. 7, 2015; Vol. 9, 141-7. Go to original source...
  27. Cameron JL, Riall TS, Coleman J, et al. One Thousand Consecutive Pancreaticoduodenectomies. Ann Surg. 2006; Sv. 244, 1: 10-15. Go to original source... Go to PubMed...




Oncology

Madam, Sir,
please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

I declare:

  1. that I have met the above instruction
  2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited


No

Yes

If your statement is not true, please be aware
that brings the risk of danger to their health or the health of others.