Faculty Collaboration Database

The integration of chemoradiation in the care of patient with localized pancreatic cancer. Cancer Radiother 2009 Apr;13(2):123-43

Date

01/27/2009

Pubmed ID

19167921

DOI

10.1016/j.canrad.2008.11.008

Scopus ID

2-s2.0-61849115176 (requires institutional sign-in at Scopus site)   16 Citations

Abstract

The use of chemoradiation for patients with localized pancreatic cancer is controversial. Although some randomized trials have indicated that chemoradiation improves the median survival of patients with locally advanced as well as resected pancreatic cancer, other more recent trials have called into question the role of chemoradiation and have supported the use of chemotherapy. In the adjuvant setting, the high local tumor recurrence/persistence rate in all trials probably reflects the inclusion of patients with incompletely resected tumors, whose prognosis is similar to the prognosis of patients with locally advanced who do not undergo resection, making these trials difficult to interpret. More precise clinical staging and selection of patients appropriate for surgical resection is an important goal. The keys to the successful integration of radiotherapy in the care of patients with localized pancreatic cancer are selection, sequencing and smaller treatment volumes. A strategy of initial chemotherapy followed by consolidation with a well-tolerated chemoradiation regimen both in the adjuvant and locally advanced settings maximizes benefits of both treatment options, which are in fact complementary. Herein, we discuss the rationale for this approach as well as the ongoing investigation of novel radiation approaches designed to enhance outcome through the molecular and physical targeting of disease as well as the investigation of neoadjuvant chemoradiation in radiographically resectable and borderline resectable pancreatic cancer.

Author List

Crane CH, Varadhachary G, Settle SH, Fleming JB, Evans DB, Wolff RA

Author

Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Antimetabolites, Antineoplastic
Biopsy, Fine-Needle
Capecitabine
Clinical Trials as Topic
Combined Modality Therapy
Deoxycytidine
Diagnostic Imaging
Fluorouracil
Humans
Pancreatic Neoplasms