Radiation therapy for pancreatic adenocarcinoma, a treatment option that must be considered in the management of a devas
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Radiation therapy for pancreatic adenocarcinoma, a treatment option that must be considered in the management of a devastating malignancy William A. Hall1* and Karyn A. Goodman2
Abstract Clinical outcomes for patients with pancreatic adenocarcinoma (PAC) remain dismal. Local recurrences, proportions of margin positive surgical resections, and overall survival outcomes remain inferior in PAC than any other solid tumor. This stems from a current standard of care management approach that needs to be inspired and transformed with modern treatment techniques and novel therapeutic options. Radiation therapy has historically been a central component in the treatment of pancreatic adenocarcinoma; however, the role of radiation therapy has been called into question based on the publication of clinical trials with conflicting results. We present an overview of the rationale for radiation therapy in resectable, borderline resectable, and unresectable pancreatic adenocarcinoma. We further present a summary of emerging clinical data and future directions to improve outcomes in this devastating malignancy. Keywords: Pancreatic cancer, Pancreatic adenocarcinoma, Pancreatic radiation therapy, Pancreatic SBRT, PRODIGE trial, PREOPANC-1 trial
Background Pancreatic adenocarcinoma (PAC) remains one of the single most devastating malignancies in existence. Median overall survival remains dismal for the vast majority of patients afflicted with PAC. It has risen to the fourth leading cause of cancer death in the United States (US) [1]. Moreover, in the next fifteen years, the projected impact of PAC is expected to increase, placing it as one of the top three causes of cancer death by 2030 [2]. The reasons for this are multifactorial. One of the dominant factors is that only a minority of patients with PAC fall into the most favorable category of surgically resectable, without clinical evidence of metastatic disease. Yet even for patients with resectable disease, the only subgroup with a potential for cure, oncologic outcomes remain abysmal. The presence of such poor outcomes requires careful consideration and examination of current management approaches to this
malignancy. Current strategies for PAC, even for patients with the best prognosis, are simply not working. Treatment for PAC has been the subject of controversy for decades. Despite, and often because of, the results of multiple contradictory clinical trials that have examined various management strategies, oncologists remain confused, conflicted, and opinionated as to the optimal manner in which PAC should be treated. At the center of much of this controversy is radiation therapy. In this article we attempt to articulate the changes to radiation therapy that have taken place over the past decade, to critically review the current literature assessing the use of radiation therapy in older trials, to present comparative data supporting its use, and we advocate for continued close examination of radiation therapy by oncologists for the management of PAC.
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