Role of radiation therapy in the management of the patient with pancreatic cancer

Abstract

Most patients who have pancreatic cancer present with advanced disease that is not amenable to surgery. For patients whose disease is amenable to surgery and who are managed with surgical resection alone, local recurrence rates are high and long-term survival rates are low. The use of radiation therapy to treat pancreatic cancer has been studied in various clinical contexts. Preoperative radiation therapy for resectable or borderline unresectable disease may benefit some patients but is not used routinely. For patients with resected disease, data from the Gastrointestinal Tumor Study Group (GITSG) trials support the use of adjuvant chemoradiation. For patients with locally unresectable disease, the use of radiation therapy plus chemotherapy provides modest benefit, as suggested by the clinical trials of the GITSG and other groups. Additional studies employing modified radiation therapy techniques and improved chemotherapeutic regimens, with enhanced radiosensitization and direct cytotoxicity, are needed to optimize treatment regimens for patients with this disease.