English

Abstract

Introduction Stereotactic body radiotherapy in the treatment of pancreatic carcinoma is a recent technique. The aim of this analysis is to present a summary of techniques and clinical results. Material and Methods Stereotactic body radiotherapy allows to perform a local treatment of the tumour in shortened time (1–5 days) compared with traditional treatments (about 1 month) but requires complex planning and delivery techniques with specific accessories for imageguided radiotherapy. The studies published to date are characterised by small series and very different methods in terms of dose, fractionation, techniques and evaluation modalities. Results The preliminary published results are positive in terms of tumour response (ORR: 50%) and local control of the tumour (crude rate: 80%). However, gastrointestinal toxicity seems to be the main limitation of stereotactic body radiotherapy, especially at the duodenal level. Conclusion If stereotactic body radiotherapy of pancreatic carcinoma will be standardised and optimised, reducing the risk of bowel toxicity, in the future it may have an increasing role in the field of integrated treatments of this tumour. Introduction The prognosis of pancreatic cancer pancreas is very unfavourable. Even in patients with non-metastatic disease at diagnosis, recurrences after primary therapy are very common both as a local relapse/progression and as distant metastases. Local recurrence rate, even of patients operated on, reached percentages of 70%–80%1,2. In addition, local disease progression produces severe symptoms (pain, biliary and/or intestinal obstruction, malnutrition) capable of significantly worsening the patients’ quality of life. Radiotherapy (RT) was used to promote local control of the disease. RT, usually associated with concurrent and adjuvant chemotherapy, is potentially useful to improve the resection rate3 and control symptoms in locally advanced carcinomas4 and to reduce the risk of recurrence in resected patients5. The main limitation of RT is the presence of radiosensitive organs in the upper abdomen in close proximity with the pancreas. In fact, due to these anatomic relationships, RT can produce severe side effects especially at the level of the duodenum. Therefore, a strong interest in the use of innovative precision RT techniques has developed, with the aim to administer effective doses * Corresponding author Email: gmacchia@rm.unicatt.it 1 Department of Radiation Oncology, Fondazione Giovanni Paolo II, Campobasso, Italy 2 Department of Medical Phisics, Fondazione Giovanni Paolo II, Campobasso, Italy 3 Department of Radiation Oncology, Ospedale San Francesco, Nuoro, Italy 4 Department of Radiation Oncology, Campus Biomedico University, Roma, Italy 5 Department of Radiation Oncology, Ospedale San Filippo Neri, Roma, Italy 6 Department of Radiation Oncology, Universita Cattolica del Sacro Cuore, Roma, Italy 7 Department of Medical Phisics, Universita Cattolica del Sacro Cuore, Roma, Italy 8 Department of General Oncology, Fondazione Giovanni Paolo II, Campobasso, Italy BODY