Pancreatic cancers

Abstract

Pancreatic cancer is only the 12th most common cancer, but it is the seventh leading cause of cancer death in both sexes and has one of the lowest 5-year overall survival rates. Management of pancreatic cancer is challenging and surgical resection offers the only potentially curative option. The role of radiation therapy in the treatment of pancreatic cancer is evolving. The main radiotherapy settings for pancreatic cancer are neoadjuvant, definitive, adjuvant, and palliative therapies. The neoadjuvant treatment usually includes chemotherapy, concurrent chemoradiotherapy, and stereotactic body radiotherapy (SBRT). Definitive treatment is used for locally advanced pancreatic cancers. Given the low rates of local control with chemotherapy or chemoradiation, the use of stereotactic body radiation therapy, with 1–5 fractions, has become an area of active investigation. Magnetic resonance image-guided radiation therapy (MRgRT) represents a new, noninvasive method for delivering SBRT for pancreatic cancer and ablative doses to larger volumes in close proximity to the organ at risk can be delivered. This technology has some advantages with better soft-tissue visualization compared to cone beam CT, intrafraction assessment of structures, daily online adaptive planning, real-time continuous tracking without invasive placement of fiducial markers, and beam gating based on target position. In this chapter, we present a review of the general management of pancreatic cancers, radiation therapy options, and a summary of selected clinical trials in pancreatic cancer including MRgRT studies.