Abstract
Pancreatic ductal carcinoma is one of the most lethal malignancies, but in recent years a number of positive developments have occurred in the management of pancreatic carcinoma. This article aims to give an overview of the current knowledge regarding the role of radiotherapy in the treatment of pancreatic ductal adenocarcinoma (PDAC). The results of meta-analyses, phase III-studies, and phase II-studies using chemoradiotherapy and chemotherapy for resectable and non-resectable PDAC were reviewed. The use of radiotherapy is discussed in the neoadjuvant and adjuvant settings as well as in the locally advanced situation. Whenever possible, radiotherapy should be performed as simultaneous chemoradiotherapy. Patients with PDAC should be offered entry into clinical trials to identify optimal treatment results.
Highlights
Despite considerable progress in oncology, the poor prognosis of patients with pancreatic ductal adenocarcinoma (PDAC) has not significantly improved
Neoadjuvant therapy The concept that neoadjuvant CRT may be more effective than adjuvant CRT has been supported recently in resectable rectal carcinoma with a high risk for local relapse (German Rectal Cancer Group)
Neoadjuvant chemoradiotherapy resulted in tumour regression causing a higher rate of R0-resections, improved local control and lower long term toxicity compared with post-operative chemoradiotherapy [33]
Summary
Despite considerable progress in oncology, the poor prognosis of patients with pancreatic ductal adenocarcinoma (PDAC) has not significantly improved. More than 80% of patients with PDAC present with irresectable disease One third of these patients have locally advanced pancreatic carcinoma (LAPC), the rest have distant metastases. For some aspects of treatment, data was not available from prospectively randomised phase III trials and some studies with a lower degree of evidence needed to be included. Before addressing the respective treatment situations (adjuvant, Diagnostic imaging and disease staging A number of imaging modalities may be useful in arriving at a diagnosis in patients presenting with symptoms or signs suggestive of pancreatic carcinoma[3]: Ultrasound, Endoscopic UltraSound (EUS), Endoscopic Retrograde CholangioPancreatography (ERCP), multidetector computed tomography (CT) and Magnetic Resonance Imaging (MRI) including Magnetic Resonance CholangioPancreatography (MRCP). Biopsy proof of a pancreatic mass is not required if the mass is resectable except within neoadjuvant treatment protocols. A chest x-ray is required if the thorax is not included in the CT scan of the abdomen
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
