Recommendations for Radiation Therapy for Pancreatic Cancer Patients

The guideline first presents indications for radiation therapy in the adjuvant, neoadjuvant and definitive settings. It delineates between conventionally fractionated and stereotactic radiation therapy, providing the first clinical guidance on the newer, shorter-course approach. "One thing this guideline offers that hasn't been available previously is context about the current status of ablative radiotherapy such as stereotactic body radiation therapy (SBRT) and where it might be useful for patients with pancreatic cancer," said Dr. Palta.


Recommendations on the indications of radiation therapy for pancreas cancer are as follows:

In the adjuvant/post-operative setting, conventionally fractionated radiation is recommended conditionally for patients with high-risk features such as positive lymph nodes and margins following surgical resection. SBRT is recommended only if the patient is enrolled in a clinical trial/data registry.
In the neoadjuvant/pre-operative setting, conventionally fractionated radiation therapy or SBRT is recommended conditionally following chemotherapy for patients with resectable disease. Neoadjuvant chemotherapy plus radiation (either conventional or stereotactic) is conditionally recommended following systemic therapy for select patients with borderline resectable disease.
For patients with locally advanced disease (who are not candidates for surgery), systemic chemotherapy followed by either chemoradiation or SBRT is recommended conditionally as an option for definitive treatment.

Recommendations also address:

optimal dosing and fractionation for different subgroups of patients;
sequencing of radiation with systemic chemotherapies in adjuvant, neoadjuvant and definitive settings;
simulation and setup strategies, such as image guidance and patient-specific motion management;
techniques for treatment planning and delivery, including a strong recommendation for the use of modulated radiation therapy to deliver treatment; and
treatment in the palliative setting, including a strong recommendation for palliative radiation therapy to either the primary tumor or select metastatic sites to help relieve the patient's pain and other symptoms.
Mitigating Side Effects

The guideline also addresses ways to mitigate side effects related to pancreatic radiation, whether given alone or with chemotherapy. While the side effects from radiation therapy depend on how the radiation is administered, the most common toxicities include fatigue and digestive/gastrointestinal effects such as nausea, vomiting and diarrhea.

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