| Abstract: |
Summary: Pancreatic carcinoma is a leading cause of cancer-related mortality. Approximately 30% of pancreatic cancer patients present with locally advanced, unresectable nonmetastatic disease. For these patients, two therapeutic options exist: systemic chemotherapy or chemoradiotherapy. Within this context, the optimal technique for pancreatic irradiation is not clearly defined. A search to identify relevant studies was undertaken using the Medline database. All Phase III randomized trials evaluating the modalities of radiotherapy in locally advanced pancreatic cancer were included, as were some noncontrolled Phase II and retrospective studies. An expert panel convened with members of the Radiation Therapy Oncology Group and GERCOR cooperative groups to review identified studies and prepare the guidelines. Each member of the working group independently evaluated five endpoints: total dose, target volume definition, radiotherapy planning technique, dose constraints to organs at risk, and quality assurance. Based on this analysis of the literature, we recommend either three-dimensional conformal radiation therapy or intensity-modulated radiation therapy to a total dose of 50 to 54 Gy at 1.8 to 2 Gy per fraction. We propose gross tumor volume identification to be followed by an expansion of 1.5 to 2 cm anteriorly, posteriorly, and laterally, and 2 to 3 cm craniocaudally to generate the planning target volume. The craniocaudal margins can be reduced with the use of respiratory gating. Organs at risk are liver, kidneys, spinal cord, stomach, and small bowel. Stereotactic body radiation therapy should not be used for pancreatic cancer outside of clinical trials. Radiotherapy quality assurance is mandatory in clinical trials. These consensus recommendations are proposed for use in the development of future trials testing new chemotherapy combinations with radiotherapy. Not all of these recommendations will be appropriate for trials testing radiotherapy dose or dose intensity concepts. © 2012 Elsevier Inc. All rights reserved. |
| Keywords: |
clinical trial; review; intensity modulated radiation therapy; advanced cancer; united states; cancer radiotherapy; pancreas cancer; radiation dose; pancreatic neoplasms; chemotherapy; quality control; computer assisted tomography; tumor volume; radiotherapy dosage; radiotherapy; randomized controlled trials as topic; radiation injury; cancer mortality; pancreas carcinoma; liver; kidney; physical therapy; radiotherapy, intensity-modulated; tumor burden; systematic review; quality assurance; radiation dose fractionation; clinical trials, phase iii as topic; quality assurance, health care; three dimensional imaging; spinal cord; pancreas adenocarcinoma; pancreatic adenocarcinoma; locally advanced; radiotherapy planning, computer-assisted; radiotherapy, conformal; clinical trials, phase ii as topic; stereotactic body radiation therapy; computer assisted radiotherapy; intestine, small; phase ii; randomized trial; radiation field; intensity-modulated radiation therapy; radiation therapy oncology groups; diseases; chemoradiotherapy; stomach; france; target volumes; gross tumor volume; cooperative groups; experiments; phase 3 clinical trial (topic); expert panels; organs at risks; spinal cords; three-dimensional conformal radiation therapy; planning target volumes; pancreatic cancers; respiratory gatings; pancreatic carcinoma; radiotherapy planning; organs at risk; dose intensity; small bowel; medline database; all phase; craniocaudal; total dose; working groups
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