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Radiation therapy in borderline resectable pancreatic cancer: A review.
Turner, Kevin M; Delman, Aaron M; Kharofa, Jordan R; Smith, Milton T; Choe, Kyuran A; Olowokure, Olugbenga; Wilson, Gregory C; Patel, Sameer H; Sohal, Davendra; Ahmad, Syed A.
Affiliation
  • Turner KM; Department of Surgery, University of Cincinnati College of Medicine, OH.
  • Delman AM; Department of Surgery, University of Cincinnati College of Medicine, OH.
  • Kharofa JR; Department of Radiation Oncology, University of Cincinnati College of Medicine, OH.
  • Smith MT; Division of Digestive Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, OH.
  • Choe KA; Department of Radiology, University of Cincinnati College of Medicine, OH.
  • Olowokure O; Division of Hematology & Oncology, Department of Internal Medicine, University of Cincinnati College of Medicine, OH.
  • Wilson GC; Department of Surgery, University of Cincinnati College of Medicine, OH; Division of Surgical Oncology, Department of Surgery, University of Cincinnati College of Medicine, OH.
  • Patel SH; Department of Surgery, University of Cincinnati College of Medicine, OH; Division of Surgical Oncology, Department of Surgery, University of Cincinnati College of Medicine, OH.
  • Sohal D; Division of Hematology & Oncology, Department of Internal Medicine, University of Cincinnati College of Medicine, OH.
  • Ahmad SA; Department of Surgery, University of Cincinnati College of Medicine, OH; Division of Surgical Oncology, Department of Surgery, University of Cincinnati College of Medicine, OH. Electronic address: ahmadsy@ucmail.uc.edu.
Surgery ; 172(1): 284-290, 2022 07.
Article in En | MEDLINE | ID: mdl-35034793
ABSTRACT

BACKGROUND:

Borderline resectable pancreatic cancer constitutes a complex clinical entity, presenting the clinician with a locally aggressive disease that has a proclivity for distant spread. The benefits of radiation therapy, such as improved local control and improved survival, have been questioned. In this review we seek to summarize the existing evidence on radiation therapy in borderline resectable pancreatic cancer and highlight future areas of research.

METHODS:

A comprehensive review of PubMed for clinical studies reporting outcomes in borderline resectable pancreatic cancer was performed in June 2021, with an emphasis placed on prospective studies.

RESULTS:

Radiologic "downstaging" in borderline resectable pancreatic cancer is a rare event, although some evidence shows increased clinical response to neoadjuvant chemotherapy over radiation therapy. Margin status seems to be equivalent between regimens that use neoadjuvant chemotherapy alone and regimens that include neoadjuvant radiation therapy. Local control in borderline resectable pancreatic cancer is likely improved with radiation therapy; however, the benefit of improved local control in a disease marked by systemic failure has been questioned. Although some studies have shown improved survival with radiation therapy, differences in the delivery and tolerance of chemotherapy between the neoadjuvant and adjuvant setting confound these results. When the evidence is evaluated as a whole, there is no clear survival benefit of radiation therapy in borderline resectable pancreatic cancer.

CONCLUSION:

Once considered a staple of therapy, the role of radiation therapy in borderline resectable pancreatic cancer is evolving as systemic therapy regimens continues to improve. Increased clinical understanding of disease phenotype and response are needed to accurately tailor therapy for individual patients and to improve outcomes in this complex patient population.
Subject(s)

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Pancreatic Neoplasms Type of study: Observational_studies / Systematic_reviews Limits: Humans Language: En Journal: Surgery Year: 2022 Document type: Article

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Pancreatic Neoplasms Type of study: Observational_studies / Systematic_reviews Limits: Humans Language: En Journal: Surgery Year: 2022 Document type: Article