STEREOTACTIC BODY RADIOTHERAPY (SBRT) FOR PANCREATIC CANCER

Introduction Pancreatic cancer is the tenth most common cancer and is the fourth leading cause of cancer mortality. Surgery remains the current potentially curative treatment of choice. Chemotherapy and radiation therapy including SBRT play a vital role in locally advanced non-metastatic pancreatic cancer. Results Patients with biopsy proven non-metastatic locally advanced unresectable pancreatic cancer who are referred for conventional chemoradiotherapy are potential candidates for SBRT. Patients with borderline resectable disease can be considered for this hypofractionated approach. While some institutions use a single fixed dose prescription, others use a radiation dose based on the relationship between the tumor location and the gastroduodenal loop, in order to limit toxicity. The suggested maximal point tolerance dose of the duodenum is three fractions of 10 Gy each. If the tumor approximated one third or more of the circumference of the duodenum or stomach, three fractions of 8 Gy each are used. There are also other schemes depending of the site and the size of the tumor, such as 30 Gy in three fractions, 36 Gy in three fractions. The use of single and multiple fraction SBRT has been shown to be feasible and safe for patients with locally advanced pancreatic cancer in several series. Initial experience with single fraction SBRT with or without external beam radiation has been fraught with acute and chronic toxicity. Conclusion SBRT can be delivered safely and quickly to patients with locally advanced unresectable pancreatic cancer or with positive margins, oligometastasis and local recurrence after prior radiation. A randomized trial will be required to answer whether SBRT plus chemotherapy will improve progression free survival, overall survival and patients quality of life compared to chemotherapy with or without conventional chemoradiation.