Role of radiation therapy

Abstract

Patients with pancreatic cancer present in one of three ways. They may be clearly resectable, not clearly resectable but without evidence of hepatic, peritoneal, or more distant dissemination, or with obvious disseminated disease. While the majority of patients do have metastatic disease (>50-60 %) and the minority with clearly resectable disease is small (10-20 %), the 30-40 % of patients who are not clearly metastatic and not clearly resectable provide special challenges and opportunities in management. In this last category, a number of factors have been recognized as important for prognostic and therapeutic decision making. These include the distinction between "borderline resectable" and more locally advanced presentations, clinical factors (performance status, anemia, weight loss), biologic factors (SMAD 4, TP53), and the impact on survival of achieving gross total resection when clinically appropriate and possible. In addition, technical advances in radiation oncology provide new opportunities for safely exploiting this expanding base of clinical and prognostic knowledge for patient benefit. These issues are reviewed with an eye toward helping the busy surgeon or medical oncologist optimize care and outcomes for their pancreatic cancer patients in this category.