Neoadjuvant chemoradiation for operable pancreatic cancer: The importance of local disease control

Abstract

Pancreatic cancer (PC) is one of the most neuroinvasive tumors of the gastrointestinal tract, and perineural invasion is associated with high rates of local-regional recurrence. Historically, the goal of local-regional control in patients with PC has largely been secondary to the prevention of metastatic disease progression. However, with improving systemic therapies, patients are now experiencing unprecedented survivals and are living long enough to be susceptible to local recurrence. Such local recurrences usually occur in the neural tissue enveloping the celiac artery, superior mesenteric artery, or hepatic artery. The use of neoadjuvant chemoradiation has been effective in decreasing perineural invasion and may be particularly effective when given preoperatively prior to the immune suppressive effects of surgery and the hypoxic tissue disruption that occurs following pancreatectomy. This chapter focuses on the rationale and importance of neoadjuvant radiation therapy in the treatment of localized, potentially operable PC and provides an introduction to current neoadjuvant radiation therapy techniques, including intensity modulated radiation therapy and stereotactic body radiation therapy.