title: Supportive care considerations during concurrent chemoradiotherapy for pancreatic adenocarcinoma: lessons learned from clinical experience.
abstract: Concurrent chemotherapy and radiotherapy (chemoradiotherapy) for the management of pancreatic adenocarcinoma in either adjuvant or locally regional advanced settings produces predictable acute toxicities that are proportional in severity to the intensity and type of systemic therapy and to the parameters of radiotherapy. In addition, relevant to the adjuvant setting, surgery for pancreatic cancer often produces physiologic alterations that may impact a patient's ability to tolerate chemoradiotherapy. Failures to anticipate, monitor, and proactively manage the effects of surgery and toxicities of chemoradiotherapy can result in the need for unplanned treatment interruptions and/or inability to complete all planned therapy. In this review, complications of pancreatic cancer itself and of pancreatic resection as well as toxicities of chemoradiotherapy are delineated, and approaches to their management before, during, and after chemoradiotherapy are presented. Planning for the treatment of side effects before the anticancer therapy begins facilitates therapy administration and improves patient tolerance.
authors.affiliation: *Division of Hematology-Oncology, Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO †Department of Radiation Oncology, Rush University Medical Center ‡Department of Surgery, University of Chicago Medical Center, Chicago, IL §Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX ∥Cancer and Digestive Diseases Institutes, Virginia Mason Medical Center, Seattle, WA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Wang-Gillam
authors.forename: Ross A
authors.initials: RA
authors.lastname: Abrams
authors.forename: Mitchell C
authors.initials: MC
authors.lastname: Posner
authors.forename: Peter W T
authors.initials: PW
authors.lastname: Pisters
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: Picozzi
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D000855:Anorexia / Q000209:etiology / Q000628:therapy; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001361:Avitaminosis / Q000209:etiology / Q000628:therapy; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods*; D003863:Depression / Q000209:etiology / Q000628:therapy; D003967:Diarrhea / Q000209:etiology / Q000628:therapy; D004377:Dumping Syndrome / Q000209:etiology / Q000628:therapy; D006801:Humans; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents