The role of radiation therapy in pancreatic ductal adenocarcinoma in the neoadjuvant and adjuvant settings.
Pancreatic adenocarcinoma (PCA) is associated with high rates of cancer-related morbidity and mortality. Yet despite modern treatment advances, the only curative therapy remains surgical resection. The adjuvant therapeutic standard of care for PCA in the United States includes both chemotherapy and chemoradiation; however, an optimal regimen has not been established. For patients with resectable and borderline resectable PCA, recent investigation has focused efforts on evaluating the feasibility and efficacy of neoadjuvant therapy. Neoadjuvant therapy allows for early initiation of systemic therapy and identification of patients who harbor micrometastatic disease, thus sparing patients the potential morbidities associated with unnecessary radiation or surgery. This article critically reviews the data supporting or refuting the role of radiation therapy in the neoadjuvant and adjuvant settings of PCA management, with a particular focus on determining which patients may be more likely to benefit from radiation therapy.
Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
Aaron J
AJ
Franke
Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
Lauren M
LM
Rosati
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Timothy M
TM
Pawlik
Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
Rachit
R
Kumar
Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: jherma15@jhmi.edu.
Joseph M
JM
Herman
D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology / Q000532:radiotherapy*; D059186:Chemoradiotherapy, Adjuvant; D006801:Humans; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D016634:Radiosurgery; D018714:Radiotherapy, Adjuvant; D050397:Radiotherapy, Intensity-Modulated