title: Individualized radiotherapy (iRT) concepts for locally advanced pancreatic cancer (LAPC): indications and prognostic factors.
abstract: BACKGROUND
  Novel techniques in radiation oncology have significantly improved the therapeutic window in locally advanced pancreatic cancer LAPC. In about one third of the patients, chemoradiation can lead to secondary resectability, contributing to an increase in outcome. Dose-escalation approaches using stereotactic body radiotherapy (SBRT) or advanced treatments such as intensity-modulated radiotherapy (IMRT) can exploit the biological benefits of hypofractionation, or use "dose painting" approaches to target defined subvolumes. Prognostic subgroups of patients have been identified, based on molecular markers such as CA 19-9, nutritional factors, diabetes or immunological properties of tumor and normal tissue.
  
  
  OBJECTIVE
  The aim of the present manuscript is to summarize data on downsizing for locally advanced pancreatic cancer (LAPC) and to elucidate the role of individualized radiotherapy (iRT).
  
  
  CONCLUSIONS
  Future concepts focus on iRT based on prognostic factors leading to a true personalized treatment.
authors.affiliation: Department of Radiation Oncology, Klinikum rechts der Isar, Technische Universität München (TUM), Ismaninger Straße 22, 81675, Munich, Bavaria, Germany. Stephanie.Combs@tum.de.|Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Neuherberg, Bavaria, Germany. Stephanie.Combs@tum.de.
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Combs
mesh_terms: D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D018579:Patient Selection; D057285:Precision Medicine / Q000379:methods*; D011379:Prognosis; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Locally advanced pancreatic cancer; Neoadjuvant chemoradiation; Personalized medicine; Radiotherapy; Stereotactic body radiotherapy (SBRT)