title: Hypofractionated radiotherapy in pancreatic cancer: Lessons from the past in the era of stereotactic body radiation therapy.
abstract: The role of neoadjuvant and definitive radiotherapy combined or not to chemotherapy in the therapeutic approach to pancreatic cancer has not been yet elucidated. There is some evidence in favour of neoadjuvant local and/or systemic approaches that enable surgical resection in patients initially considered to be "borderline resectable". Nevertheless, most of these studies have been conducted using schedules of radiotherapy (treatment volumes, total doses, dose/fraction) that are nowadays considered not efficient enough and/or too toxic. Recently, stereotactic body radiation therapy (SBRT) has been proposed as a new therapeutic option for pancreatic cancer, both in the neoadjuvant and in the definitive setting. The aim of this study is to review the radiobiological and clinical evidences supporting hypofractionation in pancreatic cancer. Moreover, we performed an extensive review of available clinical and dosimetric data on SBRT in pancreatic cancer.
authors.affiliation: Radiation Oncology Department, Centre Hospitalier Universitaire Vaudois-CHUV, Lausanne, Switzerland. Electronic address: berardino.de-bari@chuv.ch.
authors.forename: Berardino
authors.initials: B
authors.lastname: De Bari
authors.affiliation: Radiation Oncology Department, Centre Hospitalier Universitaire Vaudois-CHUV, Lausanne, Switzerland.
authors.forename: Laetitia
authors.initials: L
authors.lastname: Porta
authors.affiliation: Radiation Oncology Department, Sacro Cuore Hospital, Negrar, Verona, Italy; Radiation Oncology Department, Palermo University, Palermo, Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Mazzola
authors.affiliation: Radiation Oncology Department, Sacro Cuore Hospital, Negrar, Verona, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Alongi
authors.affiliation: Medical Oncology Department, Centre Hospitalier Universitaire Vaudois-CHUV, Lausanne, Switzerland.
authors.forename: Anna Dorothea
authors.initials: AD
authors.lastname: Wagner
authors.affiliation: Visceral Surgery Department, Centre Hospitalier Universitaire Vaudois-CHUV, Lausanne, Switzerland.
authors.forename: Markus
authors.initials: M
authors.lastname: Schäfer
authors.affiliation: Radiation Oncology Department, Centre Hospitalier Universitaire Vaudois-CHUV, Lausanne, Switzerland.
authors.forename: Jean
authors.initials: J
authors.lastname: Bourhis
authors.affiliation: Radiation Oncology Department, Centre Hospitalier Universitaire Vaudois-CHUV, Lausanne, Switzerland.
authors.forename: Mahmut
authors.initials: M
authors.lastname: Ozsahin
mesh_terms: D006801:Humans; D020360:Neoadjuvant Therapy; D010190:Pancreatic Neoplasms / Q000532:radiotherapy*; D016634:Radiosurgery / Q000009:adverse effects; D016896:Treatment Outcome
keywords: Dosimetry; Hypofractionation; Local control; Palliation; Pancreatic cancer; Radiotherapy; SBRT; Toxicity