The American Society for Radiation Oncology (ASTRO) has published an updated clinical guideline on the use of radiation therapy for adult patients with pancreatic cancer.
The new guideline reflects new clinical trial evidence across resectable, locally advanced, recurrent, metastatic, and palliative settings. It was published in Practical Radiation Oncology and was developed in collaboration with the American Society of Clinical Oncology, the European Society for Radiotherapy and Oncology, and the Society of Surgical Oncology.
Key recommendations include the following:
- For resectable pancreatic cancer, chemoradiation prior to surgery is conditionally recommended, as is postoperative chemoradiation following multiagent chemotherapy for patients with pathologically uninvolved lymph nodes who did not receive preoperative radiation.
- For borderline resectable disease, preoperative radiation therapy or chemoradiation is recommended to improve local control and increase the likelihood of margin-negative resection.
- For locally advanced pancreatic cancer, chemoradiation or radiation therapy after multiagent chemotherapy is recommended as definitive treatment.
- For isolated locoregional recurrence after surgery with no prior radiation, definitive-intent radiation therapy or chemoradiation is recommended; reirradiation is conditionally recommended for those with prior radiation.
- For oligometastatic or oligoprogressive disease, definitive-intent chemoradiation or radiation therapy is conditionally recommended.
- Palliative radiation therapy is recommended for symptom management including bleeding, pain, and obstruction.
The guideline also recommends dose escalation for locally advanced disease when volumetric image guidance and motion management are available, and adaptive radiation therapy for dose-escalated SBRT.
Read the entire guideline here.
