Optimizing neoadjuvant radiotherapy for resectable and borderline resectable pancreatic cancer using protons |
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Authors: | Romaine Charles Nichols Michael Rutenberg |
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Affiliation: | Romaine Charles Nichols, Michael Rutenberg, Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL 32206, United States |
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Abstract: | Approximately 25% of patients diagnosed with pancreatic cancer present with non-metastatic resectable or borderline resectable disease. Unfortunately, the cure rate for these "curable" patients is only in the range of 20%. Local-regional failure rates may exceed 50% after margin-negative, node-negative pancreatectomy, but up to 80% of resections are associated with regional lymph node or margin positivity. While systemic drug therapy and chemotherapy may prevent or delay the appearance of distant metastases, it is unlikely to have a significant impact on local-regional disease control. Preoperative radiotherapy would represent a rational intervention to improve local-regional control. The barrier to preoperative radiotherapy is the concern that it could potentially complicate what is already a long and complicated operation. When the radiotherapy is delivered with X-rays(photons), the entire cylinder of the abdomen is irradiated;therefore, an operating surgeon may be reluctant to accept the associated risk of increased toxicity. When preoperative radiotherapy is delivered with protons,however, significant bowel and gastric tissue-sparing is achieved and clinical outcomes indicate that proton therapy does not increase the risk of operative complications nor extend the length of the procedure. |
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Keywords: | Radiation oncology Pancreatic cancer Proton therapy |
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