ASTRO issues new guidance for pancreatic cancer

The American Society for Radiation Oncology (ASTRO) has updated its recommendations for using radiation therapy to treat patients with diagnosed pancreatic cancer.

The guidelines were published online in ASTRO’s clinical practice journal, Practical Radiation Oncology. They were created by a 14-member multidisciplinary radiation oncology task force that performed a literature review of 179 articles published from May 2007 through January 2017.

Four main areas are covered in the guidelines: the use of radiation therapy in pre-surgical, post-surgical, definitive and palliative treatment settings; stereotactic and conventional radiation therapy; technical details of radiation therapy; and limiting side effects.

"One thing this guideline offers that hasn't been available previously is context about the current status of ablative radiotherapy such as stereotactic body radiation therapy (SBRT) and where it might be useful for patients with pancreatic cancer," said Manisha Palta, MD, co-chair of the guideline task force and a radiation oncologist at Duke University, in an ASTRO statement.

ASTRO offered the following recommendations on the indications of radiation therapy for pancreatic cancer:

  • Conventionally fractionated radiation should be used conditionally in the adjuvant/ post-operative setting in those with high-risk features such as positive lymph nodes and margins following surgical resection. SBRT should be used only when the patient is enrolled in a clinical trial.
  • Conventionally fractionated radiation therapy or SBRT is recommended in the neoadjuvant/ pre-operative setting on a conditional basis after chemotherapy in patients with resectable disease. Neoadjuvant chemo with radiation should be used conditionally after systemic therapy for certain patients with borderline resectable disease.
  • Systemic chemotherapy followed by chemoradiation or SBRT should be an option for definitive treatment in patients with locally advanced disease and who are not candidates for surgery.

"Any patient who is diagnosed with pancreatic cancer deserves to have a multidisciplinary evaluation, where she or he can have nuanced conversations about the benefits and risks of different types of treatment based on the most current information available, Palta said.

It's also essential that any patient who might be an appropriate candidate for radiation have access to a radiation oncologist who can provide perspective on the pros and cons of treatment, so that the patient can make an informed decision," Palta added. “This is a rapidly evolving field and some potentially practice-changing studies that are not included in this guideline may become available in the relatively near-term future.”