ASTRO Issues Guideline for Radiation Tx in Pancreatic Cancer

In a new American Society for Radiation Oncology clinical practice guideline, published in the September-October issue of Practical Radiation Oncology, recommendations are presented for radiation treatment of pancreatic cancer.

Manisha Palta, M.D., from Duke University in Durham, North Carolina, and colleagues reviewed the evidence for treatment of pancreatic cancer with radiation in the adjuvant, neoadjuvant, definitive, and palliative settings and developed a guideline to address seven key questions focused on radiation therapy.

The authors conditionally recommend conventionally fractionated or stereotactic body radiation for neoadjuvant and definitive therapy in specific patients and conventionally fractionated regimens for adjuvant therapy. A range of appropriate dose-fractionation schemes are suggested and recommendations are provided on target volumes and radiation and chemotherapy sequencing. Recommendations are also included for motion management, daily image guidance, use of contrast, and treatment with modulated techniques. Prophylactic use of antiemetic medication is supported by the guideline task force; patients also may benefit from the use of medication to reduce acid secretion.

"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 in a statement. "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."

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