Role of radiotherapy in locally advanced pancreatic cancer
Pancreatic cancer carries a poor prognosis regardless of stage, and incidence and death rates are increasing. Pancreatic cancer is divided into four general categories, resectable, borderline resectable, locally advanced/unresectable, and metastatic. Only 15-20% of patients diagnosed with pancreatic cancer have resectable or borderline resectable disease at diagnosis. Most patients are diagnosed with more advanced disease; approximately 30-40% of patients present with locally advanced, unresectable pancreatic cancer (LAPC) at the time of diagnosis, and another 40% have distant metastatic disease. Surgery provides the only chance of cure for patients with pancreatic cancer, but the likelihood of patients with unresectable disease ultimately proceeding to surgical resection is low. The management of these patients with locally advanced, unresectable disease is controversial, and there is no internationally accepted regimen. The data for the use of radiation therapy in the setting of LAPC will be discussed in this chapter.
