Strahlentherapie beim Pankreaskarzinom

Roeder, Falk (2016): Strahlentherapie beim Pankreaskarzinom. In: Therapeutische Umschau, Bd. 73, Nr. 9: S. 515-522

Abstract

This review summarizes the current status of radiation therapy approaches in the treatment of pancreatic cancer, including a description of modern radiation techniques, and an overview on the literature regarding adjuvant and neoadjuvant radioor radiochemotherapeutic strategies both for resectable and irresectable pancreatic cancer. For resectable pancreatic cancer conflicting data regarding a possible benefit of adjuvant (chemo-) radiation exists, while its positive effect on local control seems clearly established. Therefore (additional) adjuvant chemoradiation can be considered in selected cases based on encouraging single-center data although adjuvant chemotherapy alone has to be considered as the standard of care based on high level evidence from randomized trials. Outstanding results for resectable pancreatic cancer in terms of response, local control and overall survival have also been observed with neoadjuvant radio-or radiochemotherapy in several phase I/II trials, which justify further evaluation of this strategy. However, neoadjuvant strategies have to be considered still experimental and therefore should be performed only in clinical trials. In contrast, neoadjuvant chemoradiation clearly results in secondary resectability in a substantial proportion of patients (30 -40 %) with consecutively markedly improved overall prognosis results in locally-advanced primarily non-or borderline resectable pancreatic cancer based on currently available literature and should be considered as possible alternative in pretreatment multidisciplinary evaluations. If secondary resectability is reached, median survival rates can be achieved (similar to 24 months) which nearly equal the results with upfront surgery and adjuvant chemotherapy in primary resectable cases. Even if secondary resectability is not reached, improved quality of life due to prevention of complications caused by local progression can be achieved. Combination with induction chemotherapy using newer and more potent systemic agents (Folfirinox, Gem/nab-paclitaxel) seems fruitful and is currently investigated in prospective trials. Finally modern external beam radiation techniques (IMRT, IGRT, SBRT), new radiation qualities (protons, heavy ions) or combinations with alternative boosting techniques (IOERT) widen the therapeutic window and might contribute to the reduction of toxicity.

• Dokumententyp: Zeitschriftenartikel
• Fakultät: Medizin
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• ISSN: 0040-5930
• Sprache: Deutsch