ASTRO presents first guidelines for radiotherapy for pancreatic cancer

The American Society for Radiation Oncology (ASTRO) has released guidelines for radiation therapy for pancreatic cancer. The new guidelines, published in Practical Radiation Oncology, provide information on the appropriate use of radiation therapy in a variety of clinical settings and include recommendations for systemic drug sequencing, dosing regimens and technical considerations.

The guidelines were developed in collaboration with the American Society of Clinical Oncology (ASCO) and the Society of Surgical Oncology (SSO).

Basic provisions

  • When a resectable tumor is identified, ASTRO makes a conditional recommendation for adjuvant conventional radiotherapy in patients with high-risk clinical features such as lymph node involvement or the presence of tumor cells at the resection margin. Due to limited data, adjuvant stereotactic body radiation therapy (SBRT) is recommended for use only in studies or for multi-institutional programs. In the neoadjuvant setting, patients with resectable disease are given a conditional recommendation to receive either conventional radiotherapy or SBRT after chemotherapy.
  • For borderline resectable pancreatic cancer, ASTRO makes a conditional recommendation for neoadjuvant chemotherapy followed by SBRT with multifractional radiation or conventional radiation therapy plus chemotherapy.
  • For patients with locally advanced tumors for whom surgery is contraindicated, guidelines provide a conditional recommendation for definitive treatment in the form of systemic chemotherapy followed by either conventional radiotherapy plus chemotherapy, dose-escalating chemoradiotherapy, or SBRT with a multifractionated radiation regimen without chemotherapy.
  • Preventive strategies outlined in guidelines include prophylactic use of antiemetic drugs to reduce the incidence of nausea and a conditional recommendation for prophylactic use of acid-reducing drugs.

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