Intensity-Modulated Radiotherapy in the Treatment of Pancreatic Adenocarcinoma – A Review

Pancreatic cancer remains one of the leading causes of cancer deaths. Despite improvements in imaging, surgical techniques, chemotherapy agents, and radiation techniques, the prognosis for patients with pancreatic adenocarcinoma remains poor. Traditionally, radiotherapy (RT) has been utilized as neoadjuvant, adjuvant, or definitive treatment, and represents an important therapeutic option in pancreatic adenocarcinoma. Intensity-modulated radiation therapy (IMRT), a more recent RT technique, has the potential to deliver an adequate dose to the tumour volume with a minimal dose to the surrounding critical structures such as duodenum, small intestine, liver, kidneys, and spinal cord. This article provides a review about the role of IMRT in the treatment of pancreatic cancer, concerning clinical outcomes such as toxicity, local control, and overall survival

Results of a Phase II Study of Short-Course Accelerated Radiation Therapy (SHARON) for Multiple Brain Metastases

Objectives: To assess the effectiveness of a SHort-course Accelerated RadiatiON therapy (SHARON) in the treatment of patients with multiple brain metastases. Materials and Methods: A phase II clinical trial was designed. Eligibility criteria included patients with at least 3 brain metastases or metastatic disease in >3 organ systems, and Eastern Cooperative Oncology Group performance status of 643. Fifty patients were treated with whole brain radiotherapy at 18 Gy (4.5 Gy per fraction) in 2 days with a twice daily fractionation. The primary endpoint was the assessment of efficacy in terms of overall survival. Results: Characteristics of the 50 enrolled patients were: male/female: 24/26; median age: 65 years (range, 45 to 80 y). Eastern Cooperative Oncology Group performance status was <3 in 42 patients (84%). Nineteen patients (38%) were considered to have recursive partitioning analysis class 3 disease. Grade 1-2 acute neurological (46%) and skin (24%) toxicities were recorded. Three patients (6%) experienced neurological grade 3 acute toxicity. With a median follow-up time of 6 months (range, 1 to 18 mo) 2 skin grade 1 late toxicities has been observed. Seventeen of 27 symptomatic patients showed an improvement or resolution of baseline symptoms (overall palliative response rate: 63.0%; 95% confidence interval, 36.6%-82.4%).Two-month overall survival was 86% (median survival time=7 mo). Conclusions: Short-course accelerated whole brain radiotherapy of 18 Gy in twice daily fractions for 2 consecutive days is tolerated and effective in terms of symptom relief and median survival time. These results justify a phase III comparison against the standard-of-care in this patient population (30 Gy in 10 fractions)