Do you escalate the dose in adjuvant pancreatic cancer radiation therapy similar to how many are treating locally advanced disease with dose escalation?
In the adjuvant setting, what boost dose to vascular areas can be safely applied, assuming one has all the tech to reliably breath hold the patient and meets the standard bowel dose constraints used in RTOG 0848 (including care to avoid the jejunostomies from the high dose boost)?
Do you treat to a BED of 70 Gy or higher, e.g. 58-75 Gy in 25-28 fractions?
2 Answers
Mednet MemberInvited Expert
Radiation Oncology · Memorial Sloan-Kettering Cancer Center
Answered on
A few points to consider about this modern perspective on adjuvant CXRT for pancreatic cancer are:
- A positive margin is one of the least controversial indications for adjuvant CXRT in pancreatic cancer.
- If you get a case to treat, you don't want dose to be the reason for failure.
- 50.4 Gy has been th...
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Mednet Member
Radiation Oncology · Hôtel Dieu de Lévis - CISSS Chaudière-Appalaches
Answered on · Updated on
Thanks for the great insights from Dr. @Dr. First Last!
I am wondering if you changed your practice based on the presented RTOG 0848 trial results. There was no interaction with margin status, and it seems that chemoradiation benefit is mostly limited to patients with pN0 disease.
Do you still reco...
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