Do you treat the normal pancreas as an organ at risk when delivering abdominal radiation therapy?

This is a great question. We do not do that because we have not seen any convincing evidence of exocrine or endocrine insufficiency caused by radiation at any dose. In fact, from surgical patients, we know that only a small volume of residual pancreas is needed to prevent insulin dependence. The pan...

I also do not put any specific constraints on the pancreas. For most patients, there is plenty of excess function, although I have seen an occasional patient who I think has developed endocrine insufficiency with a combination of surgery, pancreatitis (not related to the RT), and RT. Most of the dis...

For pediatric cases, I do contour the pancreas and pay particular attention to the tail dose because of this paper: de Vathaire et al., PMID 22921663.

I’ve never ordered a hemoglobin A1c on an oncology patient during follow up and I don’t routinely contour the pancreas as an OAR. I suspect I’m joined by most of our field in that regard. That said, it’s intuitive that islet cells would share the radiosensitivity of other endocrine tissues and that ...

SIOPE guidelines recommend the following be contoured as OARs near the spine: larynx, esophagus, thyroid gland, breasts, lungs, heart, liver, stomach, intestine, pancreas, kidneys, and the gonads. However, specific constraints are not given.

So I have included it as an organ at risk on VMAT craniospi...