How do you treat unresectable pancreatic adenocarcinoma invading into the duodenum?

No, 54Gy did not improve survival in the LAP-07 trial, so it is definitively not a definitive dose.

I would give 75Gy in 25 fx (100Gy BED) with capectabine. We have published how we do this in multiple papers, but essentially a 5mm duodenal PRV is carved out of the PTV75 so that there is a gradient of dose between 75Gy to 60Gy point dose at the duodenum. Typically the >80% of the GTV is covered with 75Gy.

Over the past 3.5 years we have treated 80% of the patients with LAPC referred to us after initial chemotherapy with ablative doses in this manner. This includes the common finding of radiographic abutment of the duodenum. This treatment has been so successful (60% 2 yr OS, 35% 3yr OS, 165 pts, will be presented at ASTRO) that it is diffi...