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In light of the recently published LAP07 trial, what is the role of radiation in unresectable pancreatic cancer?

In LAP07's second randomization (capecitabine+54 Gy vs maintenance gemcitabine +/- erlotinib), 60% of unresectable pancreatic cancer patients who did not progress after 4 months of induction gemcitabine +/- erlotinib, RT increased local control from 54% to 68% without significantly improving PFS or OS. Is there reason to believe hypofractionated RT or SBRT will achieve local control better than 68%, and that the improvement will prolong survival?
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In community practice, do you usually recommend radiation therapy be added to chemotherapy for locally advanced - -or so-called borderline resectable -- pancreatic adenocarcinoma

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3 Answers
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Radiation Oncology · Brigham and Women's Hospital
Answered on

The recent publication of LAP07 is welcome, as the results have been known since the data were presented at ASCO 2013, and my impression is that the results have already led to a reduction in the use of radiation for locally advanced pancreatic cancer. This may be appropriate, but the results need t...

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Radiation Oncology · Memorial Sloan-Kettering Cancer Center
Answered on

I agree with most of the comments except for the commonly held believe that low-dose palliative SBRT in 5 fractions offers any hope of a different outcome in either LAPC or BRPC. Median survival from a very large number of single arm studies treating carefully selected LAPC patients with 25-33Gy in ...

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Radiation Oncology · Florida International University - Herbert Wertheim College of Medicine
Answered on

I agree with @Dr. First Last's thoughts. Many will cite the results of this trial as indicating that there is no role for RT in locally advanced patients; I think there is a role in selected patients. However, we should be mindful that improved systemic control using regimens like FOLFIRINOX may inc...

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