Is it appropriate to use SBRT on unresectable pancreatic tumors invading the duodenum?

Duodenal invasion would be considered an absolute contraindication to SBRT at our institution. If you look at the early SBRT experiences, such as the Danish phase II trial (PMID 15990186) which treated with larger margins than we use today and did not pay as close attention to the duodenal dose, they reported high rates of duodenal ulceration all of which received 67% or greater of the prescription dose. Especially given the recent results of LAP7 which draw into question the comparative benefit of chemotherapy followed by RT over chemotherapy alone in locally advanced pancreatic cancer, I would suggest cuation in using SBRT in such patients as risk of causing harm may outwieght any potential benefit.

To answer second question, we do not h...