Is there a role for radiation therapy in the management of unresectable solid papillary cystic tumor of the pancreas?

Actually, as it happens, I am currently treating a large solid pseudopapillary neoplasm of the pancreas. It happens to be the first I have ever treated. You are correct. I could find 1 case report from the 1980s where 2D radiation was used and the treatment was "effective". When I presented the case at our tumor conference, I found that we have a 12-year survivor after IMRT to 54 Gy at MSK. When there is a complete absence of data, that can be that people have tried it and things have not gone well and never published the results. My sense is that this is not one of those situations. Since an ablative dose can overcome resistance in most tumors, that is what I have decided to treat her with, 75 Gy in 25 fractions.

I have treated a very large unresectable serous cystadenoma of the pancreas with 5 fraction SBRT (dose painted). The goal is to shrink mass/prevent further growth while minimizing toxicity. The patient has had a satisfactory clinical and radiographic response so far (still early post-treatment but tumor is shrinking).

There is a role for radiation when these are unresectable and radiation is anticipated to provide symptomatic relief or prevent further tumor-related complications.

It may not be possible to achieve an ablative dose to the entire tumor for these given sizes with multiple areas of abutment to critical OARs. I treated the majority of the tumor with ablative dose and limited tumor periphery (when near bowel) to well within safe ...