When treating pancreatic cancer with adjuvant chemoradiation, do you treat the initial field to 50 Gy, as per RTOG 0848, or to 45 Gy?
For cases with positive margins, do you boost to 54 Gy? If so, do you boost the entire tumor bed or only the area of the positive margin?
Answer from: Radiation Oncologist at Academic Institution
What I do:
R0: 50.4 Gy in 28 fractions 3D CRT with a field reduction at 45Gy off of the jejunal reconstruction as much as possible
The 45Gy goes to the SMA, Celiac, porta and tumor bed.
R1: (path says margin <1mm or postive, no soft tissue near SMA in CT): Boost to 54Gy with 3DCRT.
R2: Gross ...
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Answer from: Radiation Oncologist at Academic Institution
This is a good question without a good data-based answer.
Keep in mind that we don't even have convincing data that adjuvant radiation is of benefit in pancreatic cancer. If we did have such data, there would be no need for RTOG 0848. Without clear evidence that adjuvant radiation is indicated, it ...