When using SBRT to treat unresectable pancreatic cancer after induction chemotherapy, do you treat elective lymph nodes?

Short answer - yes, we started doing this ~6 months ago.

Longer answer: Our practice has changed here recently. Initially, when offering ablative radiation for locally advanced unresectable pancreatic cancer, either with 15-25 fractions on a conventional linac or with 5 fractions on an adaptive platform, we did not routinely cover elective lymph nodes.

Starting in 2022, we started manually editing our CTV to cover areas of high risk, such as the "triangle volume" (Hill et al., PMID 35144016), and then more recently to take into account other high-risk areas demonstrated on patterns of failure studies (Ponce et al., PMID 39182645).

Earlier this year, to coincide with the opening of NRG-GI011, a new NRG contouring atlas specific to dose escalati...