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Radiotherapy of pancreatic cancers: 2025 update
Maxime Bertrand-Chevrier1, Olivier Riou1, Alexandre Orthuon2
1Fédération universitaire d'oncologie radiothérapie d'Occitanie Méditerranée, Institut régional du cancer Montpellier (ICM), Montpellier, France.
Summary
Updated French Society of Radiotherapy Oncology recommendations address radiotherapy for pancreatic cancer. Evidence suggests adjuvant chemoradiotherapy may benefit N0 patients, while neoadjuvant approaches enhance resectability for borderline tumors.
Area of Science:
- Oncology
- Radiation Oncology
- Gastrointestinal Oncology
Background:
- The role of radiotherapy in managing pancreatic cancer, both resectable and locally advanced, remains a subject of ongoing debate.
- Current standard postoperative care involves 6 months of adjuvant chemotherapy using the FOLFOXIRI regimen (5-fluorouracil, irinotecan, oxaliplatin).
Purpose of the Study:
- To provide updated clinical recommendations for radiotherapy in pancreatic cancer treatment.
- To clarify the indications and benefits of various radiotherapy strategies in different stages of pancreatic cancer.
Main Methods:
- The recommendations synthesize current evidence and expert consensus from the French Society of Radiotherapy Oncology (SFRO).
- Key treatment scenarios discussed include postoperative adjuvant therapy, neoadjuvant therapy for borderline resectable tumors, and definitive treatment for locally advanced tumors.
- Advanced radiotherapy techniques such as intensity-modulated radiotherapy (IMRT) and stereotactic radiotherapy are evaluated for their potential benefits and technical considerations.
Main Results:
- Adjuvant chemoradiotherapy may offer benefits for patients with N0 pancreatic cancer.
- Neoadjuvant chemoradiotherapy, following induction chemotherapy, can improve complete resection rates (R0) for borderline tumors, though survival benefits are not yet proven.
- For locally advanced pancreatic cancer, induction chemotherapy followed by chemoradiotherapy in non-progressive cases enhances local control and resectability.
Conclusions:
- Radiotherapy plays a nuanced role in pancreatic cancer management, particularly in the adjuvant and neoadjuvant settings.
- Advanced techniques like IMRT and stereotactic radiotherapy are recommended to optimize tumor dose delivery while sparing organs at risk, considering respiratory motion.
- Further research is needed to definitively establish the survival benefits of neoadjuvant chemoradiotherapy in borderline resectable pancreatic cancer.
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