Beyond Opioids in Pancreatic Cancer: Palliative Radiotherapy and Celiac Plexus Radiosurgery

This review examines established and evolving approaches for radiation therapy as a palliative treatment modality in patients with pancreatic cancer within the context of effective patient-provider communication and early palliative care team based management. At presentation most patients with pancreatic cancer have advanced disease and a limited life expectancy. Typically, they suffer from multiple disease-related symptoms. Systemic therapies have limited palliative efficacy against symptoms associated with local disease. This is in contrast to radiation therapy, which appears efficient in achieving local symptom control. In addition to more conventional tumour-targeting stereotactic body radiation therapy (SBRT), and short-course conventional radiotherapy, a recent clinical trial demonstrated the effectiveness of a new approach - celiac plexus radiosurgery. In this article, we evaluate and compare the effectiveness of these treatment methods, demonstrating the important, yet underappreciated, role that hypofractionated radiation therapy has within the multidisciplinary management of patients with pancreatic cancer, including those with metastatic disease.