Selection of patients with pancreatic adenocarcinoma who may benefit from radiotherapy
Abstract Despite combination chemotherapy demonstrating a positive effect on survival, the clinical outcomes of pancreatic adenocarcinoma (PDAC) remain poor. Radiotherapy was previously a component of the curative treatment of PDAC. Advances in imaging and computer sciences have enabled the prescrip...
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| Format: | Article |
| Language: | English |
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BMC
2023-08-01
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| Series: | Radiation Oncology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13014-023-02328-y |
| _version_ | 1797451873257521152 |
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| author | I-Shiow Jan Hui Ju Ch’ang |
| author_facet | I-Shiow Jan Hui Ju Ch’ang |
| author_sort | I-Shiow Jan |
| collection | DOAJ |
| description | Abstract Despite combination chemotherapy demonstrating a positive effect on survival, the clinical outcomes of pancreatic adenocarcinoma (PDAC) remain poor. Radiotherapy was previously a component of the curative treatment of PDAC. Advances in imaging and computer sciences have enabled the prescription of higher dosage of radiation focused on tumours with minimal toxicity to normal tissue. However, the role of radiotherapy has not been established in the curative treatment of localized PDAC because of the conflicting results from large prospective trials. Most studies have demonstrated improved locoregional control but no survival benefit from additional chemoradiotherapy (CRT) in addition to chemotherapy for resectable, borderline or locally advanced PDAC. The improved locoregional control enabled by CRT does not cause extended survival because of rapid distant progression in a significant proportion of patients with PDAC. Several single-institute studies of prescribing intensive chemotherapy with modern ablative radiotherapy for locally advanced PDAC have demonstrated extended survival with an acceptable safety profile. In an analysis after long-term follow-up, the PREOPANC study demonstrated a survival benefit from neoadjuvant gemcitabine-based CRT in resected PDAC relative to upfront surgery followed by adjuvant gemcitabine only. These observations indicated that the role of radiotherapy in PDAC should be evaluated in a subgroup of patients without rapid distant progression because systemic therapy for PDAC remains underdeveloped. We reviewed critical imaging, tissue, liquid and clinical biomarkers to differentiate the heterogeneous biologic spectra of patients with PDAC to identify those who may benefit the most from local radiotherapy. Exclusion of patients with localised PDAC who develop distant progression in a short time and undergo extended upfront chemotherapy for over 4 months may enable the identification of a survival benefit of local radiotherapy. Though promising, the effectiveness of biomarkers must be validated in a multi-institutional prospective study of patients with PDAC receiving CRT or not receiving CRT. |
| first_indexed | 2024-03-09T15:00:43Z |
| format | Article |
| id | doaj.art-14da618716254a579970c996bc995721 |
| institution | Directory Open Access Journal |
| issn | 1748-717X |
| language | English |
| last_indexed | 2024-03-09T15:00:43Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Radiation Oncology |
| spelling | doaj.art-14da618716254a579970c996bc9957212023-11-26T13:54:12ZengBMCRadiation Oncology1748-717X2023-08-0118111210.1186/s13014-023-02328-ySelection of patients with pancreatic adenocarcinoma who may benefit from radiotherapyI-Shiow Jan0Hui Ju Ch’ang1Department of Laboratory Medicine, College of Medicine, National Taiwan University Hospital, National Taiwan UniversityNational Institute of Cancer Research, National Health Research InstitutesAbstract Despite combination chemotherapy demonstrating a positive effect on survival, the clinical outcomes of pancreatic adenocarcinoma (PDAC) remain poor. Radiotherapy was previously a component of the curative treatment of PDAC. Advances in imaging and computer sciences have enabled the prescription of higher dosage of radiation focused on tumours with minimal toxicity to normal tissue. However, the role of radiotherapy has not been established in the curative treatment of localized PDAC because of the conflicting results from large prospective trials. Most studies have demonstrated improved locoregional control but no survival benefit from additional chemoradiotherapy (CRT) in addition to chemotherapy for resectable, borderline or locally advanced PDAC. The improved locoregional control enabled by CRT does not cause extended survival because of rapid distant progression in a significant proportion of patients with PDAC. Several single-institute studies of prescribing intensive chemotherapy with modern ablative radiotherapy for locally advanced PDAC have demonstrated extended survival with an acceptable safety profile. In an analysis after long-term follow-up, the PREOPANC study demonstrated a survival benefit from neoadjuvant gemcitabine-based CRT in resected PDAC relative to upfront surgery followed by adjuvant gemcitabine only. These observations indicated that the role of radiotherapy in PDAC should be evaluated in a subgroup of patients without rapid distant progression because systemic therapy for PDAC remains underdeveloped. We reviewed critical imaging, tissue, liquid and clinical biomarkers to differentiate the heterogeneous biologic spectra of patients with PDAC to identify those who may benefit the most from local radiotherapy. Exclusion of patients with localised PDAC who develop distant progression in a short time and undergo extended upfront chemotherapy for over 4 months may enable the identification of a survival benefit of local radiotherapy. Though promising, the effectiveness of biomarkers must be validated in a multi-institutional prospective study of patients with PDAC receiving CRT or not receiving CRT.https://doi.org/10.1186/s13014-023-02328-yPancreatic adenocarcinomaRadiotherapyBiomarkerRadiomic |
| spellingShingle | I-Shiow Jan Hui Ju Ch’ang Selection of patients with pancreatic adenocarcinoma who may benefit from radiotherapy Radiation Oncology Pancreatic adenocarcinoma Radiotherapy Biomarker Radiomic |
| title | Selection of patients with pancreatic adenocarcinoma who may benefit from radiotherapy |
| title_full | Selection of patients with pancreatic adenocarcinoma who may benefit from radiotherapy |
| title_fullStr | Selection of patients with pancreatic adenocarcinoma who may benefit from radiotherapy |
| title_full_unstemmed | Selection of patients with pancreatic adenocarcinoma who may benefit from radiotherapy |
| title_short | Selection of patients with pancreatic adenocarcinoma who may benefit from radiotherapy |
| title_sort | selection of patients with pancreatic adenocarcinoma who may benefit from radiotherapy |
| topic | Pancreatic adenocarcinoma Radiotherapy Biomarker Radiomic |
| url | https://doi.org/10.1186/s13014-023-02328-y |
| work_keys_str_mv | AT ishiowjan selectionofpatientswithpancreaticadenocarcinomawhomaybenefitfromradiotherapy AT huijuchang selectionofpatientswithpancreaticadenocarcinomawhomaybenefitfromradiotherapy |