Ablative radiation therapy advances in pancreatic cancer

The addition of combined conventional radiation to systemic therapy for both borderline and locally advanced pancreatic cancer (LAPC) has questionable benefits, with no clear survival advantage beyond chemotherapy alone. Advancements within the field of radiation oncology has enabled safe delivery of dose escalated and ablative radiation therapy for pancreatic adenocarcinomas. Delivery of radiation therapy in pancreatic cancers is complicated by the anatomic location of the pancreas. Historically, gastrointestinal toxicity has been a major limiting factor in the delivery of escalating doses of radiation for pancreatic cancer. However, with the advent of improved radiation delivery techniques and image guidance, administering escalated doses of radiation for pancreatic cancer has become more feasible. Improvements in image guidance, integrated boosting, nonhomogeneous dosing schema, and adaptive replans have allowed for escalated doses safely to the pancreas. Current, nonrandomized data, suggest improvements in local regional control as well as overall survival compared to historical controls. While the technology has been made more readily available to implement this escalated technique, the benefit of this approach in reference to key variables such as regional control and overall survival remain to be further evaluated and tested in reference to the current standard dosing approach. Herein, a review on current data for escalated and ablative regimens will be reviewed. Additional prospective studies are needed to further improve the use of ablative radiation in pancreatic cancer.