Department of Radiation Oncology, Duke University, Durham, North Carolina.
Department of Radiation Oncology, Duke University, Durham, North Carolina.
Pract Radiat Oncol. 2019 Sep-Oct;9(5):322-332. doi: 10.1016/j.prro.2019.06.016.
This guideline systematically reviews the evidence for treatment of pancreatic cancer with radiation in the adjuvant, neoadjuvant, definitive, and palliative settings and provides recommendations on indications and technical considerations.
The American Society for Radiation Oncology convened a task force to address 7 key questions focused on radiation therapy, including dose fractionation and treatment volumes, simulation and treatment planning, and prevention of radiation-associated toxicities. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength.
The guideline conditionally recommends conventionally fractionated or stereotactic body radiation for neoadjuvant and definitive therapy in certain patients and conventionally fractionated regimens for adjuvant therapy. The task force suggests a range of appropriate dose-fractionation schemes and provides recommendations on target volumes and sequencing of radiation and chemotherapy. Motion management, daily image guidance, use of contrast, and treatment with modulated techniques are all recommended. The task force supported prophylactic antiemetic medication, and patients may also benefit from medications to reduce acid secretion.
The role of radiation in the management of pancreatic cancer is evolving, with many ongoing areas of active investigation. Radiation therapy is likely to become even more important as new systemic therapies are developed and there is increased focus on controlling local disease. It is important that the nuances of available data are discussed with patients and families and that care be coordinated in a multidisciplinary fashion.
本指南系统地回顾了在辅助、新辅助、根治和姑息治疗环境下用放射治疗胰腺癌的证据，并就适应证和技术注意事项提出了建议。
美国放射肿瘤学会召集了一个工作组，针对 7 个关键问题集中讨论放射治疗，包括剂量分割和治疗体积、模拟和治疗计划以及预防放射相关毒性。建议是基于系统的文献回顾，并使用预先确定的共识制定方法和证据质量分级系统以及推荐强度系统来制定。
该指南有条件地推荐在某些患者中进行新辅助和根治治疗的常规分割或立体定向体部放射治疗，以及辅助治疗的常规分割方案。工作组建议了一系列适当的剂量分割方案，并就靶区和放射治疗与化疗的顺序提出了建议。建议进行运动管理、每日图像引导、使用对比剂和使用调强技术。工作组支持预防性止吐药物治疗，患者也可能受益于减少胃酸分泌的药物。
随着新的系统治疗方法的不断发展，以及对控制局部疾病的重视程度不断提高，放射治疗在胰腺癌治疗中的作用正在不断发展。随着新的系统治疗方法的发展以及对控制局部疾病的重视程度的提高，放射治疗的作用将变得更加重要。重要的是，要与患者和家属讨论可用数据的细微差别，并以多学科的方式协调护理。
