Neibart Shane S, Moningi Shalini, Jethwa Krishan R
Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA, USA.
Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA.
Clin Exp Gastroenterol. 2024 Jul 16;17:213-225. doi: 10.2147/CEG.S341189. eCollection 2024.
For patients with locally advanced pancreatic cancer (LAPC), who are candidates for radiation therapy, dose-escalated radiation therapy (RT) offers unique benefits over traditional radiation techniques. In this review, we present a historical perspective of dose-escalated RT for LAPC. We also outline advances in SBRT delivery, one form of dose escalation and a framework for selecting patients for treatment with SBRT.
Techniques for delivering SBRT to patients with LAPC have evolved considerably, now allowing for dose-escalation and superior respiratory motion management. At the same time, advancements in systemic therapy, particularly the use of induction multiagent chemotherapy, have called into question which patients would benefit most from radiation therapy. Multidisciplinary assessment of patients with LAPC is critical to guide management and select patients for local therapy. Results from ongoing trials will establish if there is a role of dose-escalated SBRT after induction chemotherapy for carefully selected patients.
Patients with LAPC have more therapeutic options than ever before. Careful selection for SBRT may enhance patient outcomes, pending the maturation of pivotal clinical trials.
对于适合放疗的局部晚期胰腺癌（LAPC）患者，剂量递增放疗（RT）相较于传统放疗技术具有独特优势。在本综述中，我们呈现了LAPC剂量递增RT的历史视角。我们还概述了立体定向体部放疗（SBRT）实施方面的进展，SBRT是剂量递增的一种形式，以及选择SBRT治疗患者的框架。
为LAPC患者实施SBRT的技术已取得显著进展，现在能够实现剂量递增并更好地管理呼吸运动。与此同时，全身治疗的进展，特别是诱导多药化疗的使用，引发了对于哪些患者能从放疗中获益最多的质疑。对LAPC患者进行多学科评估对于指导治疗管理和选择局部治疗患者至关重要。正在进行的试验结果将确定诱导化疗后剂量递增SBRT对精心挑选的患者是否有作用。
LAPC患者比以往有更多的治疗选择。在关键临床试验成熟之前，谨慎选择SBRT可能会改善患者预后。
