REVIEW

JOP. J Pancreas (Online) 2005; 6(2):216-230.

Chemoradiation for Ductal Pancreatic Carcinoma: Principles of Combining Chemotherapy with Radiation, Definition of Target Volume and Radiation Dose

Ralf Wilkowski1, Martin Thoma1, Helmut Weingandt1, Eckhart Dühmke1, Volker Heinemann2

1Clinic for Radiation Oncology and 2Medical Clinic III, LMU University Hospital Grosshadern. Munich, Germany

Summary

Review of the role of chemoradiotherapy in the treatment of locally advanced pancreatic cancer with a specific focus on the technical feasibility and the integration of chemoradiotherapy into multimodal treatment concepts.

Combined chemoradiotherapy of pancreatic cancer is a safe treatment with an acceptable profile of side effects when applied with modern planning and radiation techniques as well as considering tissue tolerance. Conventionally fractionated radiation regimens with total doses of 45-50 Gy and small-volume boost radiation with 5.4 Gy have found the greatest acceptance. Locoregional lymphatic drainage should be included in the planning of target volumes because the risk of tumor involvement and local or loco-regional recurrence is high. Up to now, 5-fluorouracil has been considered the "standard" agent for concurrent chemoradiotherapy. The role of gemcitabine given concurrently with radiation has not yet been defined, since high local efficacy may also be accompanied by enhanced toxicities. In addition, no dose or administration form has been determined to be "standard" up to now.

The focus of presently ongoing research is to define an effective and feasible regimen of concurrent chemoradiotherapy. While preliminary results indicate promising results using gemcitabine-based chemoradiotherapy, reliable data derived from mature phase III trials are greatly needed. Intensity-modulated radiotherapy has been developed to improve target-specific radiation and to reduce organ toxicity. Its clinical relevance still needs to be defined.

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Keywords Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Drug Therapy; Pancreatic Neoplasms; Radiotherapy

Correspondence Martin Thoma: martin.thoma@med.uni-muenchen.de