Pancreatic cancer is malignancy arising from the pancreas.
It is the 13th most common cancer in the world, 10th most common in the United States, and 4th leading cause of cancer-related deaths in the United Stated and Europe.
Exocrine tumors account for 95% of malignant pancreatic disease.
It is more common in women.
The median age of occurrence is at 71 years old.


Neoadjuvant Therapy

Radiation Therapy

  • Recommended radiotherapy regimens post-chemotherapy:
    • Gemcitabine-based (preferred)
    • Continuous infusion 5-FU-based
    • Capecitabine-based
  • Recommended dose:
    • 45-54 Gy in 1.8-2.5 Gy fractions
      • Recommended to be given as a postoperative treatment w/ high-energy protons >4 MV to the tumor bed, surgical anastomoses & adjacent lymph node regions
      • A follow-up dose of 5-15 Gy to the tumor bed is recommended after standard dose
    • 36 Gy in 2.4 Gy fractions
  • Doses of >54 Gy may be given for patients w/ higher stages or if clinically appropriate

Adjuvant Therapy

  • Adjuvant radiation therapy w/ concurrent fluoropyrimidine therapy is not routinely recommended if surgical margin is negative

For patients w/ locally resectable tumors

  • Regimens for radiation therapy include:
    • Capecitabine-based
    • Continuous infusion 5-FU-based
    • Fluoropyrimidine-based
    • Gemcitabine-based
    • Gemcitabine or bolus 5-FU/Leucovorin
    • Gemcitabine or bolus 5-FU/Leucovorin followed by continuous infusion 5-FU or Capecitabine-based chemoradiation therapy (CRT)

For patients w/ borderline resectable tumors

  • Recommended regimens for radiation therapy include:
    • Gemcitabine-based (preferred)
    • Continuous infusion 5-FU-based
    • Capecitabine-based

For patients w/ locally advanced tumors

  • A fluoropyrimidine- or gemcitabine-based chemoradiotherapy is a reasonable alternative in select patients w/o systemic metastases
  • Patients w/ local disease causing uncontrolled pain can be considered for upfront chemoradiotherapy
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