Novel strategies using modern radiotherapy to improve pancreatic cancer outcomes: toward a new standard?
heavy-particle radiotherapy
neoadjuvant therapy
pancreatic cancer
radiotherapy
stereotactic radiotherapy
Journal
Therapeutic advances in medical oncology
ISSN: 1758-8340
Titre abrégé: Ther Adv Med Oncol
Pays: England
ID NLM: 101510808
Informations de publication
Date de publication:
2020
2020
Historique:
received:
22
10
2019
accepted:
22
05
2020
entrez:
21
7
2020
pubmed:
21
7
2020
medline:
21
7
2020
Statut:
epublish
Résumé
Pancreatic ductal adenocarcinoma (PDAC) remains one of the most aggressive solid tumours with an estimated 5-year overall survival rate of 7% for all stages combined. In this highly resistant disease that is located in the vicinity of many radiosensitive organs, the role of radiotherapy (RT) and indications for its use in this setting have been debated for a long time and are still under investigation. Although a survival benefit has yet to be clearly demonstrated for RT, it is the only technique, other than surgery, that has been demonstrated to lead to local control improvement. The adjuvant approach is now strongly challenged by neoadjuvant treatments that could spare patients with rapidly progressive systemic disease from unnecessary surgery and may increase free margin (R0) resection rates for those eligible for surgery. Recently developed dose-escalated RT treatments, designed either to maintain full-dose chemotherapy or to deliver a high biologically effective dose, particularly to areas of contact between the tumour and blood vessels, such as hypofractionated ablative RT (HFA-RT) or stereotactic body RT (SBRT), are progressively changing the treatment landscape. These modern strategies are currently being tested in prospective clinical trials with encouraging preliminary results, paving the way for more effective treatment combinations using novel targeted therapies. This review summarizes the current literature regarding the use of RT for the treatment of primary PDAC, describes the limitations of conventional RT, and discusses the emerging role of dose-escalated RT and heavy-particle RT.
Identifiants
pubmed: 32684987
doi: 10.1177/1758835920936093
pii: 10.1177_1758835920936093
pmc: PMC7343368
doi:
Types de publication
Journal Article
Review
Langues
eng
Pagination
1758835920936093Informations de copyright
© The Author(s), 2020.
Déclaration de conflit d'intérêts
Conflict of interest statement: The authors declare that there is no conflict of interest.
Références
Ann Oncol. 2014 Sep;25(9):1750-5
pubmed: 24907635
Am J Clin Oncol. 2019 Mar;42(3):247-252
pubmed: 30724781
N Engl J Med. 2013 Oct 31;369(18):1691-703
pubmed: 24131140
Front Pharmacol. 2018 Mar 05;9:185
pubmed: 29556198
JAMA Surg. 2016 Aug 17;151(8):e161137
pubmed: 27275632
Br J Cancer. 2007 Apr 23;96(8):1183-90
pubmed: 17406358
J Clin Oncol. 1985 Mar;3(3):373-8
pubmed: 3973648
Oncologist. 2018 Jan;23(1):4-e10
pubmed: 29212734
Medicine (Baltimore). 2018 Sep;97(36):e12260
pubmed: 30200163
J Clin Oncol. 2009 Apr 10;27(11):1806-13
pubmed: 19273710
Pract Radiat Oncol. 2019 Sep - Oct;9(5):322-332
pubmed: 31474330
PLoS One. 2019 Apr 12;14(4):e0214970
pubmed: 30978229
Acta Oncol. 2017 Dec;56(12):1746-1753
pubmed: 28661823
Ann Oncol. 2017 May 1;28(5):1117-1123
pubmed: 28327906
HPB (Oxford). 2014 Jan;16(1):83-90
pubmed: 23472829
Radiother Oncol. 2012 Apr;103(1):25-31
pubmed: 22300608
J Clin Oncol. 2008 Feb 20;26(6):942-7
pubmed: 18281668
J Clin Oncol. 2009 May 1;27(13):2269-77
pubmed: 19307501
Histopathology. 2009 Sep;55(3):277-83
pubmed: 19723142
Cancer Res Treat. 2018 Apr;50(2):562-574
pubmed: 28602054
Ann Surg. 2007 Nov;246(5):734-40
pubmed: 17968163
Pract Radiat Oncol. 2019 Jan;9(1):e29-e37
pubmed: 30612720
Cancer. 2017 Nov 1;123(21):4158-4167
pubmed: 28708929
Cancer Med. 2019 May;8(5):2123-2132
pubmed: 30932367
Int J Radiat Oncol Biol Phys. 2013 Dec 1;87(5):1007-15
pubmed: 24267969
N Engl J Med. 2012 Jun 28;366(26):2455-65
pubmed: 22658128
Ann Surg Oncol. 2019 Jan;26(1):109-117
pubmed: 30362063
J Gastrointest Oncol. 2016 Apr;7(2):221-7
pubmed: 27034789
Am J Clin Oncol. 2017 Apr;40(2):152-157
pubmed: 25171298
Br J Surg. 2004 May;91(5):586-94
pubmed: 15122610
J Natl Cancer Inst. 2015 Jan 31;107(2):
pubmed: 25638248
Int J Radiat Oncol Biol Phys. 2010 Feb 1;76(2):326-32
pubmed: 20117285
Cancer. 1981 Oct 15;48(8):1705-10
pubmed: 7284971
Radiat Oncol. 2013 Oct 31;8:254
pubmed: 24175982
Phys Med Biol. 2018 Aug 10;63(16):165005
pubmed: 30020079
Cancer Chemother Pharmacol. 2017 May;79(5):951-957
pubmed: 28378027
Chin Clin Oncol. 2017 Jun;6(3):28
pubmed: 28705005
Cancer. 2020 May 15;126(10):2120-2131
pubmed: 32125712
Int J Radiat Oncol Biol Phys. 2018 Nov 15;102(4):1052-1062
pubmed: 29891208
J Clin Oncol. 2014 Sep 10;32(26):2847-54
pubmed: 25113761
Cancer Med. 2017 Jun;6(6):1201-1219
pubmed: 28544758
Lancet Oncol. 2016 May;17(5):651-62
pubmed: 27055731
Strahlenther Onkol. 2017 Aug;193(8):630-638
pubmed: 28608305
Cancer Chemother Pharmacol. 2017 Jul;80(1):195-202
pubmed: 28597040
Int J Radiat Oncol Biol Phys. 2012 Feb 1;82(2):809-16
pubmed: 21277694
Arch Surg. 1985 Aug;120(8):899-903
pubmed: 4015380
Surgery. 2018 May;163(5):1090-1096
pubmed: 29395234
Future Oncol. 2016 Mar;12(5):669-85
pubmed: 26880384
Ann Surg Oncol. 2012 May;19(5):1644-62
pubmed: 22012027
JAMA Oncol. 2019 Jul 18;:
pubmed: 31318392
J Clin Oncol. 2010 Oct 10;28(29):4450-6
pubmed: 20837948
Cancer. 2017 Sep 15;123(18):3486-3493
pubmed: 28493288
Jpn J Clin Oncol. 2019 Feb 1;49(2):190-194
pubmed: 30608598
Cancer. 2009 Feb 1;115(3):665-72
pubmed: 19117351
Lancet. 2017 Mar 11;389(10073):1011-1024
pubmed: 28129987
World J Gastroenterol. 2014 Aug 21;20(31):10740-51
pubmed: 25152577
Int J Radiat Oncol Biol Phys. 2016 Mar 15;94(4):755-65
pubmed: 26972648
Semin Radiat Oncol. 2014 Apr;24(2):113-25
pubmed: 24635868
Br J Radiol. 2017 Aug;90(1076):20170157
pubmed: 28541096
Nature. 2017 Nov 23;551(7681):512-516
pubmed: 29132146
N Engl J Med. 2011 May 12;364(19):1817-25
pubmed: 21561347
Acta Oncol. 2017 Mar;56(3):391-397
pubmed: 27885876
Radiother Oncol. 2015 Jan;114(1):117-21
pubmed: 25497876
J Gastroenterol. 2014 Jun;49(6):1074-80
pubmed: 23846547
BMC Cancer. 2014 Jun 07;14:411
pubmed: 24906700
Nat Rev Clin Oncol. 2017 Aug;14(8):483-495
pubmed: 28290489
Cancer. 2015 Apr 1;121(7):1128-37
pubmed: 25538019
Cancer. 2013 Aug 1;119(15):2692-700
pubmed: 23720019
J Gastroenterol. 2017 Jan;52(1):81-93
pubmed: 27169844
CA Cancer J Clin. 2019 Jan;69(1):7-34
pubmed: 30620402
J Clin Oncol. 2020 Jun 1;38(16):1763-1773
pubmed: 32105518
J Am Coll Surg. 2008 May;206(5):833-46; discussion 846-8
pubmed: 18471707
Nat Rev Dis Primers. 2016 Apr 21;2:16022
pubmed: 27158978
N Engl J Med. 2004 Mar 18;350(12):1200-10
pubmed: 15028824
JAMA. 2016 May 3;315(17):1844-53
pubmed: 27139057
Int J Radiat Oncol Biol Phys. 2016 May 1;95(1):498-504
pubmed: 26883565
Expert Rev Anticancer Ther. 2011 Feb;11(2):173-7
pubmed: 21342036
J Clin Oncol. 2011 Nov 1;29(31):4105-12
pubmed: 21969502
World J Clin Oncol. 2016 Feb 10;7(1):1-8
pubmed: 26862486
Int J Radiat Oncol Biol Phys. 2005 Oct 1;63(2):320-3
pubmed: 16168826
Oncology (Williston Park). 2016 Jul;30(7):619-24, 627, 632
pubmed: 27422109
Pancreas. 2018 Sep;47(8):958-966
pubmed: 30074526
J Radiat Oncol. 2013 Dec;2(4):413-425
pubmed: 25755849
Int J Radiat Oncol Biol Phys. 2013 Jul 1;86(3):516-22
pubmed: 23562768
Cancer Res. 2014 Jun 1;74(11):2913-21
pubmed: 24840647
Ann Surg. 1999 Dec;230(6):776-82; discussion 782-4
pubmed: 10615932
Ther Adv Med Oncol. 2018 Dec 17;10:1758835918816281
pubmed: 30574212
Saudi J Gastroenterol. 2012 Mar-Apr;18(2):118-21
pubmed: 22421717
Am J Clin Oncol. 2018 Jul;41(7):656-661
pubmed: 28134673
Crit Rev Oncol Hematol. 2016 Jul;103:49-61
pubmed: 27233119
Strahlenther Onkol. 2015 Jan;191(1):7-16
pubmed: 25252602
Eur J Cancer. 2017 Jul;79:41-49
pubmed: 28460245
Cancer. 2012 Dec 1;118(23):5749-56
pubmed: 22605518
PLoS Med. 2010 Apr 20;7(4):e1000267
pubmed: 20422030
Dig Liver Dis. 2018 Apr;50(4):396-400
pubmed: 29326012
Cancer. 2013 Jan 1;119(1):45-51
pubmed: 22744973
Ann Surg Oncol. 2015 Jul;22(7):2352-8
pubmed: 25564157
Ann Surg. 1993 Feb;217(2):144-8
pubmed: 8094952
Eur J Surg Oncol. 2010 Oct;36(10):987-92
pubmed: 20828979
Lancet Oncol. 2013 Oct;14(11):1095-1103
pubmed: 24035532
Front Oncol. 2016 Jun 07;6:140
pubmed: 27376030
J Gastrointest Surg. 2015 Oct;19(10):1802-12
pubmed: 26224039
Acta Oncol. 2019 Sep;58(9):1259-1266
pubmed: 31237185
Radiat Oncol. 2012 Mar 02;7:28
pubmed: 22385572
Technol Cancer Res Treat. 2017 Jun;16(3):295-301
pubmed: 27311310
Surgery. 2011 Sep;150(3):466-73
pubmed: 21878232
Int J Radiat Oncol Biol Phys. 2014 Jul 15;89(4):830-8
pubmed: 24867540
J Clin Oncol. 2008 Jul 20;26(21):3496-502
pubmed: 18640930
Acta Oncol. 2017 Mar;56(3):384-390
pubmed: 27796165
Cancer Med. 2018 May 17;:
pubmed: 29771005
Lancet. 2001 Nov 10;358(9293):1576-85
pubmed: 11716884
Int J Radiat Oncol Biol Phys. 2008 Nov 1;72(3):678-86
pubmed: 18395362
J Surg Res. 2012 May 15;174(2):319-25
pubmed: 21937061
Br J Surg. 2018 Jul;105(8):946-958
pubmed: 29708592
Radiother Oncol. 2018 Nov;129(2):333-339
pubmed: 30224179
J Gastrointest Surg. 2000 Nov-Dec;4(6):567-79
pubmed: 11307091
J Natl Cancer Inst. 1988 Jul 20;80(10):751-5
pubmed: 2898536
Clin Cancer Res. 2012 Nov 15;18(22):6339-47
pubmed: 22991414
Ann Surg. 2015 Jan;261(1):12-7
pubmed: 25599322
Int J Radiat Oncol Biol Phys. 2011 Sep 1;81(1):181-8
pubmed: 21549517
Front Oncol. 2020 Jan 31;10:41
pubmed: 32083002
J Clin Oncol. 2014 Sep 10;32(26):2855-63
pubmed: 25113772
J Gastrointest Surg. 2018 Feb;22(2):235-241
pubmed: 28895032
Front Oncol. 2015 Jul 06;5:145
pubmed: 26217585
Semin Radiat Oncol. 2017 Jul;27(3):256-267
pubmed: 28577833
Adv Radiat Oncol. 2018 Apr 13;3(3):314-321
pubmed: 30202800
Anticancer Res. 2014 Jun;34(6):3011-20
pubmed: 24922667
Am J Clin Oncol. 2011 Feb;34(1):63-9
pubmed: 20308870
Acta Oncol. 2015 Jul;54(7):979-85
pubmed: 25734581
J Immunother. 2010 Oct;33(8):828-33
pubmed: 20842054
J Clin Oncol. 2016 Aug 1;34(22):2654-68
pubmed: 27247216
Lancet Oncol. 2016 Jun;17(6):801-810
pubmed: 27160474
EClinicalMedicine. 2019 Nov 19;17:100200
pubmed: 31891135
Ann Surg. 2016 Sep;264(3):457-63
pubmed: 27355262
J Am Coll Surg. 2008 Oct;207(4):510-9
pubmed: 18926452
Ann Surg Oncol. 2018 Jul;25(7):1896-1903
pubmed: 29761331
J Gastrointest Surg. 2006 Dec;10(10):1338-45; discussion 1345-6
pubmed: 17175452
Ann Oncol. 2008 Sep;19(9):1592-9
pubmed: 18467316
J Clin Oncol. 2008 Jul 20;26(21):3487-95
pubmed: 18640929
Ann Surg Oncol. 2008 Jun;15(6):1651-60
pubmed: 18351300
J Clin Oncol. 2001 Nov 15;19(22):4202-8
pubmed: 11709563
N Engl J Med. 2018 Dec 20;379(25):2395-2406
pubmed: 30575490
J Clin Oncol. 2019 Aug 10;37(23):2082-2088
pubmed: 31180816
Ann Surg Oncol. 2011 Mar;18(3):619-27
pubmed: 21213060
Int J Radiat Oncol Biol Phys. 2004 Mar 15;58(4):1017-21
pubmed: 15001240
Br J Cancer. 2005 Apr 25;92(8):1372-81
pubmed: 15812554
Phys Med Biol. 2017 Apr 21;62(8):3051-3064
pubmed: 28252445
Cancer Radiother. 2011 Jun;15(3):182-91
pubmed: 21315644
Lancet. 2001 Nov 10;358(9293):1565-6
pubmed: 11716876
Semin Radiat Oncol. 2014 Apr;24(2):140-7
pubmed: 24635871
Int J Radiat Oncol Biol Phys. 2017 Feb 1;97(2):313-322
pubmed: 28068239
Oncotarget. 2017 Jul 7;8(46):81419-81429
pubmed: 29113401
Jpn J Clin Oncol. 2018 May 1;48(5):434-441
pubmed: 29590448
Int J Radiat Oncol Biol Phys. 2018 Aug 1;101(5):1212-1221
pubmed: 29907490
Pract Radiat Oncol. 2018 Mar - Apr;8(2):95-106
pubmed: 29291966
Trials. 2016 Mar 09;17(1):127
pubmed: 26955809
J Gastrointest Oncol. 2018 Dec;9(6):1014-1026
pubmed: 30603120
Ann Surg. 2017 Mar;265(3):565-573
pubmed: 27918310
Ann Surg. 2018 Aug;268(2):215-222
pubmed: 29462005
Med Phys. 2014 Aug;41(8):081711
pubmed: 25086521
J Surg Oncol. 2018 Apr;117(5):1073-1083
pubmed: 29448308