How do you manage patients with pancreatic adenocarcinoma who progress during neoadjuvant FOLFIRINOX, such that borderline resectable disease is now unresectable but still localized?

Is there evidence for radiation therapy in this setting?

Answer from: Radiation Oncologist at Academic Institution

Great question; this area is rapidly evolving. I hope some of the ViewRay crowd will see this and chime in. We give ablative doses of radiation (~100Gy BED). That results in survival that is similar to surgery in patients like this (inoperable in an aggressive surgery practice at MSKCC, MSS in prep...

Comments

Radiation Oncologist at Meadowview Regional Medical Center
Ablative therapy can have a significant rate of co...

Radiation Oncologist at Memorial Sloan-Kettering Cancer Center
Interesting comment. What data are you basing that...

Radiation Oncologist at Meadowview Regional Medical Center
Very impressive results with a real ablative dose....

Answer from: Radiation Oncologist at Community Practice

I agree with @Christopher H. Crane and have in the past few years transitioned to ablative SBRT since moving to an institution with a ViewRay MRIdian Linac, based on the dose intensification data from MD Anderson that Dr. Crane mentioned (Krishnan et al., IJROBP 2016) and some of the early ViewRay d...

Answer from: Radiation Oncologist at Community Practice

Proceed with regional radiotherapy with adjuvant chemotherapy.

Comments

Radiation Oncologist at Memorial Sloan-Kettering Cancer Center
The randomized evidence (LAP-07 trial) does not su...

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How do you manage patients with pancreatic adenocarcinoma who progress during neoadjuvant FOLFIRINOX, such that borderline resectable disease is now unresectable but still localized?

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