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In light of the recently published LAP07 trial, what is the role of radiation in unresectable pancreatic cancer?
In LAP07's second randomization (capecitabine+54 Gy vs maintenance gemcitabine +/- erlotinib), 60% of unresectable pancreatic cancer patients who did not progress after 4 months of induction gemcitabine +/- erlotinib, RT increased local control from 54% to 68% without significantly improving PFS or OS. Is there reason to believe hypofractionated RT or SBRT will achieve local control better than 68%, and that the improvement will prolong survival?
Answer from: Radiation Oncologist at Academic Institution
The recent publication of LAP07 is welcome, as the results have been known since the data were presented at ASCO 2013, and my impression is that the results have already led to a reduction in the use of radiation for locally advanced pancreatic cancer. This may be appropriate, but the results need t...
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Answer from: Radiation Oncologist at Academic Institution
I agree with most of the comments except for the commonly held believe that low-dose palliative SBRT in 5 fractions offers any hope of a different outcome in either LAPC or BRPC. Median survival from a very large number of single arm studies treating carefully selected LAPC patients with 25-33G...
Comments
Radiation Oncologist at Lake Huron Medical Center
@Christopher H. Crane - how do you simulate t...
@Christopher H. Crane - how do you simulate t...
Radiation Oncologist at Memorial Sloan-Kettering Cancer Center
We have published these details in multiple places...
We have published these details in multiple places...
Answer from: Radiation Oncologist at Community Practice
I agree with @Harvey J. Mamon's thoughts. Many will cite the results of this trial as indicating that there is no role for RT in locally advanced patients; I think there is a role in selected patients. However, we should be mindful that improved systemic control using regimens like FOLFI...