Treatment of pancreatic cancer by radiation therapy

The role of radiation therapy in the management of pancreatic malignancy was expanded dramatically in the last decade. Development of new tumor localization and dose delivery techniques permits safe delivery of increased radiation dose to upper abdominal tumors. Interstitial implantation of radioisotopes directly into tumors has increased the local control rate for pancreatic cancer as high as 80%, but the perioperative mortality rate of this procedure is as high as 25%, except in highly controlled situations. Early data from the high linear energy transfer (LET) treatment programs suggest higher than expected complication rates, yet survival seems no better than that reported from precision high‐dose (PHD) external beam regimens. Radiation as an adjuvant to surgery has been inadequately tested, but initial reports from preoperative and postoperative trials are encouraging. Intraoperative irradiation poses theoretical advantages over external beam therapy for pancreatic cancer. Chemotherapy seems an effective adjuvant to external beam radiation therapy for pancreatic cancer. Drugs other than 5‐FU have not been adequately evaluated in adjuvant studies, nor have newer radiation treatment methods been fully evaluated in combination with drugs.