The radiation therapy is effective for treating pancreatic cancer. ASTRO guidelines have provided info about timing and optimal dose of radiation therapy. Besides these, it has also guided about the ways by which one can prevent or reduce the common side effects of the therapy. The journal Practical Radiation Oncology has presented this study.
Guidelines to mitigate the side effects of pancreatic cancer
Pancreatic cancer is the third major cause of cancer deaths in the U.S. In 2019, there were 56,770 new cases of this cancer. While it has led to the death of 45,570 people. Moreover, the five-year survival rate is about 9%. That is the lowest among all types of cancers. While the cause of high mortality rates may be unclear symptoms or difficult screening.
The guide by ASTRO covers four main areas. The first one is the use of radiation therapy in different treatment settings – before or after surgery. The second one is stereotactic (SBRT) versus conventional therapy. While the other two areas are technical aspects of this therapy and reduction in the side effects.
The surgery is a standard therapy for pancreatic cancer that hasn’t spread beyond the pancreas. While radiation therapy performed before or after surgery is to target potential residual disease. 80% of the patients with pancreatic cancer had tumors that have spread outside the pancreas. In such patients, one can’t use surgery to remove tumors.
However, if the surgery takes place, the disease may reoccur in 50 – 90% of these patients. The guidelines by ASTRO suggest methods to reduce the side effects of radiation therapy. The side effects mostly depend on the radiation’s administration method. And the most common of these effects are fatigue and GI effects. Where the GI symptoms are vomiting, nausea, and diarrhea.
It strongly suggests prophylactic anti-nausea medicines for patients who have undergone radiation therapy. And also advises to use acid-reducing drugs or antacid. Having an idea about the side effects that mostly occur in modest and high frequency can be quite helpful. It can enable the doctors to prescribe drugs to the patients for reducing these side effects.
Other recommendation related to pancreatic cancer treatment
ASTRO has also given guidelines on the indications of radiation therapy to cure pancreatic cancer. It tells about the radiation sequence with systematic chemotherapies in the pre-operative, post-operative, or definite setting. It can also advise about the fractionation and optimal dose for different subgroups of pancreatic cancer patients.
And the methods for planning and delivery of the treatment. It has suggested conventional radiation therapy in post-operative settings. That is for the people who have high-risk features like positive lymph nodes or margins after surgery. While stereotactic body radiation therapy (SBRT) is only for the patients enrolled in the data registry or clinical trial.
In the pre-operative setting, both therapies following chemotherapy are recommended for patients with resectable tumors. While for people with borderline resectable tumors, neoadjuvant chemotherapy along with radiation is suggested following systemic therapy.
Systematic therapy followed by either SBRT or chemoradiation is also an effective option for patients with locally advanced disease. One cannot perform surgery in these patients. It is vital for a patient to have an idea about the pros and cons of the therapy to make a decision. ASTRO’s guide can act as a tool to promote an individualized treatment plan.
Radiation therapy is evolving rapidly, and some practice-changing studies, not present in the ASTRO’s guide can become available in the future. All of these areas stress on a patient-centered approach, consultations with multiple disciplines, planning and follow up for effective therapy.