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Stereostatic Radiosurgery in Pancreas Cancer

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SBRT has potential role in HCC, liver mets, cholangiocarcinoma, pancreas, Klaskin tumour, GIST. The initial results are impressive with low toxicity, high response rate Short course, high dose radiation therapy will improve local control and may improve survival function. The data presented in this presented is emerging data.

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Stereotactic radiosurgery in pancreas Cancer Copyrights@www.radiosurgery-india.com
Radiosurgery in pancreatic tumour & cholangiocarcinoma - SBRT has potential role in HCC, liver mets, cholangiocarcinoma, pancreas, Klaskin tumour, GIST - Initial results are impressive with low toxicity, high response rate - Short course, high dose radiation therapy will improve local control and may improve survival function - There is emerging data Copyrights@www.radiosurgery-india.com
Local Control after Whipple+ChemoRT +ve margin (%) Local Failure (%) GITSG 0 47 EORTC 19 51 ESPAC 28 63 CONKO 19 37 RTOG 34 25 Copyrights@www.radiosurgery-india.com
Rout C Pancreas 2009 Resection status & Survival Copyrights@www.radiosurgery-india.com
R1 resection = Poor Survival Copyrights@www.radiosurgery-india.com
Post OP R1 Resection • Fiducials placed at surgery • One planning CT with oral and IV contrast • 1000cGy to +ve margins 3-4 weeks post OP • 5040cGy 5-6 field IMRT6-8 weeks postOP • Concurrent Xeloda • Adjuvant Gemcitabine BIDMCCopyrights@www.radiosurgery-india.com
R1(Pos. Margin)- Survival by Treatment Copyrights@www.radiosurgery-india.com
Locally Advanced Pancreas Cancer Copyrights@www.radiosurgery-india.com
RT vs. ChemoRT Chemo vs. ChemoRT Copyrights@www.radiosurgery-india.com
SBRT in pancreas cancer: Results Copyrights@www.radiosurgery-india.com
SBRT in pancreas cancer: Toxicity Copyrights@www.radiosurgery-india.com
Potential role of SBRTPotential role of SBRT 1. GIST with primary disease , nodal disease or metastasis 2. Neuroendocrine tumour in intestine, pancreas, nodal involvement 3. Low grade lymphomas with post-chemotherapy residual disease 4. Para-aortic nodal disease metastasis Copyrights@www.radiosurgery-india.com
SBRT in GI tumours Summary - SBRT has potential role in HCC, liver mets, cholangiocarcinoma, pancreas, Klaskin tumour, GIST… - Initial results are impressive with low toxicity, high response rate - Short course, high dose radiation therapy will improve local control and may improve survival function - Need multi-centric prospective studies. Copyrights@www.radiosurgery-india.com

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Stereostatic Radiosurgery in Pancreas Cancer

  • 1. Stereotactic radiosurgery in pancreas Cancer Copyrights@www.radiosurgery-india.com
  • 2. Radiosurgery in pancreatic tumour & cholangiocarcinoma - SBRT has potential role in HCC, liver mets, cholangiocarcinoma, pancreas, Klaskin tumour, GIST - Initial results are impressive with low toxicity, high response rate - Short course, high dose radiation therapy will improve local control and may improve survival function - There is emerging data Copyrights@www.radiosurgery-india.com
  • 3. Local Control after Whipple+ChemoRT +ve margin (%) Local Failure (%) GITSG 0 47 EORTC 19 51 ESPAC 28 63 CONKO 19 37 RTOG 34 25 Copyrights@www.radiosurgery-india.com
  • 4. Rout C Pancreas 2009 Resection status & Survival Copyrights@www.radiosurgery-india.com
  • 5. R1 resection = Poor Survival Copyrights@www.radiosurgery-india.com
  • 6. Post OP R1 Resection • Fiducials placed at surgery • One planning CT with oral and IV contrast • 1000cGy to +ve margins 3-4 weeks post OP • 5040cGy 5-6 field IMRT6-8 weeks postOP • Concurrent Xeloda • Adjuvant Gemcitabine BIDMCCopyrights@www.radiosurgery-india.com
  • 7. R1(Pos. Margin)- Survival by Treatment Copyrights@www.radiosurgery-india.com
  • 8. Locally Advanced Pancreas Cancer Copyrights@www.radiosurgery-india.com
  • 9. RT vs. ChemoRT Chemo vs. ChemoRT Copyrights@www.radiosurgery-india.com
  • 10. SBRT in pancreas cancer: Results Copyrights@www.radiosurgery-india.com
  • 11. SBRT in pancreas cancer: Toxicity Copyrights@www.radiosurgery-india.com
  • 12. Potential role of SBRTPotential role of SBRT 1. GIST with primary disease , nodal disease or metastasis 2. Neuroendocrine tumour in intestine, pancreas, nodal involvement 3. Low grade lymphomas with post-chemotherapy residual disease 4. Para-aortic nodal disease metastasis Copyrights@www.radiosurgery-india.com
  • 13. SBRT in GI tumours Summary - SBRT has potential role in HCC, liver mets, cholangiocarcinoma, pancreas, Klaskin tumour, GIST… - Initial results are impressive with low toxicity, high response rate - Short course, high dose radiation therapy will improve local control and may improve survival function - Need multi-centric prospective studies. Copyrights@www.radiosurgery-india.com