Radiation therapy in the management of pancreatic adenocarcinoma: review of current evidence and future opportunities

The role of radiation therapy for pancreatic cancer is rapidly evolving in every stage of this disease. In resectable disease, there is conflicting evidence for adjuvant therapy, but an ongoing randomized cooperative group trial is attempting to define the role of adjuvant chemoradiation with modern systemic therapies and radiation techniques with an emphasis on radiation quality assurance. In borderline resectable pancreatic cancer (BRPC), there is an emerging body of literature demonstrating the success of neoadjuvant stereotactic body radiation therapy (SBRT) and a randomized cooperative group trial is actively accruing. For locally advanced pancreatic cancer (LAPC), the recent publication of the LAP07 trial has called into question the role of conventional chemoradiation, but there is a growing experience utilizing SBRT for this patient group. Finally, in the era of immuno-oncology, there may be a new role for radiation therapy in combination with systemic immune therapy to stimulate antigen release and abscopal responses, thus benefitting even patients with metastatic pancreatic cancer.