TY - JOUR
T1 - Patterns of Recurrence After Primary Local Therapy for Pancreatic Ductal Adenocarcinoma – A Critical Review of Rationale and Target Delineation for (Neo)Adjuvant Radiation Therapy
AU - Jethwa, Krishan R.
AU - Neibart, Shane S.
AU - Truty, Mark J.
AU - Jabbour, Salma K.
AU - Hallemeier, Christopher L.
N1 - Publisher Copyright:
© 2022 American Society for Radiation Oncology
PY - 2022/11/1
Y1 - 2022/11/1
N2 - Purpose: The purpose of this work was to describe pancreatic ductal adenocarcinoma (PDAC) patterns of locoregional spread and recurrence to help guide clinicians on (neo)adjuvant radiation therapy (RT) planning strategies and target volume delineation. Methods and Materials: A comprehensive review of clinical data was performed to describe PDAC patterns of locoregional spread, including extrapancreatic tumor extension, perineural invasion, regional lymph node involvement, and patterns of disease recurrence as influenced by (neo)adjuvant treatment strategy. Results: This review describes PDAC patterns of spread, disease progression, and evolving treatment techniques. Based upon this data, we advocate for inclusion of elective at-risk regions of extrapancreatic extension, perineural invasion, and lymphatic spread for patients receiving neoadjuvant RT. Conclusions: This review provides a nuanced description of PDAC patterns of spread and recurrence to guide clinicians on target volume delineation and planning strategies to maximize the effectiveness of neo(adjuvant) RT delivery for patients with PDAC. Further prospective studies are needed to better define the optimal RT dose, fractionation regimens, and target volumes to be used in the (neo)adjuvant setting.
AB - Purpose: The purpose of this work was to describe pancreatic ductal adenocarcinoma (PDAC) patterns of locoregional spread and recurrence to help guide clinicians on (neo)adjuvant radiation therapy (RT) planning strategies and target volume delineation. Methods and Materials: A comprehensive review of clinical data was performed to describe PDAC patterns of locoregional spread, including extrapancreatic tumor extension, perineural invasion, regional lymph node involvement, and patterns of disease recurrence as influenced by (neo)adjuvant treatment strategy. Results: This review describes PDAC patterns of spread, disease progression, and evolving treatment techniques. Based upon this data, we advocate for inclusion of elective at-risk regions of extrapancreatic extension, perineural invasion, and lymphatic spread for patients receiving neoadjuvant RT. Conclusions: This review provides a nuanced description of PDAC patterns of spread and recurrence to guide clinicians on target volume delineation and planning strategies to maximize the effectiveness of neo(adjuvant) RT delivery for patients with PDAC. Further prospective studies are needed to better define the optimal RT dose, fractionation regimens, and target volumes to be used in the (neo)adjuvant setting.
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U2 - 10.1016/j.prro.2022.06.004
DO - 10.1016/j.prro.2022.06.004
M3 - Review article
C2 - 35718073
AN - SCOPUS:85136771223
SN - 1879-8500
VL - 12
SP - e463-e473
JO - Practical Radiation Oncology
JF - Practical Radiation Oncology
IS - 6
ER -