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We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com. Back to Healio Key takeaways: The guideline includes evidence from several prospective trials conducted since 2019. It addresses radiation therapy\u2019s role in the resectable, locally advanced, recurrent, metastatic and palliative settings. An updated clinical guideline is designed to clarify the settings in which radiation therapy is appropriate for pancreatic cancer and outline how the modality can be integrated safely with other treatments. The guideline \u2014 which updates recommendations that American Society for Radiation Oncology (ASTRO) issued in 2019 \u2014 address radiation therapy\u2019s role in multiple settings.
\u201cFor many years, we haven\u2019t had the prospective evidence necessary to fully demonstrate the impact of radiation therapy in pancreatic cancer,\u201d Daniel Chang, MD, FASTRO, chair of the department of radiation oncology at University of Michigan and chair of the guideline task force, told Healio. \u201cThat was partly due to lack of advancements in systemic therapy, which resulted in patients having very poor prognosis. Now, in the modern era of systemic therapy, we\u2019re seeing longer survival that opens the door for local treatments \u2014 including radiation \u2014 and the outcomes are starting to become more evident.\u201d The guidelines provide clinicians with \u201ca practical framework\u201d to identify patients who may benefit from radiation therapy and ensure it is delivered effectively and safely, Chang added. \u201cI\u2019m hopeful these guidelines give radiation oncologists the ability to make stronger arguments for radiation and foster conversations among the entire multidisciplinary team that lead to them being more open-minded about using it,\u201d he said. Noteworthy updates ASTRO \u2014 in collaboration with ASCO, the European Society for Radiotherapy and Oncology, and the Society of Surgical Oncology \u2014 convened a multidisciplinary taskforce that included radiation, medical and surgical oncologists, along with a medical physicist, radiation oncology resident and patient representative. Task force members performed a systematic review of literature published through June of this year. A formal consensus process, peer review and a public comment period took place prior to formal approval. The guideline incorporates high-quality evidence from several prospective randomized trials that authors say solidifies the role of radiation therapy for pancreatic cancer and highlights the potential of more modern radiotherapy techniques. Recommendations address indications for nonmetastatic pancreatic cancer \u2014 including resectable, borderline resectable, locally advanced disease and resectable but medically inoperable disease \u2014 as well as the role for the modality in the recurrent, metastatic and palliative settings. They provide insights about optimal dosing and target volumes for various stages of disease, including when shorter radiation courses may be appropriate. They also highlight best practices for treatment planning and delivery. A few elements are particularly noteworthy, Chang said. The updated guideline includes a strong recommendation \u2014 supported by two prospective randomized trials \u2014 for preoperative radiation for borderline resectable pancreatic cancer. Another strong recommendation addresses radiation for locally advanced disease, including use of dose escalation when appropriate volumetric image guidance and motion management are available. The previous guideline did not routinely recommend dose escalation. \u201cThis is clinically important because, historically, the radiation dose that could be safely delivered to pancreatic tumors was limited by the close proximity of the stomach and intestines,\u201d Chang said. \u201cModern image guidance, motion management and adaptive radiation therapy can allow substantially higher doses to be delivered while respecting normal tissue constraints. The updated guideline, therefore, provides a framework for moving beyond conventional radiation doses in appropriately selected patients.\u201d The updated guideline includes a recommendation for elective targeting of anatomic regions at risk for microscopic disease, such as the peritumoral margin, extrapancreatic neural pathways and regional nodal basins. \u201cThis is clinically meaningful because durable local control may depend not only on controlling the visible tumor but also on addressing microscopic disease immediately beyond it,\u201d Chang said. The guideline also includes a recommendation for the role of radiation \u2014 particularly stereotactic body radiation therapy \u2014 for patients with oligometastatic disease. A recent trial demonstrated a PFS advantage with this approach, Chang said. An \u2018exciting new era\u2019 More research is necessary to address important unanswered questions, Chang said. These include determining the optimal way to integrate radiation therapy with systemic treatments, as well as identifying which patients are likely to derive the greatest benefit from more intensive local treatment. \u201cHopefully there will be more level one evidence for integrating radiation with chemotherapy,\u201d Chang said. \u201cSome prior trials have not used the best-of-the-best chemotherapy with the best-of-the-best radiation. That is partly because the field is moving quickly and it is hard to design trials that keep up with all of the advancements. We are trying to address that now with some trials that are opening, and hopefully we can find a way to get the best of both worlds with combined-modality therapy.\u201d Additional evidence also is needed to clarify the role of radiation in the metastatic setting. \u201cHistorically, these patients have never been thought of for complex multidisciplinary therapy, but I think that is where a lot of the \u2018bang for our buck\u2019 can come from,\u201d Chang said. His enthusiasm is based on two recent trials. The randomized phase 2 EXTEND trial included patients with pancreatic cancer who had limited metastatic disease, defined as up to five sites. Researchers assigned patients to standard systemic therapy alone or with metastases-directed therapy, primarily SBRT. The results showed a PFS benefit with metastases-directed therapy, demonstrating the benefit of local therapy. Meanwhile, results of the randomized phase 3 RASolute-302 trial showed the oral pan-RAS inhibitor daraxonrasib (Revolution Medicines) doubled survival vs. standard chemotherapy for patients with previously treated metastatic disease. Other research published over the past several months highlighted the potential of other oral regimens in later-line settings, as<\/p>\n","protected":false},"author":1,"featured_media":3455,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-3454","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/3454","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3454"}],"version-history":[{"count":0,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/posts\/3454\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=\/wp\/v2\/media\/3455"}],"wp:attachment":[{"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3454"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3454"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/drsoniafawad.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3454"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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