Gb & pancreas

Stereotactic radiosurgery in pancreas Cancer

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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

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Local Control after Whipple+ChemoRT

+ve margin (%) Local Failure (%)GITSG 0 47EORTC 19 51ESPAC 28 63CONKO 19 37RTOG 34 25

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Rout C Pancreas 2009

Resection status & Survival

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R1 resection = Poor Survival

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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

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R1(Pos. Margin)- Survival by Treatment

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Locally Advanced Pancreas Cancer

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RT vs. ChemoRTChemo vs. ChemoRT

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SBRT in pancreas cancer: Results

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SBRT in pancreas cancer: Toxicity

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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

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SBRT in GI tumoursSummary

- 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.

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