Radiotherapy of pancreatic cancer patients. Past and present: a review

The treatment of patients with pancreatic cancer is one of the difficult problems in modern oncology. Surgical treatment of pancreatic cancer is still the most radical method, but at the time of diagnosis, the tumor is considered resectable in about 20% of patients. The biological features of ductal adenocarcinoma of the pancreas, primarily its radio and chemoresistance, a tendency to rapid dissemination, contributed to the development of combined / complex treatment programs. In particular, they led to the development of remote radiotherapy techniques both in combination with antitumor drug therapy and in independent treatment.

OBJECTIVE: Аnalysis of data from clinical studies of radiotherapy methods in the treatment of patients with pancreatic cancer, as well as assessment of the effectiveness and safety of modern radiation and chemoradiation therapy programs in this disease.

MATERIALS AND METHODS: Literature data in Russian and English for the period from 1981 to 2023 were searched and analyzed in Medline/PubMed, RSCI/Elibrary, CyberLeninka, Google Scholar databases related to the problem of pancreatic cancer radiotherapy.

RESULTS: The final analysis includes data from 36 literature sources on the use of radiation therapy for the treatment of pancreatic cancer, both alone and in combination with chemotherapeutic drugs. Conducting large clinical randomized trials of pancreatic cancer radiotherapy is historically associated with the difficulty of recruiting patients, the complexity of radiation methods, as well as the high specific gravity of generalized forms, which does not provide an unambiguous assessment of the role of radiation therapy as an independent method.

DISCUSSION: An analysis of the presented literature sources demonstrates that a combination of radiotherapy and current chemotherapeutic regimens can provide high local control over the disease (more than 75%) and achieve an overall survival of more than 20 months.

CONCLUSION: This work summarizes more than 40 years of experience in the use of radiation therapy in the treatment of pancreatic cancer, both independently and in combination with chemotherapy drugs, demonstrates the evolution of therapeutic approaches from 2D planning to stereotactic methods that allow achieving high local control rates with a low frequency of severe post-radiation reactions. The widespread introduction of modern accelerator technology in everyday clinical practice makes it possible to use remote radiotherapy both as a radical treatment and in palliative care programs, in cases where surgery is not possible.

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