Advances in radiotherapy delivery in hepatobiliary and pancreatic malignancies

The role of targeted radiotherapy in patients with locally advanced pancreatic cancer (LAPC) is constantly evolving. While there is uniform agreement across guidelines that patients with good performance status should receive chemotherapy as their first line of treatment, there is no consensus on how to manage patients with localised disease who do not have sufficient […]The role of targeted radiotherapy in patients with locally advanced pancreatic cancer (LAPC) is constantly evolving. While there is uniform agreement across guidelines that patients with good performance status should receive chemotherapy as their first line of treatment, there is no consensus on how to manage patients with localised disease who do not have sufficient response to become candidates for surgical resection. Conventional chemoradiotherapy (CRT) delivered over five to six weeks of daily treatments with oral chemotherapy has been shown to decrease the risk of local progression, delay symptomatic progression and increase the time off chemotherapy with no effect on overall survival (OS). LAP07 was a randomised controlled trial designed to assess the benefit of adding CRT to induction chemotherapy as compared to continuing chemotherapy alone. While LAP07 failed to meet its primary endpoint of improved OS, the addition of CRT significantly decreased the risk of local tumour progression (32% vs 46%, p=0.03), increased progression-free survival (PFS) by around one month and doubled the time without systemic treatment.

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