gb & pancreas
TRANSCRIPT
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
Local Control after Whipple+ChemoRT
+ve margin (%) Local Failure (%)GITSG 0 47EORTC 19 51ESPAC 28 63CONKO 19 37RTOG 34 25
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
BIDMC [email protected]
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
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.