Pancreatic Cancer Radiotherapy

Radiotherapy is the use of ionising radiation (high energy X-rays) to destroy cancer cells.

Unlike systemic treatments, such as chemotherapy and biological therapies, which can act on cancer cells in any part of the body, radiotherapy, a little like surgery, is a localised therapy. Therefore, generally, radiotherapy only tends to affect a person in the part of the body where the radiation is targeted.

Radiotherapy has a useful role in palliating pain but like surgery is a localized treatment and is less helpful when the disease has spread. Radiotherapy with or without chemotherapy may control localized disease ie shrink the cancer and keep it under control for as long as possible.

Once full dose radiotherapy has been given that part of the body can not receive any more radiotherapy in the future though other treatment such as chemotherapy may be considered.

This is where a cancer is advanced (ie not possible to be removed by surgery due to involvement of veins or arteries) but has not spread to other parts of the body i.e. there is no evidence of secondary or metastatic disease.

If a specialist surgeon feels the tumour is not operable, locally advanced disease is treated by chemotherapy alone, as in advanced/metastatic cancer, or, less commonly, with the combination of chemotherapy and radiation treatment (Chemo-radiation or CRT). Occasionally following chemotherapy or chemo-radiation the tumour may shrink so that it is possible to undergo surgical resection.

It is not certain whether chemo-radiation is superior or less effective than chemotherapy alone and trials are being undertaken in the USA to investigate this.

There is little evidence to support routinely using chemo-radiotherapy after surgery. The trial ESPAC-1 showed that there was no benefit from the addition of chemo-radiotherapy after surgery whereas there was benefit seen with adjuvant chemotherapy (adjuvant means following surgery).

Chemo-radiotherapy is used more widely pre and post operatively in the United States of America and some parts of Europe. Although there is little evidence to support this approach.

Radiotherapy designed as active treatment for pancreatic cancer is called radical radiotherapy. (Radical radiotherapy is where treatment is given with potentially curative intent. Palliation is where the intent of treatment is NOT cure ie for local control, pain relief etc)

Radiotherapy in either radical mode or reduced intensity or over a reduced period of time can be used to try to reduce pain from pancreatic cancer.

Radiotherapy is given in small treatments or fractions, usually being given once daily Monday to Friday. You cannot see or feel radiation therapy. The radiotherapy is carefully planned, usually with the help of a CT Scan to accurately define the area that needs to be treated, and likewise avoid normal tissue organs away from the tumour. It is usual to require approximately 4-6 weeks or 20-30 fractions of treatment. You cannot see or feel radiation therapy.

You will feel some tiredness during radiotherapy though this is not usually as severe as with chemotherapy. Other side affects include nausea, abdominal discomfort and cramping and diarrhoea. Because of careful radiotherapy planning the risk to surrounding organs such as the liver, kidneys and bowel is kept to a very low level. You will be reviewed regularly throughout your treatment.

If you are also to receive chemotherapy this is given as per usual with radiotherapy. In some cases you may start for some weeks with chemotherapy alone prior to receiving combined modality therapy.

A patient generally waits about six to eight weeks before having a follow-up magnetic resonance image or computed tomography scan, to measure the tumour's response to treatment. The wait is necessary to allow possible internal swelling to subside.

radiotherapy for pancreatic cancer from CancerHelp UK
radiotherapy for pancreatic cancer from CancerBACUP