Pancreatic tumours are often treated with proton therapy. The reason is the close proximity of critical organs to the tumour, that usually does not allow the administration of sufficient doses in photon techniques, while respecting the tolerated doses to critical organs. In addition to increasing local control of the disease, the goal is to reduce the long-term adverse effects and improve the quality of life of the patients.
Surgery has always had a fundamental role in the treatment of localised stages of pancreatic carcinoma in the form of total or partial pancreatectomy. In the cancers of the head of the pancreas, which are the most common ones, duodenectomy is used with the restoration of the continuity of anastomoses (hepatojejuno-, gastrojejuno-, possibly pancreatojejuno- or pancreatogastroanastomosis). Only radical resection is beneficial. R1 and R2 type resections lead to an early disease relapse and have minimal impact on the length of survival. However, when feasible, surgery is always beneficial.
Clinical studies conducted in the last 20 years have shown the benefit of postoperative chemotherapy and postoperative chemotherapy combined with radiation (GITSG, EORTC and subsequent analyses). Standard treatments currently based on an international consensus include surgery, radiotherapy and chemotherapy as inseparable modalies.
Contraindications for Proton Radiotherapy
- Metastasis (the cancer has spread from its primary location to other organs)
- Metal/ceramic parts in the radiation field
- Presence of a pacemaker
Advantages of Proton Therapy
Postoperative radiation after resection of the pancreas is used to reduce the risk of recurrence of the disease.
Standard techniques of photon radiation (3D-CRT, IMRT) are associated with a high risk of adverse effects. Acute adverse effects include, in particular, gastrointestinal complications, acute radiation gastritis and enteritis. Adverse effects are common also with respect to the haematopoetic system – leukopenia, thrombocytopenia and after some time anaemia.
Chronic adverse effects are based on radiation damage to the liver, kidneys and possibly hollow organs – the stomach and intestines.
A comparative dosimetric study of proton and photon radiotherapy of the pancreatic beds and the draining lymph areas shows the clear advantage of protons. The reduction of the dose to the liver, kidneys, small intestine, stomach and spinal cord is statistically significant.
Additionally, thanks to the physical properties of protons, proton therapy is able to deliver the necessary dose to the tumor bed increasing the chance of permanent cure, while sparing the healthy organs and tissues from receiving an excess dose of radiation.
An important principle must be adhered to in postoperative irradiation of the pancreas: irradiation is not a substitute for postoperative chemotherapy. Both modalities are significant, complement one another and enhance the efficacy of treatment. The Prague Proton Therapy Center cooperates with surgeons and oncologists to ensure the continuity of all the complementary methodologies.
To learn more about proton therapy for pancreatic cancer, or to find out if you are a suitable candidate for treatment at our centre, contact us today. Our team will get back to you with a detailed response as soon as possible.
* Suitability for treatment at our centre must be determined by our medical team.