Stereotactic body radiation therapy as an emerging option for localized pancreatic cancer

Localized pancreatic cancer remains a therapeutic challenge despite advances in multiple treatment techniques. In patients with borderline resectable and unresectable (locally advanced) pancreatic cancer, stereotactic body radiation therapy (SBRT) has emerged as a promising treatment option. Potential benefits include shorter treatment duration and increased patient convenience, encouraging surgical outcomes, lower acute toxicity, and reduced delay of chemotherapy. In the last decade, multiple retrospective reports have been published on this technique. More recently, prospective assessment of SBRT in pancreatic cancer has demonstrated increased resectability of previously unresectable lesions, as well as lower rates of margin-positive resections. As a higher dose of radiation is utilized, however, this technique requires careful patient selection and treatment planning to ensure safety. In this chapter, the published literature using SBRT in pancreatic cancer, along with treatment recommendations and contraindications, is presented. Long-term data regarding SBRT is forthcoming and may result in the adoption of this technique not only as an adequate option, but also as the future standard-of-care.