STEREOTIC BODY RADIOTHERAPY AS TREATMENT OF PANCREATIC CANCER

Introduction: The pancreas presents itself as a highly complex organ for ionizing radiation treatment for several reasons. It is an organ anatomically adjacent to multiple radiation sensitive organs, like the kidneys, liver, stomach, small intestine and duodenum. Thus, for a successful treatment, the dose of ionizing radiation must be delivered to the tumor while avoiding the risky organs. However, being an organ that moves during breathing up to 3.5 cm, it is necessary to cover the target during the breathing cycle with a margin of 2 cm to 3 cm. This makes the radiotherapy treatment of pancreatic cancer highly toxic. Objective: This article aims to present a review of the advances in radiotherapy treatment in pancreatic cancer and how the SBRT treatment technique has allowed a great advance in the delivery of the ionizing radiation dose, being more accurate in the tumor and providing a considerable decrease in toxicity after treatment. Methods: The present study is a literature review on SBRT in Pancreatic Cancer from October 2018 to November 2018, with reference to publications in English only from the PubMed, Medscape, Elsevier, Scielo, besides electronic journals and references obtained through selected studies which were published between 2014 and 2018, aiming at a broad study on the theme. Discussion SBRT is a new promise in pancreatic cancer treatment where it uses high doses of ionizing radiation (> 6Gy) in a few fractions, between 1 to 5 which has been shown to be more effective in controlling pain and with a higher rate of survival. Because the pancreas is an organ adjacent to and near radiosensitive organs, such as the duodenum, and moving during breathing, it presents a challenge for treatment. Technologies are developed to minimize the effects of ionizing radiation on organs at risk, such as imaging guidance, abdominal compression, gating, and hybrid tracking, which help to lower the target volume margin to 2-3 mm. Conclusion: The major advantage of stereotactic body radiotherapy is the short duration of treatment, 1 to 5 fractions, thus providing less patient discomfort when combining radiotherapy and chemotherapy. In addition, greater control of ionizing radiation dose delivery at the target volume provides lower toxicity, especially in the duodenum and stomach, making treatment safer. Importantly, the use of high technology coupled with good planning helps to reduce toxicity even with high doses of ionizing radiation.