**Part 1**

**External Beam RT and New Practices**

**1** 

*USA* 

**Stereotactic Body Radiotherapy** 

**for Pancreatic Adenocarcinoma:** 

**Internal Markers and Its Association** 

Approximately 44,000 patients will develop new pancreatic cancers in the US in 2011 and 38,000 patients will die from the disease (ACS). Prognosis is directly related to the extent of tumor. The median survivals for these patients range from 11-18 months for those with localized disease, 10-12 months for those with locally advanced disease, and 5-7 months for those with metastatic disease, respectively (Evans DBAJ 2011). Although surgical resection is the only treatment associated with long-term survival, patients with resectable diseases

Despite resection, local regional recurrence and distant metastases occur in up to 50% of patients and two-year survival rates range from 20-40% with surgery alone. In 1974, the Gastrointestinal Tumor Study Group prospectively randomized patients after curative resection of pancreatic adenocarcinoma to adjuvant chemoradiation versus observation. The results of this study indicated a doubling of median and quadrupling of long-term survival with adjuvant chemoradiation (median, 20 vs. 11 months; 5-year survival, 19% vs. 5%). A US Intergroup study compared gemcitabine vs. infusional 5-FU chemotherapy for one month prior to and three months after chemoradiation, consisting of continuous infusional 5-FU, as adjuvant therapy after pancreatic cancer resection; outcome in those with tumor located in the pancreatic head was the primary study endpoint (Regine et al. 2008). The gemcitabine plus chemoradiation arm was superior to the 5-FU plus chemoradiation arm, with a median survival of 20.6 months vs. 16.9 months and survival at 3-years of 32% vs. 21%. This survival advantage came at a cost of appreciable toxicity, with grade 3-4 hematologic and nonhematologic toxicities occurring in 58% and 58% of subjects, respectively. Oettle et al compared gemcitabine given at 1000 mg/m² weekly for 3 of 4 weeks x 6 cycles to no additional therapy in 368 patients with resected pancreatic cancer (Oettle et al. 2007). Adjuvant gemcitabine was associated with a significant improvement in disease-free survival (13.4 vs 6.9 months), and a trend towards improvement in overall survival (median 22.1 vs 20.2 months); 34% of those receiving gemcitabine were alive at 3 yr vs. 20.5% with

**1. Introduction** 

usually account for only 20-25% of cases at diagnosis.

**with the Patient's Body Mass Index** 

**Set-Up Error Correction Using** 

Chi Lin, Shifeng Chen and Michael J. Baine

*University of Nebraska Medical Center,* 
