Stereostatic Radiosurgery in Pancreas Cancer

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SBRT has potential role in HCC, liver mets, cholangiocarcinoma, pancreas, Klaskin tumour, GIST. The initial results are impressive with low toxicity, high response rate Short course, high dose radiation therapy will improve local control and may improve survival function. The data presented in this presented is emerging data.

Health & Medicine

Stereotactic radiosurgery
in pancreas Cancer
Copyrights@www.radiosurgery-india.com

Radiosurgery in pancreatic tumour & cholangiocarcinoma
- SBRT has potential role in HCC, liver mets, cholangiocarcinoma,
pancreas, Klaskin tumour, GIST
- Initial results are impressive with low toxicity, high response rate
- Short course, high dose radiation therapy will improve local control
and may improve survival function
- There is emerging data
Copyrights@www.radiosurgery-india.com

Local Control after Whipple+ChemoRT
+ve margin (%) Local Failure (%)
GITSG 0 47
EORTC 19 51
ESPAC 28 63
CONKO 19 37
RTOG 34 25
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Rout C Pancreas 2009
Resection status & Survival
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R1 resection = Poor Survival
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Post OP R1 Resection
• Fiducials placed at surgery
• One planning CT with oral and IV contrast
• 1000cGy to +ve margins 3-4 weeks post OP
• 5040cGy 5-6 field IMRT6-8 weeks postOP
• Concurrent Xeloda
• Adjuvant Gemcitabine
BIDMCCopyrights@www.radiosurgery-india.com

R1(Pos. Margin)- Survival by Treatment
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Locally Advanced Pancreas Cancer
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RT vs. ChemoRT
Chemo vs. ChemoRT
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SBRT in pancreas cancer: Results
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SBRT in pancreas cancer: Toxicity
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Potential role of SBRTPotential role of SBRT
1. GIST with primary disease , nodal disease or metastasis
2. Neuroendocrine tumour in intestine, pancreas, nodal involvement
3. Low grade lymphomas with post-chemotherapy residual disease
4. Para-aortic nodal disease metastasis
Copyrights@www.radiosurgery-india.com

SBRT in GI tumours
Summary
- SBRT has potential role in HCC, liver mets, cholangiocarcinoma,
pancreas, Klaskin tumour, GIST…
- Initial results are impressive with low toxicity, high response rate
- Short course, high dose radiation therapy will improve local control
and may improve survival function
- Need multi-centric prospective studies.
Copyrights@www.radiosurgery-india.com

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Circulatory Shock, types and stages, compensatory mechanisms

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5-year survival of GCP after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) GC cell dynamics; 9) GC characteristics; 10) tumor localization; 11) anthropometric data; 12) surgery type. Optimal diagnosis and treatment strategies for GC are: 1) screening and early detection of GC; 2) availability of sufficient quantity of experienced abdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunotherapy for GCP with unfavorable prognosis.

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