Locally advanced pancreatic cancer may be treated with chemotherapy or with combination of chemotherapy and concurrent radiation. The later is preferred in patients with locally advanced tumor with better performance status. For patients without distant disease, there is modest potential survival benefits for patients as few of the patients may become resectable. However, with rare exceptions, patients generally will ultimately succumb to their disease.
In spite of this, significant palliative benefit can be achieved by chemoradiation. Pain, anorexia, fatigue, and clinical wasting are relatively common symptoms, which significantly impact the patient's quality of life. Using EBRT with or without chemotherapy, approximately 35% to 65% of patients will experience pain resolution as well as some improvement in wasting and obstructive symptoms. Definite but less dramatic improvements in performance status and anorexic symptoms may be observed as well.
Potential side-effects and complications of radiation was discussed in detail. The dose-limiting organs for irradiation of upper-abdominal cancers are the small intestine, stomach, liver, kidneys, and spinal cord. Acute side-effects include general fatigue, transient elevation of LFT, nausea and vomitting, fever, abdominal cramping, diarrhea, skin irritations or desquamation. Examples of long-term complications include small bowel obstruction, stomach ulceration and GI bleed, hepatic failure, kidney failure and hypertension, and radiation myeolitis leading to neurological deficits.
