Pancreatic cancer Radiotherapy

Procedure

Radiation therapy focuses high-energy X-rays on the tumor inside the body to specifically kill it. Radiotherapy can also be used if the pancreatic cancer has already spread, in which case radiotherapy can prevent or alleviate symptoms caused by metastases or the pancreatic cancer itself(palliative radiotherapy).

Radiotherapy is carried out as an outpatient treatment, is non-invasive (i.e. does not require anesthesia) and can therefore be easily integrated into everyday private life. Depending on the extent of the tumor, radiotherapy can be carried out in a few treatment sessions as body stereotactic radiotherapy (SBRT) for small tumor foci, or as fractionated treatment over several weeks for larger tumors. Sometimes radiotherapy is combined with chemotherapy to improve its effectiveness. Close and personal support is a matter of course for us.

The Department of Radio-Oncology at the USZ uses only the most modern techniques to irradiate pancreatic cancer as precisely as possible and with as few side effects as possible. You will be cared for by senior physicians experienced in the treatment of pancreatic cancer.

We work closely with our colleagues in surgery and medical oncology to guarantee treatment from a single source.

For many patients, we are already offering the treatment of tomorrow: in clinical trials, we are continuously working on improving the treatment of pancreatic cancer to make it even more effective and tolerable. To the overview of currently open studies.

In the following, we will describe radiotherapy for the different types and stages of pancreatic cancer:

• Inoperable pancreatic cancer
• Pancreatic cancer after an operation
• Metastases of pancreatic cancer, e.g. in the brain or bones

Inoperable pancreatic cancer

In the case of localized pancreatic cancer, the treatment of first choice is either direct surgery or surgery after prior chemotherapy. If surgery is not possible, local radiation of the cancer is a good option to stop the growth of cancer cells and can be used in patients after chemotherapy if the disease was stable.

The body stereotactic radiotherapy (SBRT) used for this purpose kills the tumor in just a few radiotherapy sessions: typically in 5 outpatient radiotherapy sessions. This is achieved by highly focused irradiation with an accuracy in the millimeter range. If possible, this therapy is carried out on our special device, the MR-LINAC, which combines MRI imaging and radiation. The integrated MRI allows a very detailed representation of the actual anatomy. The position of the tumor and the surrounding healthy organs can thus be determined with millimeter precision every day and the radiation can – if necessary – be optimally adapted to the current situation immediately. We can also use MRI technology to monitor tumor and organ mobility “live” during radiation. Our clinic was the first in Switzerland to introduce this technology back in 2019. We are still the only clinic in German-speaking Switzerland to offer the highest level of expertise in this field.

Body stereotactic radiotherapy (SBRT) is a clinical and scientific focus of our clinic: we pass on our knowledge in a large number of international courses and congresses. We are active as international experts in guideline commissions. State-of-the-art equipment and experienced medical physicists and MTRAs contribute to treatment of optimum quality and safety.

In clinical trials, we are continuously trying to improve the treatment of inoperable pancreatic cancer in order to make it even more effective and tolerable. To the overview of currently open trials.

Pancreatic cancer after an operation

Pancreatic cancer patients who have undergone surgery are usually given additional intensive chemotherapy to eliminate any cancer cells that may have spread. In the event of incomplete resection, radiotherapy of the surgical site may also be useful, especially if intensive chemotherapy with folfirinox cannot be given and the area of incomplete resection can be well localized.

In this case, the radiation is divided into many small “portions”: the therapy is fractionated over 28 treatment sessions every working day over a period of around 5 to 6 weeks. Spreading the radiation treatment over several weeks improves the tolerability of the treatment, which is mainly carried out on an outpatient basis and can be easily integrated into everyday life. This radiation is often combined with additional low-dose chemotherapy, either in the form of tablets or infusions.

In clinical trials, we are continuously trying to improve the treatment of pancreatic cancer in order to make it even more effective and tolerable. To the overview of currently open studies.

Locally advanced pancreatic cancer

In the case of locally advanced pancreatic cancer, when surgery is not possible, radiotherapy is the treatment of first choice in most cases. In a locally advanced stage, especially if there is already metastasis in the lymph nodes, this alone is sometimes not sufficient for healing. For this reason, chemotherapy is usually given in addition to radiotherapy in these cases. This eliminates any disseminated cancer cells and makes the cancer cells more sensitive to radiation. The combination of radiation and chemotherapy offers the greatest chance of recovery.

Due to the often extensive treatment area, the radiation is divided into many small “portions”: the therapy is fractionated over 27-33 treatment sessions per working day over a period of around six to seven weeks. Spreading the radiation treatment over several weeks improves the tolerability of the treatment, which is mainly carried out on an outpatient basis and can be easily integrated into the patient’s private and professional life.

It goes without saying that patients are closely monitored by their attending doctors and nursing experts during this time to ensure the best possible support for illness- and therapy-related complaints.

The radiotherapy and individualized treatment of pancreatic cancer is a focus of our clinic and is represented clinically and scientifically by Dr. H. Garcia Schüler and PD Dr. Balermpas. We pass on our knowledge at international courses and congresses and, as a clinic, participate in state-of-the-art clinical studies on the subject. We are also active in international committees for quality assurance in studies. State-of-the-art equipment and experienced medical physicists and MTRAs contribute to treatment of optimum quality and safety.

At the same time, we work closely with our colleagues in surgery and medical oncology in order to guarantee treatment “from a single source”. We also consult with our colleagues in palliative medicine at an early stage.

In clinical trials, we are continuously trying to improve the treatment of pancreatic cancer in order to make it even more effective and tolerable. To the overview of currently open studies.

Metastases of pancreatic cancer, e.g. in the brain or bones

Pancreatic cancer is an aggressive type of cancer that often forms metastases during the course of the disease: this is called metastasis. Common sites of metastasis are the lung, adrenal gland, bones, liver or brain. Radiotherapy is a highly effective method with few side effects to prevent or treat symptoms caused by metastases. This is usually done in combination with chemotherapy, immunotherapy or other targeted therapy. The smaller the metastases are and the earlier they are irradiated, the better the results. Today, metastases in the body can be treated in a focused manner in just a few effective radiation sessions.

For tumor foci in the abdominal area, e.g. liver or upper abdomen, we carry out body stereotactic radiotherapy (SBRT) on our MRI hybrid accelerator. State-of-the-art radiation technology is combined with MRI images. The radiation is thus carried out under MRI monitoring of the tumor, so that the highest precision is combined with the best imaging. Our clinic was the first in Switzerland to introduce this technology back in 2019. We are still the only clinic in German-speaking Switzerland to offer the highest level of expertise in this field.

Today, brain metastases are treated at our center in most patients by means of a single high-dose radiation treatment: this is called radiosurgery. Metastases at other locations in the body can now also be treated in a focused manner in just a few effective radiation sessions.

Metastatic pancreatic cancer is a clinical and scientific focus of our clinic. We pass on our knowledge in a large number of international courses and congresses. We are active as international experts in guideline commissions.

State-of-the-art equipment and experienced medical physicists and MTRAs contribute to treatment of optimum quality and safety. At the same time, we work closely with our colleagues in medical oncology to guarantee “one-stop” treatment. We also consult with our colleagues in palliative medicine at an early stage.

In clinical trials, we are continuously trying to improve the treatment of pancreatic cancer in order to make it even more effective and tolerable. To the overview of currently open studies.