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).

Radiation therapy is provided on an outpatient basis, is non-invasive (and therefore does not require anesthesia), and can thus be easily integrated into patients’ daily lives. Depending on the size of the tumor, radiation therapy for small tumor lesions can be administered in just a few treatment sessions as stereotactic body radiation therapy (SBRT), or for larger tumors as a fractionated treatment over several weeks. Sometimes, radiation therapy is combined with chemotherapy to improve its effectiveness. Close and personal support is a matter of course for us.

Radiotherapy procedure

The Department of Radiation Oncology at the USZ uses only the most advanced techniques to provide the most precise radiation treatment for pancreatic cancer with minimal side effects. You will be cared for by senior physicians who are experienced in the treatment of pancreatic cancer.

We work closely with our colleagues in surgery and medical oncology to ensure a seamless treatment process.

In the following, we will describe radiation therapy for the various types and stages of pancreatic cancer:

• Inoperabler Bauchspeicheldrüsenkrebs
• Bauchspeicheldrüsenkrebs nach einer Operation
• Metastases from pancreatic cancer, e.g., in the brain or bones

Inoperable pancreatic cancer

For locally confined pancreatic cancer, the first-line treatment is either immediate surgery or surgery following prior chemotherapy. If surgery is not an option, local radiation therapy is a good way to stop the growth of cancer cells and can be used in patients who have undergone chemotherapy if their disease was stable during treatment.

The stereotactic body radiation therapy (SBRT) used for this purpose destroys the tumor in just a few radiation sessions: typically, in 5 outpatient sessions. This is achieved by highly focused irradiation with an accuracy in the millimeter range. Whenever possible, this treatment is performed using our specialized device, the MR-LINAC, which combines MRI imaging and radiation therapy. 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. In addition, MRI technology allows us to monitor tumor and organ movement “live” during radiation therapy. 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 serve as international experts on guideline committees. State-of-the-art equipment and experienced medical physicists and MTRAs contribute to treatment of optimum quality and safety.

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.

Locally advanced pancreatic cancer

In cases of locally advanced pancreatic cancer where surgery is not an option, radiation therapy is the treatment of choice in most cases. In einem lokal fortgeschrittenen Stadium, insbesondere bei bereits vorhandenen Absiedlungen in die Lymphknoten, reicht diese alleine zur Heilung manchmal nicht aus. For this reason, chemotherapy is usually administered in conjunction with radiation therapy in these cases. This eliminates any cancer cells that may be present throughout the body and makes the cancer cells more sensitive to radiation. The combination of radiation therapy and chemotherapy offers the best chance of a cure.

Because the treatment area is often extensive, radiation therapy is divided into many small “doses”: treatment is administered in fractions over 27–33 weekday sessions spanning a period of about 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.

Of course, during this time, patients receive close monitoring from their treating physicians and nursing specialists to ensure the best possible support for any symptoms related to their illness or treatment.

Radiation therapy and personalized treatment for pancreatic cancer are a key focus of our clinic. We share our knowledge through international courses and conferences, and as a clinic, we participate in cutting-edge clinical trials in this field. 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 to ensure a seamless treatment plan. We also consult with our colleagues in palliative medicine at an early stage.

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

Pancreatic cancer is an aggressive form of cancer that often spreads to other parts of the body as the disease progresses; 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.

Through clinical trials, we are constantly working to improve the treatment of pancreatic cancer to make it even more effective and better tolerated. View an overview of currently open trials.