Pancreatic Cancer

Radiotherapy and chemoradiotherapy

Radiotherapy treats cancer by using high-energy radiation such as X-rays to destroy as many cancer cells as possible, while harming normal cells as little as possible. Radiotherapy maybe effective in treating pancreatic cancer but its precise role is still being determined. At present, clinical trials are taking place to define the most appropriate place of radiotherapy in pancreatic cancer treatment.
Radiotherapy may be given:
  • before surgery to try to shrink or slow the growth of the cancer and give doctors a greater chance of removing it all with surgery. This is called neo-adjuvant radiotherapy.
  • after surgery to try to reduce the chance of the cancer coming back. This is called adjuvant radiotherapy.
  • to shrink or slow the growth of the cancer for patients with localised, inoperable cancer (cancer that hasn't spread but can't be removed by surgery).
  • to help to relieve symptoms such as pain. This is called palliative radiotherapy.

A specialised form of stereotactic radiotherapy known as CyberKnife may be appropriate for some people with pancreatic cancer (see 'CyberKnife stereotactic radiotherapy and its side effects')
Elaine had surgery followed by radiotherapy. Her doctor had ‘persuaded’ her to have the treatment to reduce the likelihood of recurrence. Doctors diagnosed her cancer in 1995, before it became more common to combine chemotherapy with radiotherapy. Recently doctors have found that the combined use of chemo- and radiotherapy has yielded better results because the chemotherapy sensitises the tumour cells to the radiotherapy. This combined treatment is known as chemoradiotherapy (or chemoradiation).
The other people we interviewed (who had had radiotherapy) all had chemotherapy at the same time. One had this combined treatment to try to shrink his tumour because his doctors hoped it would make surgery possible. Others had it after surgery, and a few as first line treatment for an inoperable tumour. The chemotherapy drugs that were used varied among them. Some had intravenous drugs such as gemcitabine; others had capecitabine chemotherapy tablets. A clinical trial called SCALOP aimed to find out which of these two drugs worked best with radiotherapy in people with inoperable, locally advanced pancreatic cancer. It showed that capecitabine was safer and possibly more effective in combination with radiotherapy, but because few patients were allocated chemoradiotherapy in this study experts interpret these results with caution. (See ‘Chemotherapy’ for more about these drugs.)
People usually have radiotherapy as an out-patient. A clinical oncologist plans the radiotherapy carefully, often with the help of the radiologist. The patient has a “planning” CT scan in the radiotherapy department sometime before treatment starts.
The health professionals involved use laser beams and ink markings or skin tattoos to help set up the treatment fields accurately and to pinpoint the exact place where radiation is to be directed. These are just pinprick tattoos, difficult to see without knowing they are there. The radiographers then know where the tattoos should be in relation to the treatment couch so can set up the patient in exactly the same position each day. The planning physicists then work out the ideal beam directions to give the optimum (best) dose of radiotherapy to the tumour while avoiding important organs near the tumour.
After planning, the patient starts treatment which usually takes 5-10 minutes. Commonly people have therapy daily from Monday–Friday, with a rest at weekends. A curative course of treatment (radical) may last for 5-6 weeks while palliative treatment will be shorter. Treatment is painless, but Michael said he found the massive machine “rather intimidating”, and Peter (Interview 13) found it difficult to lie still on the table because it was uncomfortable - he had become very thin; he said he felt disorientated after treatment.
People experienced various side effects. It was not always clear which were due to the chemotherapy and which to the radiotherapy (see ‘Side effects of radiotherapy and chemoradiotherapy’). 

Last reviewed June 2015
Last updated June 2015



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