Pancreatic cancer radiation therapy

After a pancreatic cancer diagnosis, radiation therapy may be recommended as part of the treatment plan. This type of pancreatic cancer treatment uses targeted high-energy X-rays to kill cancer cells.

Not all pancreatic cancers are treated with radiation therapy. It’s most commonly used in the following situations:

• After surgery, radiation therapy may be used to reduce the cancer’s likelihood of recurring if cancer cells are present in the margins of the excised tissue. This is known as adjuvant radiation therapy and is often combined with chemotherapy. This use of combined radiation therapy and chemotherapy is often called chemoradiotherapy or chemoradiation.
• If the tumor is classified as a borderline resectable tumor, radiation therapy and chemotherapy may be used before surgery to reduce the tumor(s) in size. This is called neoadjuvant treatment and is designed to shrink the tumor so it can be removed during surgery.

Radiation therapy may also be used for locally advanced and advanced cancers. If the cancer has spread outside the pancreas or is not resectable at all, chemoradiation may be used as the primary treatment.

Chemotherapy may also be helpful in reducing pain if the cancer has advanced or as the primary treatment if the patient’s health issues make surgery risky.

Types of radiation therapy for pancreatic cancer

Several types of radiation therapies are used to treat pancreatic cancer. The care team will advise which radiation type is suited to a particular cancer, as well as what to expect.

External beam radiation therapy (EBRT)

External beam radiation therapy (EBRT) is the most commonly used form of radiation for pancreatic cancer. This radiation type is administered via a machine that precisely targets the tumor with high-energy beams, sparing healthy tissue.

EBRT is generally given over a period of three to six weeks for five days a week on an outpatient basis (meaning the patient won’t spend the night at the hospital during treatment).

Chemotherapy is sometimes administered along with radiation therapy. Combining radiation therapy with chemotherapy is designed to help the radiation work better and may help shrink the tumor so it’s easier to surgically remove.

Radiation therapy may also be helpful in reducing the chance of cancer returning.

Stereotactic body radiotherapy (SBRT)

Stereotactic body radiation therapy (SBRT) is a type of radiation therapy delivered with higher doses of radiation given over fewer weeks. This shorter treatment time allows the patient to finish radiation therapy more quickly and with fewer trips to the treatment facility.

SBRT may also be combined with chemotherapy. However, SBRT has only recently been used to treat pancreatic cancer, so it may only be offered by certain treatment centers and is not suitable for every pancreatic cancer patient.

Palliative radiation therapy

Research has shown that, for some patients, palliative radiation therapy is useful in pain management and may help reduce the use of pain medication.

Palliative radiation therapy may be recommended for certain locally advanced and advanced pancreatic cancer patients. This type of radiation is designed to help ease possible side effects of cancer, mainly pain.

For locally advanced pancreatic cancer, palliative radiation therapy is commonly combined with chemotherapy.

Pancreatic cancer radiation therapy side effects

Although they are generally well tolerated, all types of radiation therapy may cause certain side effects.

When undergoing radiation therapy, it’s normal to experience side effects that last up to a few weeks after treatment, including:

• Nausea
• Vomiting
• Diarrhea
• Fatigue
• Difficulty swallowing
• Diminished appetite
• Digestion issues
• Hair loss at the treatment site
• Skin reaction (swelling, redness, blistering, dryness, itchiness or peeling) where the radiation is administered

Side effects depend on the area where the treatment is delivered, as well as the dosage received. Late-but-lasting side effects may occur months or even years after treatment, but are not common. When they do occur, they typically affect the gastrointestinal system.

Other late, rare side effects may include:

• Secondary cancer
• Bone fractures

Side effects may last a few weeks after treatment, or sometimes longer. Because radiation therapy is targeted to certain areas of the body, pancreatic cancer patients have an increased risk of certain side effects, including:

• Nausea
• Fatigue
• Skin reactions (usually mild)
• Loose bowel movements or diarrhea
• Upset stomach

If any side effects are noticed during or after treatment, the patient should talk to the care team for guidance on managing the discomfort.