Radiation Therapy in the Management of a Pancreatic Cancer

Technological advances in imaging, including improvements in computed tomography, magnetic resonance, and endoscopic ultrasound, have been paralleled by improvements in delivery of radiation. These advances have led to a significant number of changes to the approach for the utilization of radiation, in terms of treatment volumes, radiation dose, and fraction number. Incorporation of radiation requires careful consideration by a multi-disciplinary team and often necessitates placement of fiducials, typically performed under EUS guidance, due to target ambiguity with kV imaging at the time of treatment. In this chapter, we will review the indications for radiation, which is largely determined by imaging performed at diagnosis, as well as the role of various imaging modalities and fiducials in the treatment of pancreatic cancer.