Individualized Radiotherapy (iRT) concepts for Locally Advanced Pancreatic Cancer (LAPC): Indications and prognostic factors.

Background: Novel techniques in radiation oncology have significantly improved the therapeutic window in locally advanced pancreatic cancer LAPC. In about one third of the patients, chemoradiation can lead to secondary resectability, contributing to an increase in outcome. Dose-escalation approaches using stereotactic body radiotherapy (SBRT) or advanced treatments such as intensity-modulated radiotherapy (IMRT) can exploit the biological benefits of hypofractionation, or use “dose painting” approaches to target defined subvolumes. Prognostic subgroups of patients have been identified, based on molecular markers such as CA 19–9, nutritional factors, diabetes or immunological properties of tumor and normal tissue. Purpose: The aim of the present manuscript is to summarize data on downsizing for locally advanced pancreatic cancer (LAPC) and to elucidate the role of individualized radiotherapy (iRT). Conclusion: Future concepts focus on iRT based on prognostic factors leading to a true personalized treatment