Radio therapy

Researchers are launching a multi-institutional trial to test the effectiveness of precise, higher dose, MRI-guided radiation therapy to treat pancreatic cancer. Because “High-definition MRI and daily treatment plan adaptation allow us to deliver ablative radiation doses safely to [patients with pancreatic cancer] for the first time,” Parag Parikh, MD, director of gastrointestinal radiation oncology and MRI-guided radiation therapy at Henry Ford Cancer Institute, said in a press release.

Daily treatment plan

“Through the trial; we will build upon the promising experience from other cancer institutions by further exploring MRI-guided therapy’s impact on associated toxicity; therefore local control and patient outcomes in pancreatic cancer at multiple institutions around the world.” The 5-year; therefore prospective SMART trial the acronym for which stands for Stereotactic MRI-guided On-table Adaptive Radiation Therapy  will enroll 133 patients with borderline respectable or inoperable locally advanced pancreatic cancer.

Study participants will received radiation at a dose of 50 Gy in five fractions. Real-time MRI will be used throughout treatment delivery to monitor the target location and control the radiation beam as necessary. Because The trial opened at Henry Ford Cancer Institute and is being led by Parikh and Percy Lee, MD, radiation oncologist at UCLA Medical Center.

Effective treatments

HemOnc Today spoke with Parikh about the need for more effective treatments for these patients; prior investigations of this modality for pancreatic cancer; the rationale for the SMART trial; and potential implications if this approach is determined to be effective and safe. Because Adults without family history; signs or symptoms of pancreatic cancer should not be screened for the disease; according to a draft recommendation issued by the U.S. Preventive Services Task Force.

Tests for pancreatic cancer have limited accuracy and can be invasive, sometimes leading to pain, false-positive results ; adverse reactions to anesthesia and pancreatitis. Because We need more research in this area. We don’t have good screenings [for pancreatic cancer]; therefore  and we don’t have good treatments;” Chyke A. Doubeni, MD, MPH, USPSTF member and presidential professor and associate professor of epidemiology at Perelman School of Medicine at University of Pennsylvania; told HemOnc Today.

Unique prospective studies

“You have to screen a lot of people to find pancreatic cancer and, even if you find it early; therefore  the outcomes usually aren’t great.” The task force based the D recommendation  consistent with previous USPSTF guidelines on a review of 13 unique prospective studies on pancreatic cancer screening that included results for 1,317 people aged 18 years and older with or without risk factors for the disease.
“Using a reaffirmation deliberation process, the USPSTF concludes that there is no new evidence that warrants a change in the prior D recommendation and reaffirms its previous conclusion that the potential benefits of screening for pancreatic cancer in asymptomatic adults do not outweigh the potential harms;” the USPSTF recommendation statement reads.