Pain Palliation Using Hypofractionated Radiotherapy for Unresectable Pancreatic Cancer

BACKGROUND: Pain is a common symptom for patients with pancreatic cancer and is often treated using palliative radiation therapy. Standard palliative dose regimes typically consist of 2000 cGy to 3000 cGy in 5 to 10 fractions (fx). With the recent advancements in radiation dosimetric planning and delivery, the Juravinski Cancer Centre in Hamilton, Ontario, offers a hypofractionated dose of 2500 cGy in 5 fx for the improvement of pain and tumour control in selected pancreatic cancer patients. This project reviews the safety and efficacy of this prescription. METHODS: A retrospective analysis of 24 patients diagnosed with unresectable pancreatic cancer was conducted. Patient data were collected using in-house medical record systems including MOSAIQ, Meditech, and Centricity. Nonparametric data analysis tests were conducted using Minitab17. RESULTS: Nineteen of 24 patients (79%) reported a decrease in pain levels following radiation and 13 of 18 (72%) showed good local control of the tumour on a follow-up CT scan. Around 30% of patients reported nausea and vomiting and fatigue. Only 13% reported diarrhea and 8% reported constipation. Twenty-one percent reported pain flares. All patients were able to finish the entire treatment without pauses or delays. CONCLUSION: A palliative radiotherapy dose regime of 2500 cGy/5 fx demonstrates a potential for the effective control of pain with limited acute toxicities in patients with unresectable pancreatic cancer. This study aims to indicate the need for further prospective research comparing this regime to other standard treatments in order to determine which is most beneficial for the patient.