Aggressive pancreatic schemes

[Neuronix]

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Again with the Loki reference... I speak in metaphors. It makes me seem super smart.

My only complaint with the season opener was that Owen Wilson didn't say "oh wow" even once.

 

[metview]

I have an 80 yo patient who had a whipple 9 months ago with positive margins and 6/20 positive nodes had 6 cycles of xeloda and gemzar. Post chemo ct shows a 3 cm local recurrence in the region of the pancreatic body abutting the stomach and compressing the portal confluence. No distant Mets on pet.
She was referred for SBRT and I do pancreas SBRT routinely but she’s refusing fiducials and I am hesitant on its proximity to stomach. She lives 2 hours away from any radiation center and doesn’t prefer a 5-6 week course of rt. I haven’t done a crane approach. What would y’all do?

33 Gy in 5 makes sense here if she isn't willing to come in for 5-6 weeks. Use clips and/or stents for image guidance.

 

[ramsesthenice]

Apparently we should just freeze all rad onc technology development or any attempts to treat pancreas cancer any more aggressively because that is futile and the cancer will win anyway. So spoke TheWallnerus.

PS: We're treating 50/5 more generously and the lymph node basins with 5 fraction high dose now too. Come at me bro. Enroll on SMART trial when we can.

Pretty much all of my Panc SBRT anymore is 45-50/5. And the expansions are not tiny. We adapt based on bowel dose but keep it big posterior and medial along the vascular and pancreatic margins. Toxicity has just not been a problem.

Edit: not talking about the case from the OP. These doses wouldn’t work.