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World J Gastrointest Oncol. Sep 15, 2015; 7(9): 141-147
Published online Sep 15, 2015. doi: 10.4251/wjgo.v7.i9.141
Proton therapy for pancreatic cancer
Romaine C Nichols, Soon Huh, Zuofeng Li, Michael Rutenberg
Romaine C Nichols, Soon Huh, Zuofeng Li, Michael Rutenberg, Department of Radiation Oncology, University of Florida, Jacksonville, FL 32206, United States
Author contributions: Nichols RC wrote the first draft and the remaining authors contributed equally to revising it.
Conflict-of-interest statement: The authors have no conflict of interest related to the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Romaine C Nichols, MD, Department of Radiation Oncology, University of Florida, 2015 North Jefferson St. Jacksonville, FL 32206, United States. rnichols@floridaproton.org
Telephone: +1-904-5881800 Fax: +1-904-5881300
Received: April 2, 2015
Peer-review started: April 2, 2015
First decision: April 23, 2015
Revised: June 3, 2015
Accepted: July 18, 2015
Article in press: July 22, 2015
Published online: September 15, 2015
Processing time: 168 Days and 11.3 Hours
Abstract

Radiotherapy is commonly offered to patients with pancreatic malignancies although its ultimate utility is compromised since the pancreas is surrounded by exquisitely radiosensitive normal tissues, such as the duodenum, stomach, jejunum, liver, and kidneys. Proton radiotherapy can be used to create dose distributions that conform to tumor targets with significant normal tissue sparing. Because of this, protons appear to represent a superior modality for radiotherapy delivery to patients with unresectable tumors and those receiving postoperative radiotherapy. A particularly exciting opportunity for protons also exists for patients with resectable and marginally resectable disease. In this paper, we review the current literature on proton therapy for pancreatic cancer and discuss scenarios wherein the improvement in the therapeutic index with protons may have the potential to change the management paradigm for this malignancy.

Keywords: Proton therapy; Pancreatic cancer; Review

Core tip: Radiotherapy is commonly offered to patients with pancreatic malignancies although its ultimate utility is compromised since the pancreas is surrounded by exquisitely radiosensitive normal tissues, such as the duodenum, stomach, jejunum, liver, and kidneys. Proton radiotherapy can be used to create dose distributions that conform to tumor targets with significant normal tissue sparing. Because of this, protons appear to represent a superior modality for radiotherapy delivery to patients with unresectable tumors and those receiving postoperative radiotherapy. A particularly exciting opportunity for protons also exists for patients with resectable and marginally resectable disease.