(A) Coronal and (B) sagittal views of an IMRT plan for a pT3N0
pancreatic adenocarcinoma, resected to negative margins and with 0/15 lymph
nodes. The patient received 5,040 cGy in 180 cGy per fraction with concurrent
twice daily capecitabine. This field encompassed the preoperative tumor volume,
surgical margin, PJ, choledocojejunostomy, celiac axis, SMA and vein, porta
hepatis, and paraaortic lymph nodes. This plan incorporated 6 MV photons and
non-coplanar fields to better spare the liver and kidneys. Also, 4-dimensional
computed tomography simulation with abdominal compression was employed to allow
for reproducibility of respiratory motion. IMRT, intensity-modulated radiation
therapy; PJ, pancreaticojejunostomy; SMA, superior mesenteric artery.