Table 2.

SBRT selection criteria for dose escalation

Suggested SBRT (5 Fractions) dose-escalation inclusion criteria

Cytologic- and biopsy-confirmed adenocarcinoma

Locally advanced, unresectable, or borderline (abutment of SMA, celiac axis, SMV, or PV involvement*)

ECOG ≤2

Pancreatic tumor size ≤5 cm

No regional adenopathy†

No evidence of distant metastasis

Metal stent in place if duodenal stent required

Reproducible motion management (encompass tumor motion ≤5 mm)

Adequate hematologic function (ANC ≥ 1500/mm3, Hgb ≥ 8 g/dL, PLT ≥ 100,000/mm3)

Adequate renal function (creatinine ≤1.5 X ULN)

Adequate liver function (total bilirubin ≤ 1.5 X ULN; AST, ALT, and ALP ≤ 2.5 X ULN)

Exclusion criteria

Prior overlapping abdominal radiation treatment

Prior surgical resection of pancreatic tumor

Active or uncontrolled gastric or duodenal ulcer

Direct invasion of duodenum by tumor

Residual or persistent grade 3 chemotherapy toxicity

Therapeutic anticoagulation

Abbreviations: ALP = alkaline phosphatase; ALT = alanine aminotransferase; ANC = absolute neutrophil count; AST = aspartate aminotransferase; ECOG = Eastern Coppoeative Oncology Group; PLT = platelet; PV = portal vein; SMA = superior mesenteric artery; SMV = superior mesenteric vein; SBRT = stereotactic body radiation therapy; ULN = upper limit of normal.

^*Involvement requiring vascular reconstruction.

^†SBRT may be possible for select patients with nodal disease.