- Author
-
E. Versteijne
- Title
- Emerging insights on neoadjuvant chemoradiotherapy in pancreatic cancer
- Supervisors
-
C.R.N. Rasch
- Co-supervisors
-
G. van Tienhoven
A. Bel - Award date
- 26 May 2021
- Number of pages
- 211
- ISBN
- 9789493197619
- Document type
- PhD thesis
- Faculty
- Faculty of Medicine (AMC-UvA)
- Abstract
-
The overall survival of patients with resectable or borderline-resectable pancreatic ductal adenocarcinoma (PDAC) has hardly improved over the last decade with a rise in studies investigating the role of preoperative (neoadjuvant) chemoradiotherapy. Since neoadjuvant chemoradiotherapy has not proven its efficacy yet, little is known about the radiotherapy aspects of pancreatic cancer. As a consequence, no standard guideline is available on delineation of pancreatic tumors in the neoadjuvant setting. It is known that tumor delineation can be challenging, with poor contrast between the tumor and surrounding tissue. This thesis aimed to study the role of neoadjuvant chemoradiotherapy in patients with resectable or borderline-resectable PDAC and investigate the radiotherapeutic aspects: delineation and treatment planning of neoadjuvant radiotherapy. Within this thesis, the suggestion was found that neoadjuvant chemoradiotherapy is beneficial in patients with resectable and borderline-resectable PDAC, especially in the latter group. Further improvements in neoadjuvant chemotherapy using FOLFIRINOX and gemcitabine/nab-Paclitaxel should be investigated, but also should focus on the efficacy of neoadjuvant radiotherapy. Considerable interobserver variation was found in both CT and MRI delineation, and further improvements in radiotherapeutic approaches to reduce the treating volumes are needed, such as MR-guided stereotactic radiotherapy, breathhold or midposition radiotherapy.
- Persistent Identifier
- https://hdl.handle.net/11245.1/12c7b0b6-e48f-4d7a-9d18-abd3217a5674
- Downloads
-
Thesis (complete)
Front matter
Chapter 1: General introduction
Chapter 2: Meta-analysis comparing upfront surgery with neoadjuvant treatment in patients with resectable or borderline-resectable pancreatic cancer
Chapter 3: Preoperative radiochemotherapy versus immediate surgery for resectable and borderline-resectable pancreatic cancer (PREOPANC trial): Study protocol for a multicenter randomized controlled trial
Chapter 4: Quality assurance of the PREOPANC trial (2012-003181-40) for preoperative radiochemotherapy in pancreatic cancer: The dummy run
Chapter 5: Considerable interobserver variation in delineation of pancreatic cancer on 3DCT and 4DCT: A multi-institutional study
Chapter 6: Addition of MRI for CT-based pancreatic tumor delineation: A feasibility study
Chapter 7: Preoperative chemoradiotherapy versus immediate surgery for resectable and borderline-resectable pancreatic cancer: Results of the Dutch randomized phase III PREOPANC trial
Chapter 8: External validity of the multicenter randomized PREOPANC trial on neoadjuvant chemoradiotherapy in pancreatic cancer: Outcome of eligible but nonrandomized patients
Chapter 9: Discussion & future perspectives
Summary; Samenvatting (Nederlands); List of publications; Affiliations contributing authors; PhD portfolio; Dankwoord; Over de auteur
- Supplementary materials
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