Painting with broader strokes.

Top Line: Can elective nodal volumes be treated with pancreas SBRT?

The Study: Elective nodal volumes are typically covered with definitvie and adjuvant fractionated radiation for pancreatic cancer. But when using SBRT, narrow margins are often used that don’t typically include elective nodes--which is often criticized when comparing SBRT to ablative hypofractionated regimens. This retrospective, matched-cohort study from Stanford compares outcomes for definitive 5-fraction SBRT with (after 2018) or without (prior to 2018) elective nodal irradiation (ENI) in patients with unresectable pancreatic cancer. Gross disease plus a 3 mm margin was treated to 40 Gy in 5 fractions while elective nodal volumes received 25 Gy in 5 fractions. Nodal volumes were standard and included the porta hepatis, celiac, superior mesenteric, and peri-aortic nodes per the RTOG atlas. Stomach, duodenum, and bowel were limited to 40 Gy max, V33 < 1cc, and V30 < 5cc. There was no strict constraint on lower doses to bowel, however they aimed for a V25 < 30 cc. Compared to matched controls receiving SBRT alone, SBRT+ENI had a lower rate of local (20 vs 41%), regional (6 vs 22%), and combined locoregional progression (20 vs 51%). At 24 months, the cumulative rate of locoregional progression was 22.6% with ENI vs 44.6% without. In both groups, the most common site of nodal failure was in the peri-aortic region. While there was no major difference in grade 3+ toxicity, there was a significant increase in acute grade 1-2 nausea with ENI (60 vs 20%).

TBL: This retrospective study suggests that covering elective nodes with 25 Gy in 5 fractions as part of pancreas SBRT may reduce locoregional failure at the expense of increased low-grade GI toxicity. | Miller, Int J Radiat Oncol Biol Phys 2021


  1. Hello to everyone out here, I am here to share the unexpected miracle that happened to me … My name is Susan Christian , I live in London, UK. we got married for more than 9 years and have gotten two kids. thing were going well with us and we are always happy. until one day my husband started to behave in a way i could not understand, i was very confused by the way he treat me and the kids. later that month he did not come home again and he called me that he want a divorce, i asked him what have i done wrong to deserve this from him, all he was saying is that he want a divorce that he hate me and do not want to see me again in his life, i was mad and also frustrated do not know what to do, i was sick for more than 2 weeks because of the divorce. i love him so much he was everything to me without him my life is incomplete. i told my sister and she told me to contact a spell caster, i never believe in all this spell casting of a thing. i just want to try if something will come out of it. i contacted Dr Emu for the return of my husband to me, they told me that my husband have been taken by another woman, that she cast a spell on him that is why he hate me and also want us to divorce. then they told me that they have to cast a spell on him that will make him return to me and the kids, they casted the spell and after 24 hours my husband called me and he told me that i should forgive him, he started to apologize on phone and said that he still love me that he did not know what happen to him that he left me. it was the spell that Dr Emu casted on him that make him come back to me today, me and my family are now happy again today. thank you Dr Emu for what you have done for me i would have been nothing today if not for your great spell. i want you my friends who are passing through all this kind of love problem of getting back their husband, wife , or ex boyfriend and girlfriend to contact Dr Emu , if you need his help you can contact him through his private mail: or you can contact him through his website fb page Https://


Post a Comment

Popular Posts