Analyzing the Effect of Neoadjuvant Stereotactic Ablative Body Radiotherapy on Pancreatic Tumour Perfusion Using Computed Tomography Perfusion
type: CreativeWork
description: Surgical resection is currently the primary curative treatment for pancreatic ductal adenocarcinoma (PDAC). However, surgery is only feasible for patients who have resectable pancreatic cancer (RPC), which is nonmetastatic, well-localized, and has minimal involvement of the critical vessel structures around the primary tumour. Patients with limited but non-negligible involvement of the surrounding vasculature, known as borderline-resectable pancreatic cancer (BRPC) patients, often have poor surgical prognosis. Thus, to potentially reduce the tumour-vessel contact and downstage the overall tumour conditions for better surgical outcome, neoadjuvant chemotherapy is typically administered for BRPC patients. Unfortunately, due to the presence of a desmoplastic stroma, PDAC characteristically has a high tumour density, which can significantly limit tumour perfusion and restrict the systemic delivery of chemotherapy drugs to the tumour site. To overcome this barrier, several studies have demonstrated that irradiating the tumour volume with a high dose of radiation in hypofractionated radiotherapy can induce an acute increase in tumour perfusion. While chemoradiation is already the current standard of care for the non-resectable, locally advanced pancreatic cancer patients, conventional fractionation schemes typically deliver around 2-3 Gy per fraction. In contrast, treatment using higher doses in the range of 9-10 Gy per fraction or greater can be achieved with an emerging technique known as stereotactic ablative body radiotherapy (SABR), which can deliver intense doses of radiation for tumour ablation in just 3-5 fractions, with high precision leveraged by the guidance of an integrated imaging system, such as computed tomography (CT). As of now, however, there is a lack of clinical studies that have investigated the effect of high-dose radiotherapy on pancreatic tumour perfusion, especially in terms of monitoring its effect on reducing the PDAC tissue density, which may u…
abstract: Surgical resection is currently the primary curative treatment for pancreatic ductal adenocarcinoma (PDAC). However, surgery is only feasible for patients who have resectable pancreatic cancer (RPC), which is nonmetastatic, well-localized, and has minimal involvement of the critical vessel structures around the primary tumour. Patients with limited but non-negligible involvement of the surrounding vasculature, known as borderline-resectable pancreatic cancer (BRPC) patients, often have poor surgical prognosis. Thus, to potentially reduce the tumour-vessel contact and downstage the overall tumour conditions for better surgical outcome, neoadjuvant chemotherapy is typically administered for BRPC patients. Unfortunately, due to the presence of a desmoplastic stroma, PDAC characteristically has a high tumour density, which can significantly limit tumour perfusion and restrict the systemic delivery of chemotherapy drugs to the tumour site. To overcome this barrier, several studies have demonstrated that irradiating the tumour volume with a high dose of radiation in hypofractionated radiotherapy can induce an acute increase in tumour perfusion. While chemoradiation is already the current standard of care for the non-resectable, locally advanced pancreatic cancer patients, conventional fractionation schemes typically deliver around 2-3 Gy per fraction. In contrast, treatment using higher doses in the range of 9-10 Gy per fraction or greater can be achieved with an emerging technique known as stereotactic ablative body radiotherapy (SABR), which can deliver intense doses of radiation for tumour ablation in just 3-5 fractions, with high precision leveraged by the guidance of an integrated imaging system, such as computed tomography (CT). As of now, however, there is a lack of clinical studies that have investigated the effect of high-dose radiotherapy on pancreatic tumour perfusion, especially in terms of monitoring its effect on reducing the PDAC tissue density, which may u…
author: Bang, Jin-Young
language: en
keywords: Pancreatic Ductal Adenocarcinoma, Neoadjuvant Therapy, Stereotactic Ablative Body Radiotherapy, Tumour Perfusion, 4-Dimensional Volumetric Computed Tomography, Computed Tomography Perfusion
date published: 2025-08-08
date modified: 2026-07-27T21:56:14Z
provider: Western University
publisher: Networked Digital Library of Theses and Dissertations
type: WebPage
source organization: The University of Western Ontario

PropertyValue
property ID: Handle
value: https://hdl.handle.net/20.500.14721/38804