Management of Pancreatic Cancer with MRI-Guided Adaptive Radiotherapy

Globally, pancreatic ductal adenocarcinoma (PDAC) is the 14th most common cancer type and the seventh most common cause of cancer-related death. This disease is treated as a systemic process even though approximately 30% of patients with PDAC die with locally destructive disease. Locoregional control can be improved by escalating radiation dose with modern treatment techniques such as stereotactic body radiotherapy (SBRT) and now with magnetic resonance imaging (MRI)-guided adaptive radiotherapy (MRgRT). There is mounting evidence showing improved local control with the use of dose-escalated radiation therapy which can translate into better symptom control and therefore quality of life for patients with locally advanced disease. In patients with borderline resectable disease, local high dose radiation therapy can downstage patients allowing resection with negative margins. This chapter details the historical treatment paradigm for PDAC as well as strategies and workflows for treating patients with PDAC using MRgRT.