Healthcare Professionals

Radiotherapy

External beam radiation therapy (EBRT)

External beam radiation therapy is delivered with multiple field arrangements (2-5 fields) using cobalt/ linear accelerator (6-10MV) with daily fraction of 180-200cGy per week for 5 to 6 weeks to a total dose of 4500-5500cGy, depending on the presence of disease. The disease site with a margin of 2 to 3 cm and the duodenal loop and regional lymph nodes are irradiated. The presence of critical organs like the kidneys, liver, spinal cord, small bowel and stomach limit the total doses of radiations to be delivered, however higher doses of delivery are now possible to some extent with the newer techniques like IMRT and IGRT.

Intraoperative radiation therapy (IORT)

IORT is under evaluation as a palliative therapy in patients with locally advanced and unresectable cancer. Though IORT is reported to reduce pain and increase local control of the primary tumor no significant benefit in terms of overall survival is reported.

Brachytherapy

Brachtherapy with Ir¹⁹² and I¹²⁵ in patients with unresectable tumors was tried to gain local control of the tumor. In a study by Mohiddin et. al. it was reported that with brachytherapy with I¹²⁵, EBRT and chemoradiotherapy, 71% of the patients had a median survival of 12 months while it was 2 years for 21% of the patients. Preliminary studies with colloidal phosporus-32 are reported to be encouraging but more studies are needed for standardising the therapy.¹¹

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