Patient Presentation

A 63-year-old female was diagnosed with a resectable pancreatic adenocarcinoma. She was treated with surgery and postoperative chemotherapy. A few months later, surveillance imaging demonstrated a solitary liver lesion which was biopsied and revealed metastatic disease. She received additional systemic therapy with no significant response. The patient was referred for consideration of radiation treatment.

Treatment:

Radiation therapy was recommended to optimize her local control and prevent further tumor progression. Proton therapy was recommended given the proximity of the lesion to the heart as well as her remote history of prior radiation therapy for treatment of Hodgkin’s lymphoma. Proton stereotactic radiation therapy was the preferred treatment modality to precisely deliver high radiation dose to the tumor while better spare her normal liver as well as surrounding organs at risk as demonstrated in Figure 1.

Outcome

The patient completed her treatment course of 5 fractions. She tolerated her treatment exceedingly well and returned to her medical oncology team for continued systemic therapy.

Figure 1 depicts treatment plan comparisons. The radiation dose distribution shows complete avoidance of the heart and pericardium with protons (LEFT) versus photons (RIGHT).