Best Practices in the Multidisciplinary Management of Borderline Resectable and Unresectable Pancreatic Cancer as well as Extrahepatic/Perihilar Cholangiocarcinoma

Pancreato-biliary cancers, mainly pancreatic cancer and extrahepatic cholangiocarcinoma, are almost uniformly fatal malignancies with increasing incidence and poor prognosis even when diagnosed in the early stages of the disease. They remain a major therapeutic challenge despite the significant medical and surgical advances in the last two decades. Unfortunately, most of the patients present with locally advanced (unresectable) or metastatic disease. Systemic treatment options are limited to a number of systemic chemotherapy regimens, which have shown a modest survival benefit in global tumor population-based clinical studies. Radiation therapy paradigms continue to evolve with advancements in treatment modalities, delivery techniques, and combination approaches. Despite the advances, there continues to be a controversy on the role of radiation therapy in managing this disease. The complexity of patients with pancreatic cancer and extrahepatic cholangiocarcinoma requires a personalized and multidisciplinary approach to define how to best combine the different disciplines in each clinical situation. This activity discusses the current state of the art in the management of pancreato-biliary cancers with an emphasis on innovative therapeutic strategies.

Topics:

  1. Case Presentation and Best Practices in the Surgical Approach of Borderline Resectable and Unresectable Pancreatic Cancer and Extrahepatic Cholangiocarcinoma
    Nipun Merchant, MD, FACS
  2. Case Discussion and Borderline and Unresectable Pancreatic Cancer - Role of Ablative Therapies, including Focused Ultrasound and SBRT/SABR
    Joseph M. Herman, MD, MSc, MHCM
  3. Hypofractionation and Stereotactic Ablative (Body) Radiotherapy (SBRT/SABR) for Unresectable Perihilar and Distal Cholangiocarcinoma
    Alejandra Mendez Romero, MD, PhD
  4. Targeted Therapy and Immunotherapy in Pancreatic Cancer and Extrahepatic Cholangiocarcinoma
    Elena Gabriela Chiorean, MD, FASCO
  5. Q and A
    Higinia Rosa Cardenes, MD, PhD - Moderator
    Full Panel

This activity is available from June 17, 2025, through 11:59 p.m. Eastern time on June 16, 2027. 

The content was originally presented and recorded at the 2024 ASTRO Annual Meeting.

Target Audience

The activity is designed to meet the interests of medical oncologists, radiation oncologists, surgeons, physicists, nurses, diagnostic radiologists, pathologists, radiation therapists, radiation dosimetrists, radiation biologists, nutritional therapists and residents.

Learning Objectives

Upon completion of this activity, participants should be able to:

  • Determine how to better select patients with borderline and unresectable pancreatic cancer and extrahepatic cholangiocarcinoma for combined modality therapy.
  • Articulate what is the appropriate sequence of systemic and local therapies for borderline resectable pancreatic cancer.
  • Determine the most appropriate dose fractionation regimen and the role of ablative therapy in unresectable pancreatic cancer and extrahepatic cholangiocarcinoma.
Course summary
Available credit: 
  • 1.25 AMA PRA Category 1 Credit™

    The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council for Continuing Medical Education for physicians. ASTRO designates this Enduring material for a maximum of 1.25 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

  • 1.25 Certificate of Attendance
    This activity was designated for 1.25 AMA PRA Category 1 Credit™.
Course opens: 
06/17/2025
Course expires: 
06/16/2027
Cost:
$149.00
Rating: 
0
  • Higinia Rosa Cardenes, MD, PhD, is employed by Weill Cornell Medicine. 
  • Nipun Merchant, MD, FACS, is employed by University of Miami. 
  • Joseph M. Herman, MD, MS, MSHCM, is employed by Northwell, Department of Radiation Medicine. Dr. Herman is CMO and an independent contractor with the Canopy Cancer Collective. Dr. Herman is the medical director and receives stock and stock options with Histosonics.  
  • Alejandra Mendez Romero, MD, PhD, is employed by Erasmus MC Cancer Institute, University Medical Center Rotterdam. 
  • Elena Gabriela Chiorean, MD, FASCO, is employed by University of Washington/Fred Hutchinson Cancer Center. Dr. Chiorean receives grant/research funding from AfiniT, Lonza, Mirati and Erasca.

The person(s) above served as the developer(s) of this activity. Additionally, the ASTRO Education Committee had control over the content of this activity. All relevant financial relationships have been mitigated.

Disclosure link: 
ASTRO Education Committee

The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Available Credit

  • 1.25 AMA PRA Category 1 Credit™

    The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council for Continuing Medical Education for physicians. ASTRO designates this Enduring material for a maximum of 1.25 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

  • 1.25 Certificate of Attendance
    This activity was designated for 1.25 AMA PRA Category 1 Credit™.

Price

Cost:
$149.00
Please login or register to take this course.

Course Fees:
ASTRO members must log in to the ASTRO website to view and receive the member rate.

  • Nonmember: $149
  • Member: $99
  • Member-in-Training: $49
  • Student/Graduate Student/PGY-1 Member: $49
  • Postdoctoral Fellow Member: $49

If you are an ASTRO member from a low or lower-middle income country, as identified by the World Bank, you can receive a 50% discount off your corresponding registration for this activity. Please email [email protected] to inquire about the discount.

Policies:
No refunds, extensions, or substitutions will be made for those participants who, for any reason, have not completed the activity by the expiration date. 

Participants using ASTRO Academy activities to satisfy the requirement of a Continuing Certification (MOC) program should verify the credit number and type and availability dates of any activity before making a purchase. No refunds, extensions, or substitutions will be made for participants who have purchased activities that do not align with their MOC requirement.

The activity and its materials will only be available on the ASTRO website until June 16, 2027, regardless of purchase date. At the expiration of the activity, participants will no longer have access to the activity or its materials. ASTRO reserves the right to remove an activity before its expiration date. 

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