This look back at outcomes for 211 patients receiving chemoradiation for unresectable pancreatic cancer makes the interesting observation that the presence of a biliary stent was strongly associated with developing a GI bleed after treatment, which was the most common late toxicity observed. The underlying pathophysiology of this link remains unclear, though the authors propose that chronic stent irritation may predispose to radiation-accelerated GI ulceration. Another more techy explanation is that high-Z stents may be unknowingly enhancing radiation dose to adjacent tissue. A final take away from the study is that IMRT resulted in notably less nausea than 3D-conformal treatment. | Das, Adv Radiat Oncol 2023
