The resolution is the highest of the three 3D modalities, approaching the limit of resin-embedded sections: the glycocalyx was clear and the fibre spacings discernible, but the missing angles in the tilt series were a limiting factor in the z direction.
Even with this multi-modality approach, the median survival is only around 14 months with early recurrences primarily found in the brain.
Further, the use of combined modality approaches in pancreatic cancer is associated with increased gastrointestinal toxicity [ 16].
The majority of patients included in current study were not, however, candidates for combined modality approaches, in particular to curative therapy (as clearly specified by the inclusion criteria).
In our experience, combined modality approaches generally provide high local RC rates but are associated with suboptimal functional outcomes.
There is no consensus on the management of locally advanced pancreatic cancer, with either chemotherapy or combined modality approaches being employed (Maheshwari and Moser, 2005).
There are some reports of combined modality approaches including chemotherapy and surgery, but many reports included stage IV disease and/or thymic carcinoma histology (Berruti et al, 1999; Kim et al, 2004; Lucchi et al, 2006; Yokoi et al, 2007).
Therefore, a significant change has occurred in the last decade in the areas of interest regarding environmental catalysts and in the modality of approaching the research.
However, toxicities also increase in the combined modality approach so a major part of the respective patients are unfit to receive this combined treatment.
The hybrid modality approach provides information from different methods while using the same isocentre, resulting in sufficient spatial orientation and temporal realignment [ 21].
The rationale behind the combined modality approach is that radiotherapy provides local tumor eradication while chemotherapy reduces micrometastatic foci and is a radiosensitizer.
