Stereotactic Body Radiotherapy in the Treatment of Advanced Adenocarcinoma of the Pancreas

Department of Radiation Oncology, Division of Surgical Oncology, University of Pittsburgh Cancer Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15232, USA.
American journal of clinical oncology (Impact Factor: 3.06). 03/2010; 34(1):63-9. DOI: 10.1097/COC.0b013e3181d270b4
Source: PubMed


The aim of the study was to assess the feasibility and safety of stereotactic body radiotherapy (SBRT) in patients with advanced pancreatic adenocarcinoma.
We reviewed outcomes of 71 patients treated with SBRT for pancreatic cancer between July 2004 and January 2009. Forty patients (56%) had locally unresectable disease, 11 patients (16%) had local recurrence following surgical resection, 8 patients (11%) had metastatic disease, and 12 patients (17%) received adjuvant SBRT for positive margins. The median dose was 24 Gy (18-25 Gy), given in a single-fraction SBRT (n = 67) or fractionated SBRT (n = 4). Kaplan-Meyer survival analyses were used to estimate freedom from local progression (FFLP) and overall survival (OS) rates.
The median follow-up among surviving patients was 12.7 months (4-26 months). The median tumor volume was 17 mL (5.1-249 mL). The overall FFLP rates at 6 months/1 year were 71.7%/48.5%, respectively. Among those with macroscopic disease, FFLP was achieved in 77.3% of patients with tumor size <15 mL (n = 22), and 59.5% for ≥15 mL (n = 37) (P = 0.02). FFLP was achieved in 73% following 24 to 25 Gy, and 45% with 18 to 22 Gy (P = 0.004). The median OS was 10.3 months, with 6 month/1 year OS rates of 65.3%/41%, respectively. Grade 1-2 acute and late GI toxicity were seen in 39.5% of patients. Three patients experienced acute grade 3 toxicities.
SBRT is feasible, with minimal grade ≥3 toxicity. The overall FFLP rate for all patients was 64.8%, comparable to rates with external beam radiotherapy. This shorter treatment course can be delivered without delay in adjuvant systemic therapy.

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Available from: Jean-Claude M Rwigema, Jan 25, 2015
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    • "We also showed that SBRT is effective in achieving symptom relief. Nine out of 11 patients who initially presented at the time of SBRT with abdominal pain and 3/5 patients who presented with back pain reported symptom relief after SBRT, which is comparable with the 13/16 patients in Rwigema et al.’s study who presented with symptoms of pain and reported complete pain relief shortly after SBRT [12]. In addition, we achieved symptom relief for most patients who presented with anorexia, weight loss, jaundice, or nausea. "
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    ABSTRACT: Treatment of pancreatic adenocarcinoma in the elderly is often complicated by comorbidities that preclude surgery, chemotherapy and/or conventional external beam radiation therapy (EBRT). Stereotactic body radiotherapy (SBRT) has thus garnered interest in this setting. A retrospective review of 26 patients of age [greater than or equal to] 80 with pancreatic adenocarcinoma treated with definitive SBRT+/-chemotherapy from 2007--2011 was performed. Twenty-seven percent of patients were stage I, 38% were stage II, 27% were stage III and 8% were stage IV. Patients most commonly received 24Gy/1 fraction or 30-36Gy/3 fractions. Kaplan-Meier was used to estimate overall survival (OS), local control (LC), cause specific survival (CSS) and freedom-from-metastatic disease (FFMD). The median age was 86 (range 80--91), and median follow-up was 11.6 months (3.5-24.6). The median planning target volume was 21.48 cm3 (6.1-85.09). Median OS was 7.6 months with 6/12 month OS rates of 65.4%/34.6%, respectively. Median LC was 11.5 months, 6-month and 12-month actuarial LC rates were 60.1% and 41.2%, respectively. There were no independent predictors for LC, but there was a trend for improved LC with prescription dose greater than 20Gy (p = 0.063). Median CSS was 6.3 months, and 6-month and 12-month actuarial CSS were 53.8% and 23.1%, respectively. Median FFMD was 8.4 months, and 6-month and 12-month actuarial rates were 62.0 and 41.4%, respectively. Nine patients (47%) had local failures, 11 (58%) had distant metastasis, and 7 (37%) had both. There were no acute or late grade 3+ toxicities. Definitive SBRT is feasible, safe and effective in elderly patients who have unresectable disease, have comorbidities precluding surgery or decline surgery.
    Radiation Oncology 10/2013; 8(1):240. DOI:10.1186/1748-717X-8-240 · 2.55 Impact Factor
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    • "Recently, the encouraging results of SBRT applied to primary and secondary lesions of the lung and liver and other various sites [7,17-24], indeed, promoted several studies on hypo-fractionation technique in pancreatic cancer, as shown in Table 3. Although many of these studies were performed on a small cohort of patients whose characteristics were not always homogeneous, improvement of local control was relevant, with a success rate of 70-90% [8-16]. In the Phase II trial of Schellemberg et al, FFLP rate was 94% at 1 year and 80% at 2 years [12]. "
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    ABSTRACT: To assess the efficacy and safety of stereotactic body radiotherapy (SBRT) in patients with either unresectable locally advanced pancreatic adenocarcinoma or by locally recurrent disease after surgery. Between January 2010 and October 2011, 30 patients with unresectable or recurrent pancreatic adenocarcinoma underwent exclusive SBRT. Twenty-one patients (70%) presented with unresectable locally advanced disease and 9 patients (30%) showed local recurrence after surgery. No patients had metastatic disease. Gemcitabine-based chemotherapy was administered to all patients before SBRT. Prescription dose was 45Gy in 6 daily fractions of 7.5Gy. SBRT was delivered using the volumetric modulated arc therapy (VMAT) by RapidArc. Primary end-point of this study was freedom from local progression (FFLP), secondary end-points were overall survival (OS), progression free survival (PFS) and toxicity. Median Clinical Target Volume (CTV) was 25.6 cm3 (3.2-78.8 cm3) and median Planning Target Volume (PTV) was 70.9 cm3 (20.4- 205.2 cm3). The prescription dose was delivered in 25 patients (83%), in 5 patients (17%) it was reduced to 36Gy in 6 fractions not to exceed the dose constraints of organs at risk (OARs). Median follow-up was 11 months (2--28 months). FFLP was 91% at 6 months, 85% at median follow-up and 77% at 1 and 2 years. For the group with prescription dose of 45Gy, FFLP was 96% at 1 and 2 years. The median PFS was 8 months. The OS was 47% at 1 year and median OS was 11 months. At the end of the follow-up, 9 patients (32%) were alive and 4 (14%) were free from progression. No patients experienced G >= 3 acute toxicity. Our preliminary results show that SBRT can obtain a satisfactory local control rate for unresectable locally advanced and recurrent pancreatic adenocarcinoma. This fractionation schedule is feasible, and no G >= 3 toxicity was observed. SBRT is an effective emerging technique in the multi-modality treatment of locally advanced pancreatic tumors.
    Radiation Oncology 06/2013; 8(1):148. DOI:10.1186/1748-717X-8-148 · 2.55 Impact Factor
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    • "SBRT techniques rely on image-guided radiotherapy (IGRT) to allow radiation dose escalation to tumors while simultaneously minimizing the dose to surrounding normal tissue through the use of radiographic imaging to verify target delineation and treatment delivery. Prospective phase I and phase II studies3839 and two retrospective studies4041 show that SBRT is a safe and effective approach for treating patients with PC. In addition, hypofractionated SBRT can be effectively delivered with acceptable side effects and minimal interference to gemcitabine chemotherapy.42 "
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    ABSTRACT: Endoscopic ultrasound (EUS) can help diagnose diseases with high accuracy because it overcomes the limitations of gastrointestinal gas and abdominal fat. The emergence of curved linear-array echoendoscopy has significantly promoted the applications of the technique to new levels. The advancement has appeared from EUS imaging to EUS-guided fine needle aspiration, drainage and injection. Computed tomography and magnetic resonance imaging present certain limitations for diagnosing pancreatic tumors due to the specificity of the location of such growths. In addition, traditional chemotherapy does not show ideal results because pancreatic cancer (PC) exhibits hypovascular characteristics. Interventional EUS can overcome these limitations and has potential to become the mainstream method of PC local treatment in the future. This paper reviews the use of interventional EUS in the treatment of PC based on previous studies.
    03/2013; 2(4):181-189. DOI:10.4103/2303-9027.121238
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