Five-Fraction Stereotactic Body Radiation Therapy (SBRT) and Chemotherapy for the Local Management of Metastatic Pancreatic Cancer

Lischalk, Jonathan W.; Burke, Aidan M.; Chew, Jessica; Elledge, C.R.; Gurka, Marie Kate; Marshall, John L.; Pishvaian, Michael J.; Collins, Sean P.; Unger, Keith

doi:10.1007/s12029-016-9909-2

Cited by 25 publications

(14 citation statements)

References 23 publications

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“…Due to the inherent toxic nature of chemotherapy, using a lesser dose of FX therapy reduces toxicity and, in our model, was more effective than full dose chemotherapy. Our preclinical toxicity observations are supported by clinical retrospective studies demonstrating that concurrent administration of SBRT and chemotherapy achieved effective local tumor control with minimal/well tolerated toxicity (52)(53)(54). The concurrent dosing regimen reported here is expected to promote an optimal immune response as SBRT utilizes fewer fractions than conventional radiotherapy meaning that radiosensitive antitumor lymphocytes are likely not destroyed by the repeated radiation fractions given in the conventional schedule.…”

Section: Adaptive Immunity Phase (Bottom Of Figure 7c)supporting

confidence: 57%

Assessing the Magnitude of Immunogenic Cell Death Following Chemotherapy and Irradiation Reveals a New Strategy to Treat Pancreatic Cancer

Mills

Zhao

et al. 2020

Cancer Immunology Research

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Pancreatic ductal adenocarcinoma (PDAC) continues to have a dismal prognosis in part due to ineffective treatment strategies. The efficacy of some chemotherapies and especially radiotherapy are mediated partially by the immune system. Therefore, we hypothesized that profiling the immune response following chemotherapy and/or irradiation can be used as a readout for treatment efficacy, but also to help identify optimal therapeutic schedules for PDAC. Using murine models of PDAC, we demonstrated that concurrent administration of stereotactic body radiotherapy (SBRT) and a modified dose of FOLFIRINOX (mFX) resulted in superior tumor control when compared to single or sequential treatment groups. Importantly, this combined treatment schedule enhanced the magnitude of immunogenic cell death, which in turn amplified tumor antigen presentation by dendritic cells and intratumoral CD8 + T cell infiltration. Concurrent therapy also resulted in systemic immunity contributing to the control of established metastases. These findings provide rationale for pursuing concurrent treatment schedules of SBRT with mFX in PDAC.

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Section: Adaptive Immunity Phase (Bottom Of Figure 7c)supporting

confidence: 57%

Assessing the Magnitude of Immunogenic Cell Death Following Chemotherapy and Irradiation Reveals a New Strategy to Treat Pancreatic Cancer

Mills

Zhao

et al. 2020

Cancer Immunology Research

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“…There have been few studies investigating the role of SBRT in the local control of primary tumors of metastatic pancreatic cancer. Lischalk et al (24) analyzed 20 patients with pathologically diagnosed metastatic adenocarcinoma of the pancreas. SBRT was conducted on the primary pancreatic tumor in five fractions to a total dose of 25-30 Gy.…”

Section: Discussionmentioning

confidence: 99%

Clinical Effects of Stereotactic Body Radiation Therapy Targeting the Primary Tumor of Liver-Only Oligometastatic Pancreatic Cancer

Zhao

et al. 2021

Front. Oncol.

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AimTo investigate the efficacy and safety of stereotactic body radiotherapy (SBRT) targeting the primary tumor for liver-only oligometastatic pancreatic cancer.MethodsWe compared the efficacy and safety of SBRT plus chemotherapy with chemotherapy alone in patients with liver-only oligometastatic pancreatic cancer. The populations were balanced by propensity score-weighted and propensity score-matched analyses based on baseline variables. The primary outcome was overall survival (OS). The secondary outcomes included progression free survival (PFS), local progression, metastatic progression and symptomatic local control.ResultsThis is a retrospective study of 89 pancreatic cancer patients with liver-only oligometastasis. Overall, 34 (38.2%) and 55 (61.8%) patients received SBRT plus chemotherapy and chemotherapy alone, respectively. After propensity score matching, 1-year OS rate was 34.0% (95%CI, 17.8-65.1%) in the SBRT plus chemotherapy group and 16.5% (95%CI, 5.9-46.1%) in chemotherapy alone group (P=0.115). The 6-month PFS rate was 29.4% (95%CI, 15.4-56.1) in SBRT plus chemotherapy and 20.6% (95%CI, 8.8-48.6) in chemotherapy alone group (P=0.468), respectively. Further subgroup analysis indicated that the addition of SBRT improved OS in patients with primary tumor located in the head of pancreas (stratified HR, 0.28; 95% CI, 0.09 to 0.90) or good performance status (stratified HR, 0.24; 95% CI, 0.07 to 0.86). In terms of disease control, SBRT delayed local progression of pancreas (P=0.008), but not distant metastatic progression (P=0.56). Besides, SBRT offered significant abdominal/back pain relief (P=0.016) with acceptable toxicities.ConclusionsThe addition of SBRT to chemotherapy in patients with liver-only oligometastatic pancreatic cancer improves the OS of those with primary tumor located in the head of pancreas or good performance status. In addition, it is a safe and effective method for local progression control and local symptomatic palliation in patients with metastatic pancreatic cancer.

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“…[ 28 , 29 ] Notably, combining an esophagectomy with a pancreaticoduodenectomy requires advanced planning and efficient coordination between both thoracic and hepatobiliary surgeons. A short course of radiation therapy with SBRT may also be a reasonable option to maximize local control with very little toxicity in oligometastatic PDAC, [ 24 , 26 , 27 , 30 ] especially in cases in which a break from systemic therapy is necessary due to intolerability.…”

Section: Discussionmentioning

confidence: 99%

A rare case of esophageal metastasis from pancreatic ductal adenocarcinoma: a case report and literature review

et al. 2017

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PurposeWe report a very unique case of an esophageal metastasis from a pancreatic ductal adenocarcinoma (PDAC) primary.MethodsAfter obtaining consent from the patient, all relevant records of the case were obtained and retrospectively reviewed.ResultsAt presentation, the patient was diagnosed with synchronous pancreatic and esophageal cancer. He received six months of neoadjuvant therapy including FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) and stereotactic body radiation therapy (SBRT) to the pancreatic tumor followed by a combined pancreaticoduodenectomy and Ivor Lewis esophagectomy. Review of the final esophageal specimen revealed normal overlying squamous mucosa with an underlying focus of metastatic PDAC. The patient remains alive with no evidence of disease 17 months from surgery and 25 months from diagnosis.ConclusionsDifferentiating an esophageal metastasis from a PDAC primary versus a synchronous esophageal carcinoma is very difficult despite state-of-the-art diagnostic techniques performed at a high-volume tertiary cancer center. Extensive evaluation and continued follow-up of PDAC patients presenting with a synchronous esophageal lesion in a multidisciplinary setting may help ensure efficient and accurate management. In our case, neoadjuvant FOLFIRINOX and SBRT to the primary PDAC tumor followed by surgery has been an effective approach for this patient.

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Five-Fraction Stereotactic Body Radiation Therapy (SBRT) and Chemotherapy for the Local Management of Metastatic Pancreatic Cancer

Cited by 25 publications

References 23 publications

Assessing the Magnitude of Immunogenic Cell Death Following Chemotherapy and Irradiation Reveals a New Strategy to Treat Pancreatic Cancer

Assessing the Magnitude of Immunogenic Cell Death Following Chemotherapy and Irradiation Reveals a New Strategy to Treat Pancreatic Cancer

Clinical Effects of Stereotactic Body Radiation Therapy Targeting the Primary Tumor of Liver-Only Oligometastatic Pancreatic Cancer

A rare case of esophageal metastasis from pancreatic ductal adenocarcinoma: a case report and literature review

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