Chemotherapy in combination with stereotactic body radiation therapy (SBRT) for oligometastatic pancreatic cancer

Abstract

Metastatic pancreatic cancer is characterised by poor prognosis. High toxicity of chemotherapy limits its use in elderly patients with severe comorbidities. Meanwhile, in metastatic disease, local treatment did not show the positive effect on life expectancy. We present a clinical case of a 72-year-old woman with metastatic pancreatic adenocarcinoma tumour, node, metastases (T3N0M1) (according to the seventh TNM classification of the International Union Against Cancer). Chemotherapy led to partial response, but later was stopped due to severe toxicity. Thereafter, consolidating radiosurgical treatment was performed. Dose to pancreatic and liver lesions was 35 Gy in five fractions. After 9 months, only one liver lesion and primary pancreatic tumour, stable in size were determined by MRI. At present time, the patient is alive and in good condition, the disease is stable 50 months after stereotactic body radiation therapy (SBRT). SBRT provides a high level of local control and in combination with systemic treatment can potentially increase survival.

Prophylactic dendritic cell vaccination controls pancreatic cancer growth in a mouse model

“…PDAC recurrence rate after surgical resection is up to 60% in the first year, and 5-year survival of patients who underwent complete resection is only 25% (3). Nonsurgical therapies for PDAC include systemic chemotherapies (4-7), molecularly-targeted therapies (8), conventional ablative therapies (9)(10)(11)(12)(13), and radiotherapy (14)(15)(16)(17); however, they have so far offered little or no survival benefit (4,6,7,11,17).…”

Liver Metastasis–Directed Ablative Radiotherapy in Pancreatic Cancer Offers Prolonged Time Off Systemic Therapy in Selected Patients

“…24 Given the poor prognosis of patients with MPC and commonly widespread systemic disease, only a few studies evaluating the role of radical local therapy for MPC exist. [25][26][27][28] These studies mostly involve the treatment of LM, which are the most frequent (80%-85%) distant metastases in MPC. 2,[4][5][6] In a retrospective analysis by Hackert et al, 25 128 MPC patients underwent radical resection of LM (n = 85) or interaortocaval lymph node metastases (n = 43) and had a favorable median OS of 12.3 months, suggesting a role of radical local therapy for metastases in MPC.…”

“…Given the poor prognosis of patients with MPC and commonly widespread systemic disease, only a few studies evaluating the role of radical local therapy for MPC exist 25–28 . These studies mostly involve the treatment of LM, which are the most frequent (80%–85%) distant metastases in MPC 2,4–6 .…”