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

Ji, Xiaoqin; Zhao, Yulu; He, Chenglong; Han, Siqi; Zhu, Xiaodong; Shen, Zetian; Chen, Cheng; Chen, Xiaoyuan

doi:10.3389/fonc.2021.659987

Cited by 11 publications

(20 citation statements)

References 30 publications

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“…Given the small number of patients, the presence of local interventions in our cohort was not seen to reflect an improvement in OS. This conflicts with other recent publications that have introduced this hypothesis 25 . However, our group of patients who underwent local interventions was very small, and therefore the findings in this cohort are not reliably interpretable.…”

Section: Discussioncontrasting

confidence: 95%

“…This conflicts with other recent publications that have introduced this hypothesis. 25 However, our group of patients who underwent local interventions was very small, and therefore the findings in this cohort are not reliably interpretable.…”

Section: Discussionmentioning

confidence: 83%

“…While we are not ready to endorse this approach, excellent local control can be obtained with SBRT in oligometastatic pancreatic cancer, with an impressive median OS of 23 months 26 . These results were also seen in a retrospective cohort from China 25 . These encouraging results suggest that PDAC may harbor an oligometastatic state in a very carefully selected subset of patients.…”

Section: Discussionmentioning

confidence: 84%

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Characterization of an oligometastatic state in patients with metastatic pancreatic adenocarcinoma undergoing systemic chemotherapy

de Ortiz de Choudens,

Visotcky,

Banerjee

et al. 2023

Cancer Medicine

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Purpose/ObjectivesMost patients with pancreatic adenocarcinoma (PDAC) will present with distant metastatic disease at diagnosis. We sought to identify clinical characteristics associated with prolonged overall survival (OS) in patients presenting with metastatic PDAC.Materials/MethodsPatients presenting with metastatic PDAC that received treatment at our institution with FOLFIRINOX or gemcitabine‐based chemotherapies between August 1, 2011 and September 1, 2017 were included in the study. Metastatic disease burden was comprehensively characterized radiologically via individual diagnostic imaging segmentation. Landmark analysis was performed at 18 months, and survival curves were estimated using the Kaplan–Meier method and compared between groups via the log‐rank test. ECOG and Charlson Comorbidity Index (CCI) were calculated for all patients.Results121 patients were included with a median age of 62 years (37–86), 40% were female, 25% had ECOG 0 at presentation. Of the 121 patients included, 33% (n = 41) were alive at 12 months and 25% (n = 31) were alive at 18 months. Landmark analysis demonstrated a significant difference between patients surviving <18 months and ≥18 months regarding the presence of lung only metastases (36% vs. 16%, p = 0.04), number of organs with metastases (≥2 vs. 1, p = 0.04), and disease volume (mean of 19.1 cc vs. 1.4 cc, p = 0.04). At Year 1, predictors for improved OS included ECOG status at diagnosis (ECOG 0 vs. ECOG 1, p = 0.04), metastatic disease volume at diagnosis (≤0.1 cc vs. >60 cc, p = 0.004), metastasis only in the liver (p = 0.04), and normalization of CA 19‐9 (p < 0.001). At Year 2, the only predictor of improved OS was normalization of the CA 19‐9 (p = 0.03). In those patients that normalized their CA 19‐9, median overall survival was 16 months.ConclusionsIn this exploratory analysis normalization of CA‐19‐9 or volumetric metastatic disease burden less than 0.2 cc demonstrated a remarkable OS, similar to that of patients with non‐metastatic disease. These metrics are useful for counseling patients and identifying cohorts that may be optimal for trials exploring metastatic and/or local tumor‐directed interventions.

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Section: Discussioncontrasting

confidence: 95%

Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 84%

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Characterization of an oligometastatic state in patients with metastatic pancreatic adenocarcinoma undergoing systemic chemotherapy

de Ortiz de Choudens,

Visotcky,

Banerjee

et al. 2023

Cancer Medicine

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“… Forest plots of pooled analyses regarding progression-free survival, including all studies (A), studies with reliable comparability (B), and randomized controlled trials (C) [ 6 – 8 , 20 – 22 , 25 – 28 , 31 – 33 , 35 , 36 , 38 , 39 , 42 , 43 , 46 – 48 , 50 , 52 – 54 , 56 , 58 – 60 , 62 – 64 , 66 , 67 , 69 – 71 , 73 ]. HCC, hepatocellular carcinoma; H&N, head and neck; LCT, local consolidative therapy; NSCLC, non-small cell lung cancer; RCC, renal cell carcinoma; SCLC, small cell lung cancer; 5ySSFS, 5-year second-line systemic therapy free survival.…”

Section: Figmentioning

confidence: 99%

Role of Local Treatment for Oligometastasis: A Comparability Based Meta-Analysis

et al. 2022

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We intend to investigate the oncological efficacy and feasibility of local consolidative therapy (LCT) through a meta-analysis method. Materials and MethodsFour databases including Pubmed, Medline, Embase, and Cochrane library were searched.Target studies are controlled trials comparing outcomes of LCT versus a control group. Primary endpoints are overall survival (OS) and progression-free survival (PFS). ResultsA total of 54 studies involving 7,242 patients were included. Pooled analyses showed that the LCT arm could achieve improved OS with pooled odds ratio of 2.896 (95% CI [confidence interval]: 2.377-3.528, p<0.001). Regarding PFS, pooled analyses showed pooled odds ratio of 3.045 (95% CI: 2.356-3.937, p<0.001) in favor of the LCT arm. In the subgroup analyses including the studies with reliable comparability (e.g. randomized studies or intentionally matched studies without significant favorable prognosticator in LCT arms), pooled odds ratio was 2.548 (95% CI: 1.808-3.591, p<0.001) favoring the LCT arm regarding OS. Regarding PFS, pooled OR was 2.656 (95% CI: 1.713-4.120, p<0.001) which also favored the LCT arm.Subgroup analyses limited to the randomized controlled trials (RCT) were also performed and pooled odds ratios on OS and PFS were 1.535 (95% CI: 1.082-2.177, p=0.016) and 1.668 (95% CI: 1.187-2.344, p=0.003). The rates of grade ≥3 complications related to LCT was mostly low (<10%) and not significantly higher compared to the control arm. ConclusionPooled analyses results of all included studies, selected studies with reliable comparability, and RCT's demonstrated the survival benefit of LCT. These consistent results suggest that LCT was beneficial to the patients with oligometastasis.

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“…The pancreas is a retroperitoneal organ with a relatively xed position, which makes it easier to deliver precision radiotherapy. Research shows that radiotherapy for patients with oligometastatic pancreatic cancer can not only relieve obstruction, compression, or pain but also improve local tumor control, thus prolonging the overall survival of patients [13][14][15]. But most of them are single-center, small samples, With high heterogeneity.…”

Section: Introductionmentioning

confidence: 99%

The effects of radiotherapy and prognostic nomogram for pancreatic cancer patients with liver-only metastases

Liu,

Yang,

Peng

et al. 2024

Preprint

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Background: This study aimed to investigate the effect of radiotherapy on pancreatic cancer patients with liver metastasis only, and to establish a prognostic model. Methods: Pancreatic cancer patients with liver-only metastases were obtained from 2010 to 2019 in the Surveillance, Epidemiology, and End Results (SEER) database. Then they were divided into a radiotherapy group and a non-radiotherapy group. Cancer-specific survival (CSS) before and after propensity score matching(PSM) was compared between the two groups. The radiotherapy group was then divided into training and validation cohorts. The prognostic nomogram for 6-, and 12-mouth CSS was constructed based on the training set. In addition, 38 patients were recruited from our hospital as an external validation set. The calibration curves, receiver operating characteristic (ROC) curve, Harrell’s concordance index (C-index), decision curve analysis (DCA), and Kaplan-Meier analysis based on risk stratification were performed to evaluate and verify this model. Results: A total of 17453 patients with hepatic oligometastatic pancreatic cancer were included, of which 622 ( 3.6 % ) received radiotherapy and 16831 ( 96.4 % ) did not. Radiotherapy can significantly prolong survival time [median CSS: 8 months vs 5 months (HR, 0.716; 95%CI=0.655–0.783; p<0.001)]. After PSM, similar results can be obtained [median CSS: 8 months vs 7 months (HR, 0877; 95% CI=0.772–0.997; P=0.045)]. Independent prognostic factors in radiotherapy patients included age, race, histology, N staging, surgery, and chemotherapy. The ROC, C-index and Calibration curves showed good discrimination and calibration. DCA and KM curves further demonstrated the model's clinical applicability. Conclusion: Radiotherapy significantly improves survival compared to non-radiotherapy. Patients younger than 70 years old, non-black, with no lymph node metastasis, primary tumor surgery, and systemic chemotherapy have better prognosis. Finally, we developed and validated a model for prognostication and patient counseling.

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

Cited by 11 publications

References 30 publications

Characterization of an oligometastatic state in patients with metastatic pancreatic adenocarcinoma undergoing systemic chemotherapy

Characterization of an oligometastatic state in patients with metastatic pancreatic adenocarcinoma undergoing systemic chemotherapy

Role of Local Treatment for Oligometastasis: A Comparability Based Meta-Analysis

The effects of radiotherapy and prognostic nomogram for pancreatic cancer patients with liver-only metastases

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