Pain Relief after Stereotactic Radiotherapy of Pancreatic Adenocarcinoma: An Updated Systematic Review

Abstract

Severe pain is frequent in patients with locally advanced pancreatic ductal adenocarcinoma (PDCA). Stereotactic body radiotherapy (SBRT) provides high local control rates in these patients. The aim of this review was to systematically analyze the available evidence on pain relief in patients with PDCA. We updated our previous systematic review through a search on PubMed of papers published from 1 January 2018 to 30 June 2021. Studies with full available text, published in English, and reporting pain relief after SBRT on PDCA were included in this analysis. Statistical analysis was carried out using the MEDCALC statistical software. All tests were two-sided. The I2 statistic was used to quantify statistical heterogeneity (high heterogeneity level: >50%). Nineteen papers were included in this updated literature review. None of them specifically aimed at assessing pain and/or quality of life. The rate of analgesics reduction or suspension ranged between 40.0 and 100.0% (median: 60.3%) in six studies. The pooled rate was 71.5% (95% CI, 61.6–80.0%), with high heterogeneity between studies (Q2 test: p < 0.0001; I2 = 83.8%). The rate of complete response of pain after SBRT ranged between 30.0 and 81.3% (median: 48.4%) in three studies. The pooled rate was 51.9% (95% CI, 39.3–64.3%), with high heterogeneity (Q2 test: p < 0.008; I2 = 79.1%). The rate of partial plus complete pain response ranged between 44.4 and 100% (median: 78.6%) in nine studies. The pooled rate was 78.3% (95% CI, 71.0–84.5%), with high heterogeneity (Q2 test: p < 0.0001; I2 = 79.4%). A linear regression with sensitivity analysis showed significantly improved overall pain response as the EQD2α/β:10 increases (p: 0.005). Eight papers did not report any side effect during and after SBRT. In three studies only transient acute effects were recorded. The results of the included studies showed high heterogeneity. However, SBRT of PDCA resulted reasonably effective in producing pain relief in these patients. Further studies are needed to assess the impact of SBRT in this setting based on Patient-Reported Outcomes.

A 15-Year Single-Institution Retrospective Study of Primary Pancreatic Cancer Treated with Non-Ablative Palliative Radiotherapy

“…And that the almost identical time to local progression could probably be due to the overlapping values of the biologically effective doses used in those two groups. Stereotactic radiotherapy given in short duration regimens may have a useful role to play in ensuring local control among patients with locally advanced pancreatic cancer with a more favorable prognoses, or even in elderly patients and those with a more tenuous performance status, so long as the treatment goals and acceptable risks are aligned between the patient and their care teams [ 24 , 25 , 26 , 27 , 28 , 29 , 30 ].…”

Application effect of PDCA circulation on nursing quality management and risk control in digestive endoscopy room

“…Inserting digestive endoscope into the body can reduce the body's defense ability and increase the risk of infection after examination, so it is necessary to strengthen risk management. [26][27][28] With the development of current medical management models, PDCA cycle model management is gradually applied to clinical management, which can not only reduce nursing risks and nursing error events, but also improve nursing quality. [29,30] During the implementation of the PDCA cycle model, first, evaluate the existing problems in nursing, develop reasonable intervention plans based on the evaluation results, target and address nursing problems through regular or irregular inspections, and then conduct PDCA management again to improve the risk management awareness of nursing personnel through a step-by-step model.…”

Stereotactic Body Radiotherapy (SBRT) of Pancreatic Cancer—A Critical Review and Practical Consideration

“…A recent systematic review by Buwenge et al (2020) [ 94 ] analyzed 19 papers reporting pain relief after SBRT. The rate of analgesic reduction or discontinuation ranged between 40 and 100% (median 60.3%) in six studies.…”