Prognostic role of stereotactic body radiation therapy for elderly patients with advanced and medically inoperable pancreatic cancer

Abstract

The role of stereotactic body radiation therapy for the elderly with advanced or medically inoperable pancreatic cancer was still debated. Therefore, we evaluated the value of stereotactic body radiation therapy and its association with survival of those patients. A total of 417 elderly patients were retrospectively reviewed from 2012 to 2015. Overall survival (OS), progression‐free survival (PFS), local recurrence‐free survival (LRFS), distant metastasis‐free survival (DMFS), and toxicities were analyzed. Prescription doses ranged from 30–46.8 Gy in 5–8 fractions. Median age was 73 years old. Median OS, PFS, LRFS, and DMFS were 10, 8, 10, and 9.5 months, respectively. One‐year OS, PFS, LRFS, and DMFS rate were 35.5%, 18.2%, 26.6%, and 27.1%, respectively. Tumor stage and tumor response at 6 months and CA19‐9 levels normalization at 3 months after treatment were independent predictors of OS, PFS, LRFS, and DMFS. Patients with early‐stage cancer, better tumor response, and normalization of CA19‐9 levels had significantly longer OS, PFS, LRFS, and DMFS. Patients with the prodrug of 5‐FU and radiotherapy had longer survival than those with gemcitabine‐based chemotherapy and radiotherapy. Patients who received BED 10 ≥ 60 Gy achieved better tumor response compared with those who received BED 10 < 60 Gy. Two patients had grade 4 intestinal strictures. No grade 3 or higher hematologic toxicities occurred. Stereotactic body radiation therapy is safe and effective for elderly patients with advanced or medically inoperable pancreatic cancer. Early efficacy could be predictive of prognosis. Higher doses may be associated with efficacy but need further investigation.

Prospective analysis of different combined regimens of stereotactic body radiation therapy and chemotherapy for locally advanced pancreatic cancer

“…The protocol of SBRT was similar to our previous studies . SBRT was delivered via CyberKnife ® (Accuray Incorporated, Sunnyvale, CA), an image‐guided frameless stereotactic robotic radiosurgery system.…”

Short-term outcomes and clinical efficacy of stereotactic body radiation therapy (SBRT) in treatment of adrenal gland metastases from lung cancer

“…Given the real-time tracking, beam angles could be simultaneously corrected intrafractionally via pre-identified patient’s breathing patterns [ 10 ]. Despite the previous employment of SBRT in the lung cancer, pancreatic cancer, prostate cancer and liver cancer [ 11 – 14 ], few studies investigated the management of AGMs from lung cancer with SBRT. The aim of this retrospective study was to assess the efficacy and safety of SBRT for AGMs from lung cancer.…”

Health-related quality of life for gemcitabine and nab-paclitaxel plus radiotherapy versus gemcitabine and S-1 plus radiotherapy in patients with metastatic pancreatic cancer

“…Amelioration of symptoms, especially abdominal pain, should be given the priority in the treatment for metastatic pancreatic cancer, which was the aim of radiotherapy in addition to local control. Though our previous studies elucidated that BED 10 ≥60 Gy was predictive of tumor response, 5 and Krishnan et al 31 showed that patients with BED 10 >70 Gy had a superior OS, no studies have confirmed the correlation between radiation doses and alleviation of pain. However, better response to the treatment resulting from higher BED 10 indicated potential eradication of primary lesions, which may contribute to the remission of local symptoms.…”

“…The protocol of SBRT was similar to our previous studies. 4 , 5 SBRT was delivered via CyberKnife ® (Accuray Incorporated, Sunnyvale, CA, USA), an image-guided frameless stereotactic robotic radiosurgery system. All patients underwent endoscopic ultrasound-guided implantation of 3–5 gold fiducials within or adjacent to the pancreatic tumor.…”