Proton beam reirradiation for locally recurrent pancreatic adenocarcinoma

Boimel, Pamela J.; Berman, Abigail T.; Li, Jonathan; Apisarnthanarax, Smith; Both, Stefan; Lelionis, Kristi; Larson, Gary; Teitelbaum, Ursina R.; Lukens, John N.; Ben‐Josef, Edgar; Metz, James M.; Plastaras, John P.

doi:10.21037/jgo.2017.03.04

Cited by 24 publications

(21 citation statements)

References 18 publications

(44 reference statements)

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“…Proton beam therapy for reRT has been investigated at other disease sites including head and neck, 38,39 central nervous system, 40,41 lung, 42,43 gynecological, 44 and gastrointestinal malignancies. [45][46][47] A recent systematic review found that reRT with PBT is safe and effective. 48 Furthermore, the authors concluded that, for local recurrences, PBT might be the safest option for reRT.…”

Section: Discussionmentioning

confidence: 99%

Proton beam therapy reirradiation for breast cancer: Multi‐institutional prospective PCG registry analysis

et al. 2019

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To investigate adverse events (AEs, CTCAE v4.0) and clinical outcomes for proton beam therapy (PBT) reirradiation (reRT) for breast cancer. From 2011 to 2016, 50 patients received PBT reRT for breast cancer in the prospective Proton Collaborative Group (PCG) registry. Acute AEs occurred within 180 days from start of reRT. Late AEs began or persisted beyond 180 days. Fisher's exact and Mann‐Whitney rank‐sum tests were utilized. Kaplan‐Meier methods were used to estimate overall survival (OS) and local recurrence‐free survival (LFRS). Median follow‐up was 12.7 months (0‐41.8). Median prior RT dose was 60 Gy (10‐96.7). Median reRT dose was 55.1 Gy (45.1‐76.3). Median cumulative dose was 110.6 Gy (70.6‐156.8). Median interval between RT courses was 103.8 months (5.5‐430.8). ReRT included regional nodes in 84% (66% internal mammary node [IMN]). Surgery included the following: 44% mastectomy, 22% wide local excision, 6% lumpectomy, 2% reduction mammoplasty, and 26% no surgery. Grade 3 AEs were experienced by 16% of patients (10% acute, 8% late) and were associated with body mass index (BMI) > 30 kg/m2 (P = 0.04), bilateral recurrence (P = 0.02), and bilateral reRT (P = 0.004). All grade 3 AEs occurred in patients receiving IMN reRT (P = 0.08). At 1 year, LRFS was 93%, and OS was 97%. Patients with gross disease at time of PBT trended toward worse 1‐year LRFS (100% without vs. 84% with, P = 0.06). PBT reRT is well tolerated with favorable local control. BMI > 30, bilateral disease, and IMN reRT were associated with grade 3 AEs. Toxicity was acceptable despite median cumulative dose > 110 Gy.

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Section: Discussionmentioning

confidence: 99%

Proton beam therapy reirradiation for breast cancer: Multi‐institutional prospective PCG registry analysis

et al. 2019

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“…A retrospective study of carbon-ion RT for lung cancer by Karube et al showed that the 2-year overall survival rate was 67% without severe pneumonitis (16). In abdominal tumors, the 2-year overall survival rates were 30 to 37% for proton and photon therapy (23, 25). One prospective study of proton therapy for recurrent esophageal cancer found that grade 5 esophageal fistulas and ulcers were observed in 14% of patients during the acute and late periods (22).…”

Section: Discussionmentioning

confidence: 99%

Prospective Study of Isolated Recurrent Tumor Re-irradiation With Carbon-Ion Beams

et al. 2019

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Purpose: To perform a prospective study to evaluate the efficacy and safety of isolated recurrent tumor re-irradiation with carbon-ion radiotherapy (RT). Methods and Materials: The inclusion criteria were clinically proven recurrent tumors, measurable by computed tomography or magnetic resonance imaging, patients ≥ 16 years old, performance status scores between 0 and 2, isolated tumor at a previously irradiated site, and a life expectancy > 6 months. The exclusion criteria were tumor invasion into the gastrointestinal tract or a major blood vessel, uncontrolled infection, early recurrence (<3 months), and severe concomitant diseases. The primary end-point was the local control rate, the secondary end-points including the overall survival rate, and adverse events. Results: Between December 2013 and March 2016, 22 patients were enrolled in this prospective study. All patients were re-irradiated with carbon-ion RT with radical intent. Five patients had rectal cancer, 4 had sarcoma, 4 had lung cancer, 3 had hepatic cell carcinoma, and 6 had other tumors. The median follow-up time was 26 months. Eight patients developed local recurrence, and the 1- and 2-year local control rates were 71 and 60%, respectively. Eight patients died of their cancers and 2 died of other diseases. The 1- and 2-year overall survival rates were 76 and 67%, respectively. There were no grade 2 or higher acute adverse events and 4 patients (18%) developed grade 3 late adverse events. The group with the longer interval (>16 months) between the first RT and re-irradiation had significantly better outcomes than the shorter interval group (≤ 16 months). Conclusions: Re-irradiation, using carbon-ion RT with radical intent, had favorable local control and overall survival rates without severe toxicities for selected patients. Re-irradiation has the potential to improve clinical outcomes for isolated, local, recurrent tumors; further investigations are required to confirm the therapeutic efficacy.

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“…At a follow-up of one year, less than 10% of patients experienced serious toxicity. 35 Boimel et al 36 described auspicious results for reirradiation by PBT for locally recurrent pancreatic cancer. Proton beam therapy resulted in prolonged OS, local-regional progression-free, and DMFS, when compared to historical controls.…”

Section: Re-irradiation Of All Sites For Curative Intentmentioning

confidence: 99%

Defining Clinical Indications of Proton Beam Therapy at National Level in the Kingdom of Saudi Arabia

AlHussain

Balbaid

Malyapa

et al. 2019

SMJ

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Proton beam reirradiation for locally recurrent pancreatic adenocarcinoma

Cited by 24 publications

References 18 publications

Proton beam therapy reirradiation for breast cancer: Multi‐institutional prospective PCG registry analysis

Proton beam therapy reirradiation for breast cancer: Multi‐institutional prospective PCG registry analysis

Prospective Study of Isolated Recurrent Tumor Re-irradiation With Carbon-Ion Beams

Defining Clinical Indications of Proton Beam Therapy at National Level in the Kingdom of Saudi Arabia

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