Radiation Therapy for Pancreatic Cancer: Executive Summary of an ASTRO Clinical Practice Guideline

Palta, Manisha; Godfrey, D; Goodman, Karyn A.; Hoffe, Sarah E.; Dawson, Laura A.; Dessert, David; Hall, William A.; Herman, Joseph M.; Khorana, Alok A.; Merchant, Nipun B.; Parekh, Arti; Patton, Caroline; Pepek, Joseph M.; Salama, Joseph K.; Tuli, Richard; Koong, Albert C.

doi:10.1016/j.prro.2019.06.016

Cited by 127 publications

(101 citation statements)

References 16 publications

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“…Moreover, three-dimensional conformal radiation therapy was applied in this study, which was not a mainstay modality of radiotherapy in the case of intensi ed modulated radiotherapy or SBRT commonly used in LAPC [8]. Most importantly, SBRT has already been recommended in the management of pancreatic cancer according to American Society for Radiation Oncology clinical practice guideline for pancreatic cancer [22]. Hence, evaluations of patients' outcomes after standard chemotherapy regimens with the novel radiotherapy technique are required.…”

Section: Discussionmentioning

confidence: 99%

Development and Validation of Multicenter Predictive Nomograms for Locally Advanced Pancreatic Cancer after Chemoradiotherapy

Zhu

Liu

Cao

et al. 2020

Preprint

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Background: Due to common practice of hypofractionated radiotherapy in pancreatic cancer and heterogeneous chemotherapy regimens in previous studies, modified nomograms are required. Therefore, we aim to develop and validate prognostic nomograms for locally advanced pancreatic cancer (LAPC) after stereotactic body radiation therapy (SBRT) and chemotherapy.Methods: The development cohort comprised 925 patients with LAPC receiving SBRT and gemcitabine-based chemotherapy in our center, while 297 patients from another two centers formed the validation cohort. Nomograms were created from COX models and internally validated by bootstrap. Model discriminations were evaluated by calibration plots and concordance index (C-index). A decision curve analysis (DCA) was performed to evaluate clinical benefits of nomograms. Additionally, recursive partitioning analysis (RPA) was used for stratifications of survival probability based on the total score of each patient calculated by nomograms.Results: Weight loss, tumor diameter, radiation dose, CA19-9 kinetics after treatment and surgical resection were included in the nomogram for overall survival (OS), while the five factors plus performance status formed the nomogram for progression free survival (PFS). The corrected C-indexes for estimated 1-year and 2-year OS of the development cohort were 0.88 (95% CI: 0.85-0.91) and 0.86 (95% CI: 0.83-0.90). For those of the validation cohort, it was 0.88 (95% CI: 0.82-0.94) and 0.83 (95% CI: 0.74-0.91). Additionally, the corrected C-index for predicted 1-year PFS in the development and validation cohort was 0.83 (95% CI: 0.81-0.86) and 0.82 (95% CI: 0.78-0.87), respectively. The calibration plots showed good agreement of 1- and 2-year OS and 1-year PFS between the estimations and actual observations. Potential clinical benefits were demonstrated with DCA. Additionally, for 1- and 2-year OS and 1-year PFS, patients were stratified into four groups with different survival probability by RPA.Conclusion: The validated nomograms provided useful predictions of OS and PFS for LAPC with chemoradiotherapy.

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Section: Discussionmentioning

confidence: 99%

Development and Validation of Multicenter Predictive Nomograms for Locally Advanced Pancreatic Cancer after Chemoradiotherapy

Zhu

Liu

Cao

et al. 2020

Preprint

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“…In 2019, the American Society for Radiation Oncology released new guidelines for the treatment of pancreatic cancer 24 . These recommended the consideration of conventionally fractionated RT or SBRT in high-risk adjuvant settings, as neoadjuvant downstaging for BRPC/LAPC, and for LAPC as part of definitive treatment, all admittedly with low to moderate quality of evidence.…”

Section: Radiationmentioning

confidence: 99%

Recent advances in the treatment of pancreatic cancer

2020

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F1000 Faculty Reviews are written by members of the prestigious . They are F1000 Faculty commissioned and are peer reviewed before publication to ensure that the final, published version is comprehensive and accessible. The reviewers who approved the final version are listed with their names and affiliations. AbstractPancreatic ductal adenocarcinoma is one of the deadliest solid tumor malignancies and is projected to become a leading cause of cancer-related death in coming years. Improving quality of life and survival amongst these patients will require new ideas and novel therapies in a multidisciplinary approach. This review will cover the most recent advances in the comprehensive treatment of pancreatic cancer and place them within a historical context when necessary. Treatment of all disease stages will be discussed, but the focus is on systemic therapy as novel drugs and new treatment combinations enter the clinic. This will include more aggressive chemotherapy in earlier disease stages, approved uses for immunotherapy, and targetable mutations. In addition, negative trials of importance and controversial topics will be noted. Neoptolemos JP, Stocken DD, Friess H, et al.: A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med. 2004; 350(12): 1200-10. PubMed Abstract | Publisher Full Text 4. Oettle H, Neuhaus P, Hochhaus A, et al.: Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial. JAMA. 2013; 310(14): 1473-81. PubMed Abstract | Publisher Full Text 5. Neoptolemos JP, Palmer DH, Ghaneh P, et al.: Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. Lancet. 2017; 389(10073): 1011-24. PubMed Abstract | Publisher Full Text | F1000 Recommendation 6. Conroy T, Hammel P, Hebbar M, et al.: FOLFIRINOX or Gemcitabine as Adjuvant Therapy for Pancreatic Cancer. N Engl J Med. 2018; 379(25): 2395-406. PubMed Abstract | Publisher Full Text | F1000 Recommendation 7. Tempero MA, Reni M, Riess H, et al.: APACT: phase III, multicenter, international, open-label, randomized trial of adjuvant nab-paclitaxel plus gemcitabine (nab-P/G) vs gemcitabine (G) for surgically resected pancreatic adenocarcinoma. JCO. 2019; 37: 4000. Publisher Full Text 8. Conroy T, Desseigne F, Ychou M, et al.: FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011; 364(19): 1817-25. PubMed Abstract | Publisher Full Text | F1000 Recommendation 9. Von Hoff DD, Ervin T, Arena FP, et al.: Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med. 2013; 369(18): 1691-703. PubMed Abstract | Publisher Full Text | Free Full Text | F1000 Recommendation 10. Wang-Gillam A, Li CP, Bodoky G, et al.: Nanoliposomal irinotecan with fluorouracil and folinic acid in metastatic pancreatic cancer after previous gemcitabine-based therapy (N...

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“…Although evidence level is low, ASTRO guideline suggest dose escalation for LAPC with high consensus in panel (85%). [10] Technical innovations and the relatively low toxicity observed thus far with SMART, has led to new initiatives to attempt local dose-escalation for LAPC.…”

Section: ] Soumonmentioning

confidence: 99%

Symptom Relief is the Most Significant Prognostic Factor for Unresectable Locally Advanced/Recurrent Pancreatic Cancer Receiving Chemoradiotherapy: Analysis of 65 Cases

Jiang

Shen

Liu

et al. 2020

Preprint

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BackgroundPancreatic cancer is the fourth leading cause of cancer-related death throughout the world. For local advanced and recurrent pancreatic cancer (LAPC/LRPC), chemoradiotherapy (CRT) is a main choice which may prolong their survival and ease patients’ symptoms.MethodsWe constructed a database of 65 patients with LAPC/LRPC treated from June, 2004 to February, 2018. We used log-rank test to evaluate the different overall survival (OS) rates of all factors involved, and used cox regression model to find out independent prognostic factors for these patients.ResultsThe median OS time for 65 eligible patients was 23.6 months. 47 (72.3%) and 18 (27.7%) patients had unresectable LAPC and LRPC, and median OS time was 17.2 and 40.7 months (P= 0.02), respectively. The mean biological effective dose (BED) to gross tumor volume (GTV) was 64.8Gy (46.7-85.5 Gy). 11(16.9%) and 54(83.1%) patients had BED> 72 Gy and BED≤ 72 Gy, and their mOS was 31.8 and 21.9 months (P= 0.08), respectively. Simultaneous dose boost to interval GTV (GTVin) was applied to 23 patients (35.4%). Patients with large GTV volume (≥ 109.2 cm3) may benefit from radiation dose boost (mOS: 27.6 vs. 5.3 months, P= 0.004). Patients with symptom relief including relief of pain, jaundice, and/or diarrhea had higher OS rates than those without response (mOS: 25.7 vs. 13.2 months, P< 0.01) and multivariate cox regression analysis suggested symptom relief was the most significant prognostic factor for OS (HR= 0.44, 95%CI 0.35-2.36, P= 0.02).ConclusionCRT with simultaneous integrated boost of radiation dose may bring survival benefit for LAPC/LRPC patients with bulk tumor. Symptom relief is the most significant prognostic factor for LAPC/LRPC patients after comprehensive CRT.

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Radiation Therapy for Pancreatic Cancer: Executive Summary of an ASTRO Clinical Practice Guideline

Cited by 127 publications

References 16 publications

Development and Validation of Multicenter Predictive Nomograms for Locally Advanced Pancreatic Cancer after Chemoradiotherapy

Development and Validation of Multicenter Predictive Nomograms for Locally Advanced Pancreatic Cancer after Chemoradiotherapy

Recent advances in the treatment of pancreatic cancer

Symptom Relief is the Most Significant Prognostic Factor for Unresectable Locally Advanced/Recurrent Pancreatic Cancer Receiving Chemoradiotherapy: Analysis of 65 Cases

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