Stereotactic Body Radiation Therapy (SBRT) Combined With Chemotherapy for Unresected Pancreatic Adenocarcinoma

Abstract

Introduction The role of conventionally fractionated radiation therapy in the management of unresectable pancreatic cancer is controversial. One concern about concurrent chemoradiation relates to the timing of chemotherapy. In contrast to conventional radiation therapy, SBRT delivers high doses in a shorter duration resulting in minimal disruption in chemotherapy. Here we report our results of patients treated with SBRT and chemotherapy for inoperable pancreatic cancer. Methods Thirty-eight consecutive patients treated with SBRT and chemotherapy for locally advanced, borderline resectable, and medically inoperable at our institution from January 2008 to December 2012 were included in this retrospective analysis. Treatment was delivered in 5 fractions of 5 or 6 Gy per fraction over five days. Median time from diagnosis to SBRT was 1.9 months. Toxicities were scored using the CTCAE v.3. Survival was calculated using the Kaplan-Meier method. Results The median age was 70 years (range 45 – 90). ECOG performance status ranged from 0 – 3. Thirty-four patients received concurrent chemotherapy. Four other patients received sequential chemotherapy. Median OS was 14.3 months and median PFS was 9.2 months from diagnosis. From radiation, OS and PFS were 12.3 months and 6.8 months, respectively. The overall local control rate was 79%. Acute toxicity was minimal. Severe late SBRT-related toxicities included one grade 3 gastric outlet obstruction, one grade 4 biliary stricture and a grade 5 gastric hemorrhage. Conclusions SBRT combined with chemotherapy for unresectable pancreatic cancer is convenient, feasible and generally well tolerated. The outcomes of SBRT combined with chemotherapy compare favorably to the results of treatment with chemotherapy and conventional radiation therapy.

Stereotactic body radiotherapy for unresected pancreatic cancer: A nationwide review

“…A retrospective series by Gurka et al, 35 including 38 patients with locally advanced, borderline resectable, and medically inoperable pancreatic cancer treated with SBRT and gemcitabine or folinic acid, fluorouracil, and oxaliplatin (modified FOLFOX), revealed a median overall survival of 14.3 months. 35 A subsequent study by Moningi et al 36 evaluating patients with borderline resectable and locally advanced pancreatic cancer showed similar results with a median survival of 13.9 months. Similarly, a multi-institutional phase 2 study of 49 patients with locally advanced pancreatic cancer treated with gemcitabine followed by SBRT also demonstrated a median overall survival of 13.9 months.…”

“…Patients with metastatic disease at diagnosis (n 5 85,653) or surgery of the primary site (n 5 42,794) were excluded. Patients who underwent resection were identified according to the Facility Oncology Registry Data Standards surgery codes: 25,30,35,36,37,40,60,70,80, and 90. The cohort was further restricted by the sequential exclusion of patients who did not receive any treatment at the reporting facility (n 5 13,659), were diagnosed with other malignancies (n 5 11,501), or did not receive chemotherapy (n 5 22,417) as well as those whose radiation treatment included electrons and/or neutrons (n 5 54), proton therapy (n 5 43), or radioisotopes (n 5 11) or who started treatment more than 90 days after their diagnosis (n 5 1222).…”

Application of stereotactic body radiotherapy in advanced pancreatic cancers in Australia

“…Iacobuzio-Donahue et al 5 demonstrated up to 30% of pancreatic cancer patients died from locally obstructive disease with few or no distant metastases. These findings highlight the potential benefit 14 20 LA 25 Gy 9 1 94 11.8 1c induction + post-SBRT GEM Goyal et al 15 19 LA/LR 20-25 Gy 9 1, 8-10 Gy 9 3 81 14.4 5-FU or GEM Lominska et al 16 28 LA/LR 4-8 Gy 9 3-5 86 5.9 5-FU or GEM prior to SBRT Chuong et al 17 73 BR/LA 5-10 Gy 9 5 81 16.4 BR, 15 LA 3 cycles GTX Gurka et al 18 38 BR/LA 5-6 Gy 9 5 79 12.3 Post/concurrent-GEM or 5-FU Moningi et al 19 88 BR/LA 5-6.6 Gy 9 5 61 18.4 Peri-SBRT GEM or 5-FU Herman et al 20 49 LA 6.5 Gy 9 5 78 13.9…”

Radiation therapy for hepatobiliary malignancies

“…In recent years SBRT has emerged as an effective treatment option for a variety of malignancies including early stage lung cancer, prostate cancer, and pancreatic cancer (24)(25)(26). SBRT represents a novel means of delivering highly conformal ultra-high dose hypofractionated radiation therapy.…”