Stereotactic body radiation therapy with concurrent full-dose gemcitabine for locally advanced pancreatic cancer: a pilot trial demonstrating safety

Abstract

BackgroundConcurrent chemoradiation is a standard option for locally advanced pancreatic cancer (LAPC). Concurrent conventional radiation with full-dose gemcitabine has significant toxicity. Stereotactic body radiation therapy (SBRT) may provide the opportunity to administer radiation in a shorter time frame with similar efficacy and reduced toxicity. This Pilot study assessed the safety of concurrent full-dose gemcitabine with SBRT for LAPC.MethodsPatients received gemcitabine, 1000 mg/m2 for 6 cycles. During week 4 of cycle 1, patients received SBRT (25 Gy delivered in five consecutive daily fractions of 5 Gy prescribed to the 75-83% isodose line). Acute and late toxicities were assessed using NIH CTCAE v3. Tumor response was assessed by RECIST. Patients underwent an esophagogastroduodenoscopy at baseline, 2, and 6 months to assess the duodenal mucosa. Quality of life (QoL) data was collected before and after treatment using the QLQ-C30 and QLQ-PAN26 questionnaires.ResultsBetween September 2009 and February 2011, 11 patients enrolled with one withdrawal during radiation therapy. Patients had grade 1 to 2 gastrointestinal toxicity from the start of SBRT to 2 weeks after treatment. There were no grade 3 or greater radiation-related toxicities or delays for cycle 2 of gemcitabine. On endoscopy, there were no grade 2 or higher mucosal toxicities. Two patients had a partial response. The median progression free and overall survival were 6.8 and 12.2 months, respectively. Global QoL did not change between baseline and immediately after radiation treatment.ConclusionsSBRT with concurrent full dose gemcitabine is safe when administered to patients with LAPC. There is no delay in administration of radiation or chemotherapy, and radiation is completed with minimal toxicity.

SBRT in pancreatic cancer: What is the therapeutic window?

“…One of the studies included patients from three previously reported prospective trials [31]. Another four studies of upper abdominal SBRT reporting on toxicity and providing sufficient dose information were additionally chosen for the toxicity analysis [32][33][34][35][36][37][38]. From the respective studies, a total of 572 patients treated for pancreatic cancer at the primary site could be analysed for efficacy and additionally another 149 patients for toxicity using CTCAE versions 2.0, 3.0 and 4.0.…”

Individually optimized stereotactic radiotherapy for pancreatic head tumors: A planning feasibility study

“…3 Recently, it has been proposed by some authors to use stereotactic body radiation therapy (SBRT) for the treatment of these tumors. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] The use of stereotactic techniques is theoretically useful to administer high doses of radiation to the tumor with optimum sparing of organs at risk (OARs). Furthermore, SBRT treatment has other advantages and particularly its brevity.…”

Feasibility and reproducibility of substituting oral contrast with water for duodenal volume delineation in patients undergoing pancreatic stereotactic body radiotherapy

“…No prophylactic radiation to the regional lymphatic drainage area, similar to published work (8)(9)(10). The prescribed dose was required to cover 95% of the PTV at minimum.…”