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The Role of Stereotactic Body Radiation Therapy for Pancreatic Cancer: A Single-Institution Experience

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Stereotactic body radiation therapy (SBRT) is a promising option for patients with pancreatic cancer (PCA); however, limited data support its efficacy. This study reviews our institutional experience of SBRT in the treatment of locally advanced (LAPC) and borderline resectable (BRPC) PCA.

Methods

Charts of all PCA patients receiving SBRT at our institution from 2010 to 2014 were reviewed. Most patients received pre-SBRT chemotherapy. Primary endpoints included overall survival (OS) and local progression-free survival (LPFS). Patients received a total dose of 25–33 Gy in five fractions.

Results

A total of 88 patients were included in the analysis, 74 with LAPC and 14 with BRPC. The median age at diagnosis was 67.2 years, and median follow-up from date of diagnosis for LAPC and BRPC patients was 14.5 and 10.3 months, respectively. Median OS from date of diagnosis was 18.4 months (LAPC, 18.4 mo; BRPC, 14.4 mo) and median PFS was 9.8 months (95 % CI 8.0–12.3). Acute toxicity was minimal with only three patients (3.4 %) experiencing acute grade ≥3 toxicity. Late grade ≥2 gastrointestinal toxicity was seen in five patients (5.7 %). Of the 19 patients (21.6 %) who underwent surgery, 79 % were LAPC patients and 84 % had margin-negative resections.

Conclusions

Chemotherapy followed by SBRT in patients with LAPC and BRPC resulted in minimal acute and late toxicity. A large proportion of patients underwent surgical resection despite limited radiographic response to therapy. Further refinements in the integration of chemotherapy, SBRT, and surgery might offer additional advancements toward optimizing patient outcomes.

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References

  1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin. 2013;63(1):11–30.

    Article  PubMed  Google Scholar 

  2. Hidalgo M. Pancreatic cancer. N Engl J Med. 2010;362(17):1605–17.

    Article  CAS  PubMed  Google Scholar 

  3. Wagner M, Redaelli C, Lietz M, Seiler CA, Friess H, Buchler MW. Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. Br J Surg. 2004;91(5):586–94.

    Article  CAS  PubMed  Google Scholar 

  4. Mahadevan A, Jain S, Goldstein M, et al. Stereotactic body radiotherapy and gemcitabine for locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys. 2010;78(3):735–42.

    Article  PubMed  Google Scholar 

  5. Chuong MD, Springett GM, Freilich JM, et al. Stereotactic body radiation therapy for locally advanced and borderline resectable pancreatic cancer is effective and well tolerated. Int J Radiat Oncol Biol Phys. 2013;86(3):516–22.

    Article  PubMed  Google Scholar 

  6. Iyengar P, Westover K, Timmerman RD. Stereotactic ablative radiotherapy (SABR) for non-small cell lung cancer. Semin Respir Crit Care Med. 2013;34(6):845–54.

    Article  PubMed  Google Scholar 

  7. Timmerman RD, Kavanagh BD, Cho LC, Papiez L, Xing L. Stereotactic body radiation therapy in multiple organ sites. J Clin Oncol. 2007;25(8):947–52.

    Article  PubMed  Google Scholar 

  8. Koong AC, Le QT, Ho A, et al. Phase I study of stereotactic radiosurgery in patients with locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys. 2004;58(4):1017–21.

    Article  PubMed  Google Scholar 

  9. Koong AC, Christofferson E, Le QT, et al. Phase II study to assess the efficacy of conventionally fractionated radiotherapy followed by a stereotactic radiosurgery boost in patients with locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys. 2005;63(2):320–3.

    Article  PubMed  Google Scholar 

  10. Schellenberg D, Goodman KA, Lee F, et al. Gemcitabine chemotherapy and single-fraction stereotactic body radiotherapy for locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys. 2008;72(3):678–86.

    Article  CAS  PubMed  Google Scholar 

  11. Hoyer M, Roed H, Sengelov L, et al. Phase-II study on stereotactic radiotherapy of locally advanced pancreatic carcinoma. Radiother Oncol. 2005;76(1):48–53.

    Article  PubMed  Google Scholar 

  12. Callery MP, Chang KJ, Fishman EK, Talamonti MS, Traverso WL, Linehan DC. Pretreatment assessment of resectable and borderline resectable pancreatic cancer: Expert consensus statement. Ann Surg Oncol. 2009;16(7):1727–33.

    Article  PubMed  Google Scholar 

  13. Pawlik TM, Laheru D, Hruban RH, et al. Evaluating the impact of a single-day multidisciplinary clinic on the management of pancreatic cancer. Ann Surg Oncol. 2008;15(8):2081–8.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Khashab MA, Kim KJ, Tryggestad EJ, et al. Comparative analysis of traditional and coiled fiducials implanted during EUS for pancreatic cancer patients receiving stereotactic body radiation therapy. Gastrointest Endosc. 2012;76(5):962–71.

  15. Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45(2):228–47.

    Article  CAS  PubMed  Google Scholar 

  16. Patel M, Hoffe S, Malafa M, et al. Neoadjuvant GTX chemotherapy and IMRT-based chemoradiation for borderline resectable pancreatic cancer. J Surg Oncol. 2011;104(2):155–61.

    Article  PubMed Central  PubMed  Google Scholar 

  17. http://www.sciencedirect.com/science/article/pii/S009377541400284X.

  18. Goyal K, Einstein D, Ibarra RA, et al. Stereotactic body radiation therapy for nonresectable tumors of the pancreas. J Surg Res. 2012;174(2):319–25.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Polistina F, Costantin G, Casamassima F, et al. Unresectable locally advanced pancreatic cancer: A multimodal treatment using neoadjuvant chemoradiotherapy (gemcitabine plus stereotactic radiosurgery) and subsequent surgical exploration. Ann Surg Oncol. 2010;17(8):2092–101.

    Article  PubMed  Google Scholar 

  20. Rwigema JC, Parikh SD, Heron DE, et al. Stereotactic body radiotherapy in the treatment of advanced adenocarcinoma of the pancreas. Am J Clin Oncol. 2011;34(1):63–9.

    Article  CAS  PubMed  Google Scholar 

  21. Chang DT, Schellenberg D, Shen J, et al. Stereotactic radiotherapy for unresectable adenocarcinoma of the pancreas. Cancer. 2009;115(3):665–72.

    Article  PubMed  Google Scholar 

  22. Rajagopalan MS, Heron DE, Wegner RE, et al. Pathologic response with neoadjuvant chemotherapy and stereotactic body radiotherapy for borderline resectable and locally-advanced pancreatic cancer. Radiat Oncol. 2013;8:254-717X-8-254.

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Authors and Affiliations

  1. Department of Radiation Oncology & Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Shalini Moningi BA, Avani S. Dholakia BS, Amanda Blackford Sc.M, Amy Hacker-Prietz MS, Lauren M. Rosati BS, Ryan K. Assadi BS, Shirl Dipasquale RN & Joseph M. Herman MD

  2. Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Siva P. Raman MD

  3. Department of Surgery, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    John L. Cameron MD, Timothy M. Pawlik MD, Matthew J. Weiss MD & Christopher L. Wolfgang MD

  4. Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Dung T. Le MD, Ana M. C. De Jesus-Acosta MD, Lei Zheng MD & Daniel A. Laheru MD

Authors
  1. Shalini Moningi BA
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  2. Avani S. Dholakia BS
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  3. Siva P. Raman MD
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  4. Amanda Blackford Sc.M
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  5. John L. Cameron MD
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  6. Dung T. Le MD
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  7. Ana M. C. De Jesus-Acosta MD
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  8. Amy Hacker-Prietz MS
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  9. Lauren M. Rosati BS
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  10. Ryan K. Assadi BS
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  11. Shirl Dipasquale RN
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  12. Timothy M. Pawlik MD
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  13. Lei Zheng MD
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  14. Matthew J. Weiss MD
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  15. Daniel A. Laheru MD
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  16. Christopher L. Wolfgang MD
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  17. Joseph M. Herman MD
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Corresponding author

Correspondence to Joseph M. Herman MD.

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Cite this article

Moningi, S., Dholakia, A.S., Raman, S.P. et al. The Role of Stereotactic Body Radiation Therapy for Pancreatic Cancer: A Single-Institution Experience. Ann Surg Oncol 22, 2352–2358 (2015). https://doi.org/10.1245/s10434-014-4274-5

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  • DOI: https://doi.org/10.1245/s10434-014-4274-5

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