Strahlentherapie und Onkologie

, Volume 193, Issue 6, pp 433–443 | Cite as

Stereotactic body radiotherapy (SBRT) in recurrent or oligometastatic pancreatic cancer

A toxicity review of simultaneous integrated protection (SIP) versus conventional SBRT
  • E. Gkika
  • S. Adebahr
  • S. Kirste
  • T. Schimek-Jasch
  • R. Wiehle
  • R. Claus
  • U. Wittel
  • U. Nestle
  • D. Baltas
  • A. L. Grosu
  • T. B. Brunner
Original Article

Abstract

Background

Stereotactic body radiotherapy (SBRT) in pancreatic cancer can be limited by its proximity to organs at risk (OAR). In this analysis, we evaluated the toxicity and efficacy of two different treatment approaches in patients with locally recurrent or oligometastatic pancreatic cancer.

Materials and methods

According to the prescription method, patients were divided in two cohorts (C1 and C2). The planning target volume (PTV) was created through a 4 mm expansion of the internal target volume. In C2, a subvolume was additionally created, a simultaneous integrated protection (SIP), which is the overlap of the PTV with the planning risk volume of an OAR to which we prescribed a reduced dose.

Results

In all, 18 patients were treated (7 with local recurrences, 9 for oligometastases, 2 for both). Twelve of 23 lesions were treated without SIP (C1) and 11 with SIP (C2). The median follow-up was 12.8 months. Median overall survival (OS) was 13.2 (95% confidence interval [CI] 9.8–14.6) months. The OS rates at 6 and 12 months were 87 and 58%, respectively. Freedom from local progression for combined cohorts at 6 and 12 months was 93 and 67% (95% CI 15–36), respectively. Local control was not statistically different between the two groups. One patient in C2 experienced grade ≥3 acute toxicities and 1 patient in C1 experienced a grade ≥3 late toxicity.

Conclusion

The SIP approach is a useful prescription method for abdominal SBRT with a favorable toxicity profile which does not compromise local control and overall survival despite dose sacrifices in small subvolumes.

Keywords

Local progression Radiation therapy Overall survival Prognosis Toxicity 

Stereotaktische Strahlentherapie (SBRT) beim wiederkehrenden oder oligometastatischen Pankreaskarzinom

Bewertung der Toxizität bei simultan integrierter Protektion (SIP) versus konventioneller SBRT

Zusammenfassung

Hintergrund

Die stereotaktische Strahlentherapie (SBRT) ist bei Pankreaskarzinomen durch die enge Lagebeziehung der Risikoorgane (OAR) zum Zielvolumen erschwert. In dieser Analyse evaluierten wir die Toxizität und die Lokalkontrolle von zwei unterschiedlichen Therapiestrategien bei Patienten mit rezidivierendem oder oligometastatischem Pankreaskarzinom.

Material und Methoden

Die Patienten wurden anhand der Verschreibungsmethode in zwei Kohorten geteilt (C1 und C2). Das Planungszielvolumen (PTV) wurde durch eine Expansion des internen Zielvolumens (ITV) um 4 mm erzeugt. In C2 wurde zusätzlich ein Subvolumen (simultan integrierte Protektion, SIP) definiert, welches durch die Überlappung des PTV mit dem Planungsrisikovolumen (PRV) eines OAR generiert wurde, um die Grenzdosen für das jeweilige OAR einhalten zu können.

Ergebnisse

Insgesamt 18 Patienten wurden behandelt (7 Lokalrezidive, 9 Oligometastasen, 2 kombiniert). Zwölf von 23 Läsionen wurden ohne SIP (C1) und 11 mit SIP (C2) therapiert. Bei einem medianen Follow-up von 12,8 Monaten lag das mediane Überleben bei 13,2 Monaten (95 %-Konfidenzintervall [KI] 9,8–14,6). Das Gesamtüberleben nach 6 und 12 Monaten betrug je 87 % und 58 %. Die Lokalkontrolle für das Gesamtkollektiv betrug nach 6 und 12 Monaten jeweils 93 % und 67 % (95 %-KI 15–36); sie war statistisch nicht unterschiedlich zwischen den beiden Gruppen. Ein Patient in C2 entwickelte eine akute Grad-4-Toxizität und 1 Patient in C1 entwickelte eine Grad-4-Spättoxizität.

Schlussfolgerung

Die SIP-Verschreibungsmethode ist eine hilfreiche Strategie bei der SBRT mit einem günstigen Nebenwirkungsprofil. Trotz der Dosisreduktion in kleinen Subvolumina waren die lokale Kontrolle und das Gesamtüberleben identisch.

Schlüsselwörter

Lokale Progression Strahlentherapie  Gesamtüberleben Prognose Toxizität 

Supplementary material

66_2017_1099_MOESM1_ESM.docx (24 kb)
Supplementary Table 1: Treatment characteristics of the 23 lesions

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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • E. Gkika
    • 1
  • S. Adebahr
    • 1
    • 5
  • S. Kirste
    • 1
  • T. Schimek-Jasch
    • 1
  • R. Wiehle
    • 4
  • R. Claus
    • 2
  • U. Wittel
    • 3
  • U. Nestle
    • 1
    • 5
    • 6
  • D. Baltas
    • 4
    • 5
    • 6
  • A. L. Grosu
    • 1
    • 5
    • 6
  • T. B. Brunner
    • 1
    • 5
    • 6
  1. 1.Department of Radiation OncologyUniversity Medical Center FreiburgFreiburg im BreisgauGermany
  2. 2.Department of Hematology, Oncology and Stem-Cell TransplantationUniversity Medical Center FreiburgFreiburgGermany
  3. 3.Department of General and Visceral SurgeryUniversity Medical Center FreiburgFreiburgGermany
  4. 4.Division of Medical Physics, Department of Radiation OncologyUniversity Medical Center FreiburgFreiburgGermany
  5. 5.German Cancer Consortium (DKTK)Heidelberg (partner site Freiburg)Germany
  6. 6.Faculty of MedicineUniversity of FreiburgFreiburgGermany

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