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Clinical outcomes following stereotactic body radiation therapy (SBRT) for non-resectable pancreatic adenocarcinoma

Abstract

Objectives

The purpose of this study was to report on progression-free survival (PFS), overall survival (OS), and related toxicities following stereotactic body radiation therapy (SBRT) for non-resectable pancreatic cancer (PCa).

Methods

The RSSearch® Patient Registry was screened for PCa patients treated with SBRT. The relationship between PFS, OS, and potential prognostic factors were evaluated using the Kaplan-Meier method and continuous log-rank analysis, and the correlation between treatment planning and toxicity incidence was examined by logistic regression.

Results

Sixty patients met inclusion criteria. Twenty-three patients (38.33%) had received adjuvant gemcitabine. Following SBRT, median PFS was 6.07 months (range: 2.33 - 34.4 months) and median OS was 8.55 months (range: 2.66 - 78.53 months). Single-fraction SBRT trended towards poorer median PFS (5.13 vs. 6.76 months; p = 0.0122) with no significant difference in median OS (10.3 vs. 7.17 months; p = 0.8896). PCas located in the head had a significantly higher median OS (9.58 months) as compared to those in the body (5.66 months; p = 0.0376). Adjuvant gemcitabine did not result in superior PFS (5.12 vs. 6.35 months; p = 0.52) or OS (8.67 vs. 7.07 months; p = 0.6010). Eight (13.3%) and six (10%) patients reported acute and late toxicities, respectively, that were all Grade 1 or 2. Single-fraction SBRT was associated with an increased risk of toxicity incidence (5/9 patients vs. 3/51 patients; p = 0.001).

Conclusion

SBRT was well-tolerated by PCa patients with fractionated SBRT trending towards superior PFS and less toxicity as compared to single-fraction SBRT.

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References

  1. Siegel RL, Miller KD, Jemal A (2016) Cancer statistics, 2016. CA Cancer J Clin 66(1):7–30. doi:10.3322/caac.21332

    Article  PubMed  Google Scholar 

  2. Willett CG, Czito BG, Bendell JC, Ryan DP (2005) Locally advanced pancreatic cancer. J Clin Oncol 23(20):4538–4544. doi:10.1200/JCO.2005.23.911

    Article  PubMed  Google Scholar 

  3. Wagner M, Redaelli C, Lietz M, Seiler CA, Friess H, Buchler MW (2004) Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. Br J Surg 91(5):586–594. doi:10.1002/bjs.4484

    CAS  Article  PubMed  Google Scholar 

  4. Malik NK, May KS, Chandrasekhar R, Wee W, Flaherty L, Iyer R, Gibbs J, Kuvshinoff B, Wilding G, Warren G, Yang GY (2012) Treatment of locally advanced unresectable pancreatic cancer: a 10-year experience. J Gastrointest Oncol 3(4):326–334. doi:10.3978/j.issn.2078-6891.2012.029

    PubMed  PubMed Central  Google Scholar 

  5. Ryan DP, Hong TS, Bardeesy N (2014) Pancreatic adenocarcinoma. N Engl J Med 371(22):2140–2141. doi:10.1056/NEJMc1412266

    PubMed  Google Scholar 

  6. Oh SY, Edwards A, Mandelson MT, Lin B, Dorer R, Helton WS, Kozarek RA, Picozzi VJ (2015) Rare long-term survivors of pancreatic adenocarcinoma without curative resection. World J Gastroenterol 21(48):13574–13581. doi:10.3748/wjg.v21.i48.13574

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  7. Lominska CE, Unger K, Nasr NM, Haddad N, Gagnon G (2012) Stereotactic body radiation therapy for reirradiation of localized adenocarcinoma of the pancreas. Radiat Oncol 7:74. doi:10.1186/1748-717X-7-74

    Article  PubMed  PubMed Central  Google Scholar 

  8. Chang DT, Schellenberg D, Shen J, Kim J, Goodman KA, Fisher GA, Ford JM, Desser T, Quon A, Koong AC (2009) Stereotactic radiotherapy for unresectable adenocarcinoma of the pancreas. Cancer 115(3):665–672. doi:10.1002/cncr.24059

    Article  PubMed  Google Scholar 

  9. Schellenberg D, Goodman KA, Lee F, Chang S, Kuo T, Ford JM, Fisher GA, Quon A, Desser TS, Norton J, Greco R, Yang GP, Koong AC (2008) Gemcitabine chemotherapy and single-fraction stereotactic body radiotherapy for locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 72(3):678–686. doi:10.1016/j.ijrobp.2008.01.051

    CAS  Article  PubMed  Google Scholar 

  10. Klaassen DJ, MacIntyre JM, Catton GE, Engstrom PF, Moertel CG (1985) Treatment of locally unresectable cancer of the stomach and pancreas: a randomized comparison of 5-fluorouracil alone with radiation plus concurrent and maintenance 5-fluorouracil—an Eastern Cooperative Oncology Group study. J Clin Oncol 3(3):373–378. doi:10.1200/JCO.1985.3.3.373

    CAS  Article  PubMed  Google Scholar 

  11. Mahadevan A, Jain S, Goldstein M, Miksad R, Pleskow D, Sawhney M, Brennan D, Callery M, Vollmer C (2010) Stereotactic body radiotherapy and gemcitabine for locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 78(3):735–742. doi:10.1016/j.ijrobp.2009.08.046

    Article  PubMed  Google Scholar 

  12. Moertel CG, Frytak S, Hahn RG, O'Connell MJ, Reitemeier RJ, Rubin J, Schutt AJ, Weiland LH, Childs DS, Holbrook MA, Lavin PT, Livstone E, Spiro H, Knowlton A, Kalser M, Barkin J, Lessner H, Mann-Kaplan R, Ramming K, Douglas HO Jr, Thomas P, Nave H, Bateman J, Lokich J, Brooks J, Chaffey J, Corson JM, Zamcheck N, Novak JW (1981) Therapy of locally unresectable pancreatic carcinoma: a randomized comparison of high dose (6000 rads) radiation alone, moderate dose radiation (4000 rads + 5-fluorouracil), and high dose radiation + 5-fluorouracil: The Gastrointestinal Tumor Study Group. Cancer 48(8):1705–1710

    CAS  Article  PubMed  Google Scholar 

  13. Goyal K, Einstein D, Ibarra RA, Yao M, Kunos C, Ellis R, Brindle J, Singh D, Hardacre J, Zhang Y, Fabians J, Funkhouser G, Machtay M, Sanabria JR (2012) Stereotactic body radiation therapy for nonresectable tumors of the pancreas. J Surg Res 174(2):319–325. doi:10.1016/j.jss.2011.07.044

    Article  PubMed  Google Scholar 

  14. Lominska CE, Nasr NM, Silver NL, Gagnon GJ (2008) Salvage stereotactic radiosurgery for locally recurrent previously irradiated pancreatic cancer. Int J Radiat Oncol Biol Phys 72(1):S276–S277

    Article  Google Scholar 

  15. Davis JN, Medbery C 3rd, Sharma S, Danish A, Mahadevan A (2013) The RSSearch registry: patterns of care and outcomes research on patients treated with stereotactic radiosurgery and stereotactic body radiotherapy. Radiat Oncol 8:275. doi:10.1186/1748-717X-8-275

    Article  PubMed  PubMed Central  Google Scholar 

  16. Singh R, Davis J, Sharma S (2016) Stereotactic radiosurgery for trigeminal neuralgia: a retrospective multi-institutional examination of treatment outcomes. Cureus 8(4):e554. doi:10.7759/cureus.554

    PubMed  PubMed Central  Google Scholar 

  17. Davis JN, Medbery C, Sharma S, Pablo J, Kimsey F, Perry D, Muacevic A, Mahadevan A (2015) Stereotactic body radiotherapy for centrally located early-stage non-small cell lung cancer or lung metastases from the RSSearch((R)) patient registry. Radiat Oncol 10:113. doi:10.1186/s13014-015-0417-5

    Article  PubMed  PubMed Central  Google Scholar 

  18. Didolkar MS, Coleman CW, Brnener MJ, Chu KU, Olexa N, Stanwyck E, Yu A, Neerchal N, Rabinotwitz S (2010) Image-guided stereotactic radiosurgery for locally advanced pancreatic adenocarcinoma: results of first 85 patients. J Gastrointest Surg 14(10):1547–1559. doi:10.1007/s11605-010-1323-7

    Article  PubMed  Google Scholar 

  19. Mahadevan A, Floyd S, Wong E, Jeyapalan S, Groff M, Kasper E (2011) Stereotactic body radiotherapy reirradiation for recurrent epidural spinal metastases. Int J Radiat Oncol Biol Phys 81(5):1500–1505. doi:10.1016/j.ijrobp.2010.08.012

    Article  PubMed  Google Scholar 

  20. Small W Jr, Berlin J, Freedman GM, Lawrence T, Talamonti MS, Mulcahy MF, Chakravarthy AB, Konski AA, Zalupski MM, Philip PA, Kinsella TJ, Merchant NB, Hoffman JP, Benson AB, Nicol S, Xu RM, Gill JF, McGinn CJ (2008) Full-dose gemcitabine with concurrent radiation therapy in patients with nonmetastatic pancreatic cancer: a multicenter phase II trial. J Clin Oncol 26(6):942–947. doi:10.1200/JCO.2007.13.9014

    CAS  Article  PubMed  Google Scholar 

  21. Murphy JD, Adusumilli S, Griffith KA, Ray ME, Zalupski MM, Lawrence TS, Ben-Josef E (2007) Full-dose gemcitabine and concurrent radiotherapy for unresectable pancreatic cancer. Int J Radiat Oncol Biol Phys 68(3):801–808. doi:10.1016/j.ijrobp.2006.12.053

    CAS  Article  PubMed  Google Scholar 

  22. Min YJ, Joo KR, Park NH, Yun TK, Nah YW, Nam CW, Park JH (2002) Gemcitabine therapy in patients with advanced pancreatic cancer. Korean J Intern Med 17(4):259–262

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  23. Rwigema JC, Parikh SD, Heron DE, Howell M, Zeh H, Moser AJ, Bahary N, Quinn A, Burton SA (2011) Stereotactic body radiotherapy in the treatment of advanced adenocarcinoma of the pancreas. Am J Clin Oncol 34(1):63–69. doi:10.1097/COC.0b013e3181d270b4

    CAS  Article  PubMed  Google Scholar 

  24. Hoyer M, Roed H, Sengelov L, Traberg A, Ohlhuis L, Pedersen J, Nellemann H, Kiil Berthelsen A, Eberholst F, Engelholm SA, von der Maase H (2005) Phase-II study on stereotactic radiotherapy of locally advanced pancreatic carcinoma. Radiother Oncol 76(1):48–53. doi:10.1016/j.radonc.2004.12.022

    Article  PubMed  Google Scholar 

  25. Nimura Y, Hattori T, Miura K, Nakajima N, Hibi M (1976) Experience of Appleby’s operation for advanced carcinoma of the pancreatic body and tail. Shujutsu 30:885–889

    Google Scholar 

  26. Parlak C, Topkan E, Onal C, Reyhan M, Selek U (2012) Prognostic value of gross tumor volume delineated by FDG-PET-CT based radiotherapy treatment planning in patients with locally advanced pancreatic cancer treated with chemoradiotherapy. Radiat Oncol 7:37. doi:10.1186/1748-717X-7-37

    Article  PubMed  PubMed Central  Google Scholar 

  27. Tas F, Sen F, Keskin S, Kilic L, Yildiz I (2013) Prognostic factors in metastatic pancreatic cancer: older patients are associated with reduced overall survival. Mol Clin Oncol 1(4):788–792. doi:10.3892/mco.2013.131

    CAS  PubMed  PubMed Central  Google Scholar 

  28. Su TS, Liang P, Lu HZ, Liang JN, Liu JM, Zhou Y, Gao YC, Tang MY (2015) Stereotactic body radiotherapy using CyberKnife for locally advanced unresectable and metastatic pancreatic cancer. World J Gastroenterol 21(26):8156–8162. doi:10.3748/wjg.v21.i26.8156

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

We would like to thank all of the participating physicians, patients, and administrators of the RSSearch Registry that made this study possible.

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Correspondence to Raj Singh.

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No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Cite this article

Singh, R., Ansinelli, H. & Sharma, S. Clinical outcomes following stereotactic body radiation therapy (SBRT) for non-resectable pancreatic adenocarcinoma. J Radiat Oncol 6, 279–286 (2017). https://doi.org/10.1007/s13566-017-0313-8

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  • DOI: https://doi.org/10.1007/s13566-017-0313-8

Keywords

  • Pancreatic adenocarcinoma
  • Radiotherapy
  • SBRT
  • Registry