Abstract
Objective
Stereotactic body radiotherapy (SBRT) is increasingly used for pancreatic cancer; however, there is a dearth of data guiding its use after prior SBRT.
Methods
We conducted an institutional review board (IRB)–approved retrospective study of patients treated with SBRT for pancreatic cancer on two occasions from 2005 to 2018. Patients were followed for response to treatment and toxicity assessment (Common Terminology Criteria for Adverse Events [CTCAE] version 5). Demographic and survival data for the cohort were described using frequencies, medians, and ranges. Survival analysis was performed using the Kaplan-Meier method.
Results
Twenty-four patients met the inclusion criteria. Local control at 1 year after the second SBRT treatment was 77.2%. Median survival from 1st SBRT course and 2nd SBRT course was 31 months and 13 months, respectively. Most patients were treated with 24 Gy in 3 fractions for their first course and 25 Gy in 5 fractions for their second course. Thirteen patients did not undergo surgery, and 9 had detailed radiation treatment planning data available with non-distorted GI anatomy. For the total summation dose (first and second courses of SBRT combined), the D0.03cc and D1cc to the duodenum received up to 46.1 Gy and 42.3 Gy, respectively, while the stomach received up to D0.03cc of 49.2 Gy and D1cc of 43.8 Gy.
Conclusion
SBRT after prior SBRT for pancreatic cancer is a reasonably safe and efficacious treatment that leads to durable local control and reasonable survival. Retreatment of the duodenum and stomach with a D0.03cc and D1cc of at least 40 Gy may be safe, although more data is needed.
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Data availability
Research data are stored in an institutional repository and will be shared upon request to the corresponding authors.
References
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68:394–424. https://doi.org/10.3322/caac.21492
Siegel RL, Miller KD, Jemal A (2020) Cancer statistics, 2020. CA Cancer J Clin 70:7–30. https://doi.org/10.3322/caac.21590
American Cancer Society (2020) Cancer Facts & Figures 2020. American Cancer Society, Atlanta
Hand F, Conlon KC (2019) Pancreatic cancer. Surgery (Oxford) 37:319–326. https://doi.org/10.1016/j.mpsur.2019.03.005
Chadha AS, Khoo A, Aliru ML, Arora HK, Gunther JR, Krishnan S (2016) Recent advances and prospects for multimodality therapy in pancreatic cancer. Semin Radiat Oncol 26:320–337. https://doi.org/10.1016/j.semradonc.2016.05.002
Herman JM, Chang DT, Goodman KA, Dholakia AS, Raman SP, Hacker-Prietz A, Iacobuzio-Donahue CA, Griffith ME, Pawlik TM, Pai JS, O'Reilly E, Fisher GA, Wild AT, Rosati LM, Zheng L, Wolfgang CL, Laheru DA, Columbo LA, Sugar EA, Koong AC (2015) Phase 2 multi-institutional trial evaluating gemcitabine and stereotactic body radiotherapy for patients with locally advanced unresectable pancreatic adenocarcinoma. Cancer 121:1128–1137. https://doi.org/10.1002/cncr.29161
Chuong MD, Springett GM, Freilich JM, Park CK, Weber JM, Mellon EA, Hodul PJ, Malafa MP, Meredith KL, Hoffe SE, Shridhar R (2013) Stereotactic body radiation therapy for locally advanced and borderline resectable pancreatic cancer is effective and well tolerated. Int J Radiat Oncol Biol Phys 86:516–522. https://doi.org/10.1016/j.ijrobp.2013.02.022
Rosati LM, Kumar R, Herman JM (2017) Integration of stereotactic body radiation therapy into the multidisciplinary management of pancreatic cancer. Semin Radiat Oncol 27:256–267. https://doi.org/10.1016/j.semradonc.2017.02.005
Conroy T, Hammel P, Hebbar M, Ben Abdelghani M, Wei AC, Raoul JL, Choné L, Francois E, Artru P, Biagi JJ, Lecomte T, Assenat E, Faroux R, Ychou M, Volet J, Sauvanet A, Breysacher G, di Fiore F, Cripps C, Kavan P, Texereau P, Bouhier-Leporrier K, Khemissa-Akouz F, Legoux JL, Juzyna B, Gourgou S, O'Callaghan CJ, Jouffroy-Zeller C, Rat P, Malka D, Castan F, Bachet JB, Canadian Cancer Trials Group and the Unicancer-GI–PRODIGE Group (2018) FOLFIRINOX or gemcitabine as adjuvant therapy for pancreatic cancer. N Engl J Med 379:2395–2406. https://doi.org/10.1056/NEJMoa1809775
Von Hoff DD, Ervin T, Arena FP et al (2013) Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med 369:1691–1703. https://doi.org/10.1056/NEJMoa1304369
Golan T, Hammel P, Reni M, van Cutsem E, Macarulla T, Hall MJ, Park JO, Hochhauser D, Arnold D, Oh DY, Reinacher-Schick A, Tortora G, Algül H, O’Reilly EM, McGuinness D, Cui KY, Schlienger K, Locker GY, Kindler HL (2019) Maintenance olaparib for germline BRCA-mutated metastatic pancreatic cancer. N Engl J Med 381:317–327. https://doi.org/10.1056/NEJMoa1903387
Hammel P, Huguet F, Van Laethem JL et al (2016) Effect of chemoradiotherapy vs chemotherapy on survival in patients with locally advanced pancreatic cancer controlled after 4 months of gemcitabine with or without erlotinib the LAP07 randomized clinical trial. JAMA 315:1844–1853. https://doi.org/10.1001/jama.2016.4324
Kleeff J, Reiser C, Hinz U et al (2007) Surgery for recurrent pancreatic ductal adenocarcinoma. Ann Surg 245:566–572. https://doi.org/10.1097/01.sla.0000245845.06772.7d
Wild AT, Hiniker SM, Chang DT, Tran PT, Khashab MA, Limaye MR, Laheru DA, le DT, Kumar R, Pai JS, Hargens B, Sharabi AB, Shin EJ, Zheng L, Pawlik TM, Wolfgang CL, Koong AC, Herman JM (2013) Re-irradiation with stereotactic body radiation therapy as a novel treatment option for isolated local recurrence of pancreatic cancer after multimodality therapy: experience from two institutions. J Gastrointest Oncol 4:343–351. https://doi.org/10.3978/j.issn.2078-6891.2013.044
Koong AJ, Toesca DAS, von Eyben R, Pollom EL, Chang DT (2017) Reirradiation with stereotactic body radiation therapy after prior conventional fractionation radiation for locally recurrent pancreatic adenocarcinoma. Adv Radiat Oncol 2:27–36. https://doi.org/10.1016/j.adro.2017.01.003
Dagoglu N, Callery M, Moser J, Tseng J, Kent T, Bullock A, Miksad R, Mancias JD, Mahadevan A (2016) Stereotactic body radiotherapy (SBRT) reirradiation for recurrent pancreas cancer. J Cancer 7:283–288. https://doi.org/10.7150/jca.13295
Krishnan S, Chadha AS, Suh Y, Chen HC, Rao A, Das P, Minsky BD, Mahmood U, Delclos ME, Sawakuchi GO, Beddar S, Katz MH, Fleming JB, Javle MM, Varadhachary GR, Wolff RA, Crane CH (2016) Focal radiation therapy dose escalation improves overall survival in locally advanced pancreatic cancer patients receiving induction chemotherapy and consolidative chemoradiation. Int J Radiat Oncol Biol Phys 94:755–765. https://doi.org/10.1016/j.ijrobp.2015.12.003
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Duran, J.F., Hurwitz, M., Chapman, T. et al. SBRT re-irradiation after prior SBRT in pancreatic cancer—outcomes and a focus on stomach and bowel toxicity. J Radiat Oncol 9, 235–241 (2020). https://doi.org/10.1007/s13566-020-00443-x
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DOI: https://doi.org/10.1007/s13566-020-00443-x