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Stereotactic Body Radiation Therapy for Isolated Local Recurrence After Surgical Resection of Pancreatic Ductal Adenocarcinoma Appears to be Safe and Effective

  • Pancreatic Tumors
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

A standardized treatment regimen for unresectable isolated local recurrence (ILR) of pancreatic ductal adenocarcinoma has not been established. This study evaluated the outcomes for patients with ILR who underwent stereotactic body radiation therapy (SBRT).

Methods

The records of patients with ILR who underwent SBRT between 2010 and 2016 were retrospectively reviewed. Symptom palliation and treatment-related toxicity were recorded. Associations between patient or treatment characteristics and overall survival (OS), progression-free survival (PFS), and local progression-free survival (LPFS) were assessed.

Results

The study identified 51 patients who received SBRT for ILR. Of the 51 patients, 26 (51%) had not received radiation therapy before SBRT. The median OS was 36 months after diagnosis. From the first day of SBRT, the median OS, PFS, and LPFS were respectively 16, 7, and 10 months. Patients with a recurrence-free interval of 9 months or longer after surgery had superior OS (P = 0.019). Maintenance chemotherapy after SBRT was associated with superior OS (P < 0.001) and LPFS (P = 0.027). In the multivariable analysis, poorly differentiated tumor grade [hazard ratio (HR) 11.274], positive surgical margins (HR 0.126), and reception of maintenance chemotherapy (HR 0.141) were independently associated with OS. Positive surgical margins (HR 0.255) and maintenance chemotherapy (HR 0.299) were associated with improved LPFS. Of 16 patients, 10 (63%) experienced abdominal pain relief after SBRT. Four patients (8%) experienced grade 3 gastrointestinal toxicity, and one patient experienced grade 4 gastrointestinal toxicity.

Conclusions

Use of SBRT for ILR improved pain for a majority of the patients with acceptable acute and late toxicity. The findings show that SBRT is a feasible treatment for select patients with ILR. For those who receive SBRT, maintenance chemotherapy should be considered.

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Acknowledgment

The authors received funds for this project from the Claudio X. Gonzalez Family Foundation, Flannery Family Foundation, Alexander Family Foundation, Keeling Family Foundation, DeSanti Family Foundation, McKnight Family Foundation, and My Blue Dots Foundation.

Disclosure

There are no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology & Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    John F. Ryan BS, Lauren M. Rosati BS, Amy Hacker-Prietz MS, PA-C, Amol K. Narang MD, Todd R. McNutt MS, PhD, Juan F. Jackson CMD, Dung T. Le MD & Joseph M. Herman MD, MSc

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

    Vincent P. Groot MD, Jin He MD, PhD, Timothy M. Pawlik MD, MPH, PhD, Matthew J. Weiss MD & Christopher L. Wolfgang MD, PhD

  3. Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Elizabeth M. Jaffee MD, Lei Zheng MD, PhD & Daniel A. Laheru MD

  4. Director of Clinical Research, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1422, Houston, TX, USA

    Joseph M. Herman MD, MSc

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  1. John F. Ryan BS
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Correspondence to Joseph M. Herman MD, MSc.

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Ryan, J.F., Groot, V.P., Rosati, L.M. et al. Stereotactic Body Radiation Therapy for Isolated Local Recurrence After Surgical Resection of Pancreatic Ductal Adenocarcinoma Appears to be Safe and Effective. Ann Surg Oncol 25, 280–289 (2018). https://doi.org/10.1245/s10434-017-6134-6

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  • DOI: https://doi.org/10.1245/s10434-017-6134-6

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