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Stereotactic Body Radiotherapy (SBRT) for Pancreatic Cancer

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Stereotactic Body Radiotherapy

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Abstract

Pancreatic cancer is the tenth most common cancer and is the fourth leading cause of cancer mortality. While surgery remains the current potentially curative treatment of choice, few cancers are resectable at presentation. Chemotherapy and radiation play a vital role in locally advanced non-metastatic pancreatic cancer. Systemic therapy is vital in these patients and often, when they remain non-metastatic after induction therapy radiation improves local control. Conventional chemoradiation is delivered in 5–6 weeks. Stereotactic body radiotherapy (SBRT) has been used in patients with locally advanced pancreas cancer, in fewer treatments, without significantly affecting systemic therapy, thereby maximizing systemic and local control. SBRT has also been used to boost positive margins, local recurrences after prior radiation, and in oligometastatic pancreatic cancer.

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References

  1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin. 2013;63(1):11–30. PubMed PMID: 23335087.

    Article  PubMed  Google Scholar 

  2. Vincent A, Herman J, Schulick R, Hruban RH, Goggins M. Pancreatic cancer. Lancet. 2011;378(9791):607–20. PubMed PMID: 21620466.

    Article  PubMed  Google Scholar 

  3. Staley CA, Cleary KR, Abbruzzese JL, Lee JE, Ames FC, Fenoglio CJ, et al. The need for standardized pathologic staging of pancreaticoduodenectomy specimens. Pancreas. 1996;12(4):373–80. PubMed PMID: 8740405.

    Article  CAS  PubMed  Google Scholar 

  4. Cardenes HR, Chiorean EG, Dewitt J, Schmidt M, Loehrer P. Locally advanced pancreatic cancer: current therapeutic approach. Oncologist. 2006;11(6):612–23. PubMed PMID: 16794240.

    Article  CAS  PubMed  Google Scholar 

  5. Ducreux M, Boige V, Goere D, Deutsch E, Ezra P, Elias D, et al. The multidisciplinary management of gastrointestinal cancer. Pancreatic cancer: from pathogenesis to cure. Best Pract Res Clin Gastroenterol. 2007;21(6):997–1014. PubMed PMID: 18070700.

    Article  CAS  PubMed  Google Scholar 

  6. Yip D, Karapetis C, Strickland A, Steer CB, Goldstein D. Chemotherapy and radiotherapy for inoperable advanced pancreatic cancer. Cochrane Database Syst Rev. 2006;3, CD002093. PubMed PMID: 16855985.

    PubMed  Google Scholar 

  7. Morganti AG, Massaccesi M, La Torre G, Caravatta L, Piscopo A, Tambaro R, et al. A systematic review of resectability and survival after concurrent chemoradiation in primarily unresectable pancreatic cancer. Ann Surg Oncol. 2010;17(1):194–205. PubMed PMID: 19856029.

    Article  PubMed  Google Scholar 

  8. Blackstock AW, Tepper JE, Niedwiecki D, Hollis DR, Mayer RJ, Tempero MA. Cancer and leukemia group B (CALGB) 89805: phase II chemoradiation trial using gemcitabine in patients with locoregional adenocarcinoma of the pancreas. Int J Gastrointest Cancer. 2003;34(2–3):107–16. PubMed PMID: 15361643.

    Article  CAS  PubMed  Google Scholar 

  9. Chauffert B, Mornex F, Bonnetain F, Rougier P, Mariette C, Bouche O, et al. Phase III trial comparing intensive induction chemoradiotherapy (60 Gy, infusional 5-FU and intermittent cisplatin) followed by maintenance gemcitabine with gemcitabine alone for locally advanced unresectable pancreatic cancer. Definitive results of the 2000–01 FFCD/SFRO study. Ann Oncol. 2008;19(9):1592–9.

    Article  CAS  PubMed  Google Scholar 

  10. Crane CH, Varadhachary G, Pisters PW, Evans DB, Wolff RA. Future chemoradiation strategies in pancreatic cancer. Semin Oncol. 2007;34(4):335–46. PubMed PMID: 17674962.

    Article  CAS  PubMed  Google Scholar 

  11. Crane CH, Winter K, Regine WF, Safran H, Rich TA, Curran W, et al. Phase II study of bevacizumab with concurrent capecitabine and radiation followed by maintenance gemcitabine and bevacizumab for locally advanced pancreatic cancer: Radiation Therapy Oncology Group RTOG 0411. J Clin Oncol. 2009;27(25):4096–102. PubMed PMID: 19636002. Pubmed Central PMCID: 2734421.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Huguet F, Andre T, Hammel P, Artru P, Balosso J, Selle F, et al. Impact of chemoradiotherapy after disease control with chemotherapy in locally advanced pancreatic adenocarcinoma in GERCOR phase II and III studies. J Clin Oncol. 2007;25(3):326–31. PubMed PMID: 17235048.

    Article  CAS  PubMed  Google Scholar 

  13. Magnino A, Gatti M, Massucco P, Sperti E, Faggiuolo R, Regge D, et al. Phase II trial of primary radiation therapy and concurrent chemotherapy for patients with locally advanced pancreatic cancer. Oncology. 2005;68(4–6):493–9. PubMed PMID: 16020980.

    Article  CAS  PubMed  Google Scholar 

  14. Okusaka T, Furuse J, Funakoshi A, Ioka T, Yamao K, Ohkawa S, et al. Phase II study of erlotinib plus gemcitabine in Japanese patients with unresectable pancreatic cancer. Cancer Sci. 2011;102(2):425–31. PubMed PMID: 21175992.

    Article  CAS  PubMed  Google Scholar 

  15. Okusaka T, Ito Y, Ueno H, Ikeda M, Takezako Y, Morizane C, et al. Phase II study of radiotherapy combined with gemcitabine for locally advanced pancreatic cancer. Br J Cancer. 2004;91(4):673–7. PubMed PMID: 15226765. Pubmed Central PMCID: 2364779.

    CAS  PubMed Central  PubMed  Google Scholar 

  16. Andre T, Noirclerc M, Hammel P, Meckenstock R, Landi B, Cattan S, et al. Phase II study of leucovorin, 5-fluorouracil and gemcitabine for locally advanced and metastatic pancreatic cancer (FOLFUGEM 2). Gastroenterol Clin Biol. 2004;28(8–9):645–50. PubMed PMID: 15646530.

    Article  CAS  PubMed  Google Scholar 

  17. El-Rayes BF, Zalupski MM, Shields AF, Vaishampayan U, Heilbrun LK, Jain V, et al. Phase II study of gemcitabine, cisplatin, and infusional fluorouracil in advanced pancreatic cancer. J Clin Oncol. 2003;21(15):2920–5. PubMed PMID: 12885810.

    Article  CAS  PubMed  Google Scholar 

  18. Heinemann V, Quietzsch D, Gieseler F, Gonnermann M, Schonekas H, Rost A, et al. Randomized phase III trial of gemcitabine plus cisplatin compared with gemcitabine alone in advanced pancreatic cancer. J Clin Oncol. 2006;24(24):3946–52. PubMed PMID: 16921047.

    Article  CAS  PubMed  Google Scholar 

  19. Louvet C, Andre T, Lledo G, Hammel P, Bleiberg H, Bouleuc C, et al. Gemcitabine combined with oxaliplatin in advanced pancreatic adenocarcinoma: final results of a GERCOR multicenter phase II study. J Clin Oncol. 2002;20(6):1512–8. PubMed PMID: 11896099.

    Article  CAS  PubMed  Google Scholar 

  20. Louvet C, Labianca R, Hammel P, Lledo G, Zampino MG, Andre T, et al. Gemcitabine in combination with oxaliplatin compared with gemcitabine alone in locally advanced or metastatic pancreatic cancer: results of a GERCOR and GISCAD phase III trial. J Clin Oncol. 2005;23(15):3509–16. PubMed PMID: 15908661.

    Article  CAS  PubMed  Google Scholar 

  21. O’Reilly EM, Abou-Alfa GK. Cytotoxic therapy for advanced pancreatic adenocarcinoma. Semin Oncol. 2007;34(4):347–53. PubMed PMID: 17674963.

    Article  PubMed  Google Scholar 

  22. Reni M, Passoni P, Panucci MG, Nicoletti R, Galli L, Balzano G, et al. Definitive results of a phase II trial of cisplatin, epirubicin, continuous-infusion fluorouracil, and gemcitabine in stage IV pancreatic adenocarcinoma. J Clin Oncol. 2001;19(10):2679–86. PubMed PMID: 11352960.

    CAS  PubMed  Google Scholar 

  23. Stathopoulos GP, Syrigos K, Aravantinos G, Polyzos A, Papakotoulas P, Fountzilas G, et al. A multicenter phase III trial comparing irinotecan-gemcitabine (IG) with gemcitabine (G) monotherapy as first-line treatment in patients with locally advanced or metastatic pancreatic cancer. Br J Cancer. 2006;95(5):587–92. PubMed PMID: 16909140. Pubmed Central PMCID: 2360678.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Chang BW, Saif MW. Stereotactic body radiation therapy (SBRT) in pancreatic cancer: is it ready for prime time? JOP. 2008;9(6):676–82. PubMed PMID: 18981547.

    PubMed  Google Scholar 

  25. Chang DT, Schellenberg D, Shen J, Kim J, Goodman KA, Fisher GA, et al. Stereotactic radiotherapy for unresectable adenocarcinoma of the pancreas. Cancer. 2009;115(3):665–72. PubMed PMID: 19117351.

    Article  PubMed  Google Scholar 

  26. Schellenberg D, Kim J, Christman-Skieller C, Chun CL, Columbo LA, Ford JM, et al. Single-fraction stereotactic body radiation therapy and sequential gemcitabine for the treatment of locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys. 2011;81(1):181–8. PubMed PMID: 21549517.

    Article  PubMed  Google Scholar 

  27. Hoyer M, Roed H, Sengelov L, Traberg A, Ohlhuis L, Pedersen J, et al. Phase-II study on stereotactic radiotherapy of locally advanced pancreatic carcinoma. Radiother Oncol. 2005;76(1):48–53. PubMed PMID: 15990186.

    Article  PubMed  Google Scholar 

  28. Schellenberg D, Goodman KA, Lee F, Chang S, Kuo T, Ford JM, 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. PubMed PMID: 18395362.

    Article  CAS  PubMed  Google Scholar 

  29. Koong AC, Le QT, Ho A, Fong B, Fisher G, Cho C, 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. PubMed PMID: 15001240.

    Article  PubMed  Google Scholar 

  30. Koong AC, Christofferson E, Le QT, Goodman KA, Ho A, Kuo T, 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. PubMed PMID: 16168826.

    Article  PubMed  Google Scholar 

  31. Mahadevan A, Miksad R, Goldstein M, Sullivan R, Bullock A, Buchbinder E, et al. Induction gemcitabine and stereotactic body radiotherapy for locally advanced nonmetastatic pancreas cancer. Int J Radiat Oncol Biol Phys. 2011;81(4):e615–22. PubMed PMID: 21658854.

    Article  CAS  PubMed  Google Scholar 

  32. Mahadevan A, Jain S, Goldstein M, Miksad R, Pleskow D, Sawhney M, et al. Stereotactic body radiotherapy and gemcitabine for locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys. 2010;78(3):735–42. PubMed PMID: 20171803.

    Article  PubMed  Google Scholar 

  33. Polistina F, Costantin G, Casamassima F, Francescon P, Guglielmi R, Panizzoni G, 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. PubMed PMID: 20224860.

    Article  PubMed  Google Scholar 

  34. Rwigema JC, Parikh SD, Heron DE, Howell M, Zeh H, Moser AJ, et al. Stereotactic body radiotherapy in the treatment of advanced adenocarcinoma of the pancreas. Am J Clin Oncol. 2011;34(1):63–9. PubMed PMID: 20308870.

    Article  CAS  PubMed  Google Scholar 

  35. Tozzi A, Comito T, Alongi F, Navarria P, Iftode C, Mancosu P, et al. SBRT in unresectable advanced pancreatic cancer: preliminary results of a mono-institutional experience. Radiat Oncol. 2013;8(1):148. PubMed PMID: 23799996. Pubmed Central PMCID: 3707803.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Chuong MD, Springett GM, Freilich JM, Park CK, Weber JM, Mellon EA, 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. PubMed PMID: 23562768.

    Article  PubMed  Google Scholar 

  37. Raptopoulos V, Steer ML, Sheiman RG, Vrachliotis TG, Gougoutas CA, Movson JS. The use of helical CT and CT angiography to predict vascular involvement from pancreatic cancer: correlation with findings at surgery. AJR Am J Roentgenol. 1997;168(4):971–7. PubMed PMID: 9124153.

    Article  CAS  PubMed  Google Scholar 

  38. Morris-Stiff G, Escofet X, Barry JD, Lewis WG, Puntis MC, Roberts SA. Selective use of endoscopic ultrasound in the evaluation of carcinomas of the pancreatic head. Dig Surg. 2011;28(5–6):373–8. PubMed PMID: 22134196.

    Article  PubMed  Google Scholar 

  39. Goyal K, Einstein D, Ibarra RA, Yao M, Kunos C, Ellis R, et al. Stereotactic body radiation therapy for nonresectable tumors of the pancreas. J Surg Res. 2012;174(2):319–25. PubMed PMID: 21937061.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Rusthoven KE, Kavanagh BD, Cardenes H, Stieber VW, Burri SH, Feigenberg SJ, et al. Multi-institutional phase I/II trial of stereotactic body radiation therapy for liver metastases. J Clin Oncol. 2009;27(10):1572–8. PubMed PMID: 19255321.

    Article  PubMed  Google Scholar 

  41. Schefter TE, Kavanagh BD, Timmerman RD, Cardenes HR, Baron A, Gaspar LE. A phase I trial of stereotactic body radiation therapy (SBRT) for liver metastases. Int J Radiat Oncol Biol Phys. 2005;62(5):1371–8. PubMed PMID: 16029795.

    Article  PubMed  Google Scholar 

  42. Pan CC, Kavanagh BD, Dawson LA, Li XA, Das SK, Miften M, et al. Radiation-associated liver injury. Int J Radiat Oncol Biol Phys. 2010;76(3 Suppl):S94–100. PubMed PMID: 20171524.

    Article  PubMed  Google Scholar 

  43. Didolkar MS, Coleman CW, Brenner MJ, Chu KU, Olexa N, Stanwyck E, et al. Image-guided stereotactic radiosurgery for locally advanced pancreatic adenocarcinoma results of first 85 patients. J Gastrointest Surg. 2010;14(10):1547–59. PubMed PMID: 20839073.

    Article  PubMed  Google Scholar 

  44. Gurka MK, Collins SP, Slack R, Tse G, Charabaty A, Ley L, et al. Stereotactic body radiation therapy with concurrent full-dose gemcitabine for locally advanced pancreatic cancer: a pilot trial demonstrating safety. Radiat Oncol. 2013;8:44. PubMed PMID: 23452509. Pubmed Central PMCID: 3607991.

    Article  PubMed Central  PubMed  Google Scholar 

  45. Taniguchi CM, Murphy JD, Eclov N, Atwood TF, Kielar KN, Christman-Skieller C, et al. Dosimetric analysis of organs at risk during expiratory gating in stereotactic body radiation therapy for pancreatic cancer. Int J Radiat Oncol Biol Phys. 2013;85(4):1090–5. PubMed PMID: 23273994.

    Article  PubMed  Google Scholar 

  46. Murphy JD, Christman-Skieller C, Kim J, Dieterich S, Chang DT, Koong AC. A dosimetric model of duodenal toxicity after stereotactic body radiotherapy for pancreatic cancer. Int J Radiat Oncol Biol Phys. 2010;78(5):1420–6. PubMed PMID: 20399033.

    Article  PubMed  Google Scholar 

  47. Lee MT, Kim JJ, Dinniwell R, Brierley J, Lockwood G, Wong R, et al. Phase I study of individualized stereotactic body radiotherapy of liver metastases. J Clin Oncol. 2009;27(10):1585–91. PubMed PMID: 19255313.

    Article  PubMed  Google Scholar 

  48. Tse RV, Hawkins M, Lockwood G, Kim JJ, Cummings B, Knox J, et al. Phase I study of individualized stereotactic body radiotherapy for hepatocellular carcinoma and intrahepatic cholangiocarcinoma. J Clin Oncol. 2008;26(4):657–64. PubMed PMID: 18172187.

    Article  PubMed  Google Scholar 

  49. Richter J, Saif MW. Locally advanced pancreatic adenocarcinoma: where are we and where are we going? Highlights from the “2010 ASCO Gastrointestinal Cancers Symposium”. Orlando, FL, USA. January 22–24, 2010. JOP. 2010;11(2):139–43.

    PubMed  Google Scholar 

  50. Ko AH, Crane CH. Radiation therapy in operable and locally advanced pancreatic cancer. J Natl Compr Canc Netw. 2010;8(9):1022–31. PubMed PMID: 20876542.

    CAS  PubMed  Google Scholar 

  51. Minn AY, Koong AC, Chang DT. Stereotactic body radiation therapy for gastrointestinal malignancies. Front Radiat Ther Oncol. 2011;43:412–27. PubMed PMID: 21625166.

    Article  PubMed  Google Scholar 

  52. Savir G, Huber KE, Saif MW. Locally advanced pancreatic cancer. Looking beyond traditional chemotherapy and radiation. JOP. 2013;14(4):337–9. PubMed PMID: 23846922.

    PubMed  Google Scholar 

  53. Rwigema JC, Heron DE, Parikh SD, Zeh 3rd HJ, Moser JA, Bahary N, et al. Adjuvant stereotactic body radiotherapy for resected pancreatic adenocarcinoma with close or positive margins. J Gastrointest Cancer. 2012;43(1):70–6. PubMed PMID: 20809393.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Anand Mahadevan MD, FRCS, FRCR

  2. Department of Clinical Oncology, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK

    Andrew M. Gaya MD

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  1. Anand Mahadevan MD, FRCS, FRCR
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  2. Andrew M. Gaya MD
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Correspondence to Anand Mahadevan MD, FRCS, FRCR .

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Editors and Affiliations

  1. Guy's Hospital, London, United Kingdom

    Andrew Gaya

  2. Dept. Radiation Oncology, Harvard Medical School Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

    Anand Mahadevan

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Mahadevan, A., Gaya, A.M. (2015). Stereotactic Body Radiotherapy (SBRT) for Pancreatic Cancer. In: Gaya, A., Mahadevan, A. (eds) Stereotactic Body Radiotherapy. Springer, London. https://doi.org/10.1007/978-0-85729-597-2_10

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