Palliative radiosurgery for localized pancreatic cancer in the elderly.

Abstract

583 Background: At least 15% of patients diagnosed with localized pancreatic cancer are medically unfit for surgical resection or systemic therapy. Traditionally, these patients are enrolled in palliative care with symptom management alone. With local progression of their disease, they may experience pain, obstruction, weight loss and nausea. Radiosurgery is a localized high dose conformal therapy allowing for noninvasive treatment of pancreatic cancer. This study retrospectively examines the role of palliative radiosurgery as monotherapy for elderly patients who are not candidates for standard of care therapy. Methods: From 2017-2021, 28 patients over the age of 80 with biopsy confirmed pancreatic adenocarcinoma and localized disease by imaging were retrospectively evaluated. All had been deemed not to be candidates for surgical resection or systemic chemotherapy. Outcomes were reviewed to evaluate patient characteristics, local control, quality of life, ECOG status and survival duration. Results: Median patient age was 84 years (range 80-99). All 28 patients received SBRT radiosurgery to the pancreas with 35-40Gy in 5 fractions with photon LINAC platform. Mean ECOG score was 1.2 at time of treatment. At 6 month follow up, 18 patients were alive with a mean ECOG of 1.4. Four patients reported grade 2 acute GI toxicity in the first three months with no late toxicity reported. Eight patients developed local progression while fourteen patients developed distant metastatic disease. Six patients at least one year out from treatment have no evidence of disease progression. Median overall survival is 10.8 months. Conclusions: Pancreatic radiosurgery is a safe and effective method of palliative therapy for elderly patients who are not candidates for surgical resection or systemic therapy. It can provide durable local control, relief of pain and obstructive symptoms, is well tolerated with minimal toxicity and provides favorable survival when compared to palliative care alone.