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Abstract
Background and ObjectiveTo assess the efficacy of a Risk-Adapted Ablative Radiotherapy (RAdAR) approach, after intensive induction chemotherapy, in patients with locally advanced pancreatic cancer (LAPC).Material and MethodsPatients with LAPC who received RAdAR following induction chemotherapy from January 2017 to December 2019 were included in this observational study. The RAdAR approach consisted of an anatomy- and simultaneous integrated boost (SIB)-based dose prescription strategy. RAdAR was delivered with stereotactic ablative radiation therapy (SAbR), administering 30 Gy in 5 fractions to the tumor volume (PTVt) and 50 Gy SIB (BED10 100 Gy) to the vascular involvement, or with (hypo-)fractionated ablative radiotherapy (HART) prescribing 50.4 Gy in 28 fractions to the PTVt, with a vascular SIB of 78.4 Gy (BED10 100 Gy). Primary end points were freedom from local progression (FFLP), overall survival (OS), and progression-free survival (PFS).ResultsSixty-four LAPC patients were included. Induction chemotherapy consisted of gemcitabine/nab-paclitaxel in 60.9% and FOLFIRINOX in 39.1% of cases. SAbR was used in 52 (81.2%) patients, and HART in 12 (18.8%). After RAdAR, surgery was performed in 17 (26.6%) patients. Median follow-up was 16.1 months. Overall local control (LC) rate was 78.1%, with no difference between resected and non-resected patients (2-year FFLP 75.3% vs 56.4%; p = 0.112). Median OS and PFS were 29.7 months and 8.7 months, respectively, for the entire cohort. Resected patients had a better median OS (not reached versus 26.1 months; p = 0.0001) and PFS (19 versus 5.6 months; p < 0.0001) compared to non-resected patients. In non-resected patients, no significant difference was found between SAbR and HART for median FFLP (28.1 versus 18.5 months; p = 0.614), OS (27.4 versus 25.3 months; p = 0.624), and PFS (5.7 versus 4.3 months; p = 0.486). One patient (1.6%) experienced acute grade 4 gastro-intestinal bleeding. No other acute or late grade ≥ 3 toxicities were observed.ConclusionsThe RAdAR approach, following intensive induction chemotherapy, is an effective radiation treatment strategy for selected LAPC patients, representing a promising therapeutic option in a multimodality treatment regimen.
Highlights
The prognosis of pancreatic cancer remains dismal, with a 5-year survival rate of less than 10% [1, 2]
A total of 64 locally advanced pancreatic cancer (LAPC) patients were included in the analysis; of these 36 (56.3%) were male
In non-resected patients, no significant difference was found between stereotactic ablative radiation therapy (SAbR) and HART for median Freedom from local progression (FFLP) (28.1 versus 18.5 months; p = 0.614), overall survival (OS) (27.4 versus 25.3 months; p = 0.624), and progression-free survival (PFS) (5.7 versus 4.3 months; p = 0.486)
Summary
The prognosis of pancreatic cancer remains dismal, with a 5-year survival rate of less than 10% [1, 2]. Pancreatic cancer mortality continues to increase, and the advanced stage of disease at the time of diagnosis is predictive of decreased survival [3]. About 30-35% of patients present with nonmetastatic, locally advanced pancreatic cancer (LAPC) and are not suitable for surgery [4]. Chemotherapy represents the treatment of choice for LAPC, with consolidative radiotherapy as an option for patients in response to systemic therapy. New more active multiagent chemotherapy regimens have changed this paradigm. To assess the efficacy of a Risk-Adapted Ablative Radiotherapy (RAdAR) approach, after intensive induction chemotherapy, in patients with locally advanced pancreatic cancer (LAPC)
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