Abstract
BackgroundTo assess the efficacy and safety of stereotactic body radiotherapy (SBRT) in patients with either unresectable locally advanced pancreatic adenocarcinoma or by locally recurrent disease after surgery.MethodsBetween January 2010 and October 2011, 30 patients with unresectable or recurrent pancreatic adenocarcinoma underwent exclusive SBRT. Twenty-one patients (70%) presented with unresectable locally advanced disease and 9 patients (30%) showed local recurrence after surgery. No patients had metastatic disease. Gemcitabine-based chemotherapy was administered to all patients before SBRT. Prescription dose was 45Gy in 6 daily fractions of 7.5Gy. SBRT was delivered using the volumetric modulated arc therapy (VMAT) by RapidArc. Primary end-point of this study was freedom from local progression (FFLP), secondary end-points were overall survival (OS), progression free survival (PFS) and toxicity.ResultsMedian Clinical Target Volume (CTV) was 25.6 cm3 (3.2-78.8 cm3) and median Planning Target Volume (PTV) was 70.9 cm3 (20.4- 205.2 cm3). The prescription dose was delivered in 25 patients (83%), in 5 patients (17%) it was reduced to 36Gy in 6 fractions not to exceed the dose constraints of organs at risk (OARs). Median follow-up was 11 months (2–28 months). FFLP was 91% at 6 months, 85% at median follow-up and 77% at 1 and 2 years. For the group with prescription dose of 45Gy, FFLP was 96% at 1 and 2 years. The median PFS was 8 months. The OS was 47% at 1 year and median OS was 11 months. At the end of the follow-up, 9 patients (32%) were alive and 4 (14%) were free from progression. No patients experienced G ≥ 3 acute toxicity.ConclusionsOur preliminary results show that SBRT can obtain a satisfactory local control rate for unresectable locally advanced and recurrent pancreatic adenocarcinoma. This fractionation schedule is feasible, and no G ≥ 3 toxicity was observed. SBRT is an effective emerging technique in the multi-modality treatment of locally advanced pancreatic tumors.
Highlights
To assess the efficacy and safety of stereotactic body radiotherapy (SBRT) in patients with either unresectable locally advanced pancreatic adenocarcinoma or by locally recurrent disease after surgery
This trend has been confirmed in other studies on stereotactic body radiotherapy (SBRT) for locally advanced pancreatic cancer, with a higher incidence of gastrointestinal toxicity, due to the radio-sensitivity of normal organs of the upper abdomen, such as the stomach and the duodenum [8,9,10,11,12,13,14,15,16]
Patients and eligibility Between January 2010 and October 2011, 30 consecutive patients with unresectable or recurrent pancreatic adenocarcinoma were enrolled in this prospective, single-institutional study
Summary
To assess the efficacy and safety of stereotactic body radiotherapy (SBRT) in patients with either unresectable locally advanced pancreatic adenocarcinoma or by locally recurrent disease after surgery. Prognosis of pancreatic adenocarcinoma is still challenging, because of occult and evident metastatic disease at the time of diagnosis [1] For those patients with no evidence of distant metastasis, multimodality approach (surgery, chemotherapy and radiotherapy) increase survival and local control rates, improving quality of life [2]. Innovations of radiation techniques have promoted the use of hypo-fractionated regimens, allowing to improve local control for lung and liver cancer [7] This trend has been confirmed in other studies on stereotactic body radiotherapy (SBRT) for locally advanced pancreatic cancer, with a higher incidence of gastrointestinal toxicity, due to the radio-sensitivity of normal organs of the upper abdomen, such as the stomach and the duodenum [8,9,10,11,12,13,14,15,16]
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