Stereotactic body radiation for pancreatic cancer: results of an international survey of practice patterns

Abstract

Stereotactic body radiotherapy (SBRT) is an emerging treatment option for borderline resectable and locally advanced, unresectable pancreatic cancer (PCA). However, no standardized guidelines for treatment exist and patterns of SBRT use for PCA are unclear. Radiation oncologists known to use SBRT in the setting of PCA were invited to complete a 26-item Web-based survey on practice patterns. Thirty of the 36 (83 %) invited radiation oncologists completed the survey. Of the responders, 86 % treat with 6–8 Gy ×5 fractions. The majority (93 %) of responders use four-dimensional computed tomography (4D-CT) for simulation, with 50 % using gating for breathing motion. Two thirds of radiation oncologists use fiducials for tumor localization. Most (79 %) responders noted an improvement in patient-reported pain after SBRT. Approximately, 59 % report difficulty obtaining insurance clearance for pancreas SBRT in the absence of a clinical trial. The largest variations in practice were related to gross tumor volume (GTV) to planning target volume (PTV) expansions and management of respiratory motion. SBRT is increasingly used for PCA. The data presented here indicate that the majority of radiation oncologists treat with 6–8 Gy ×5 fractions and use fiducials with 4D-CT simulation for localization and planning. Although the majority of the surveyed physicians prefer SBRT to standard radiation, it may be underutilized due to the difficulty of obtaining insurance approval outside of a clinical trial. Our investigation documents current pancreas SBRT practice patterns and highlights the need for prospective clinical trials as a means to develop consensus guidelines for this emerging treatment.