Abstract
Stereotactic body radiation therapy (SBRT) represents a promising treatment option for patients with localized pancreatic ductal adenocarcinoma (PDAC) who cannot tolerate surgical therapy. We retrospectively reviewed the records of patients with localized PDAC treated with SBRT at our institution between 2010 and 2016 to identify patients deemed medically inoperable due to poor performance status, advanced age, and/or comorbid conditions. Overall survival (OS), progression-free survival (PFS), and local progression-free survival (LPFS) were estimated using Kaplan-Meier curves. Twenty-nine patients were included. Median age was 74 (IQR 68-79). Thirteen patients (45%) had an Eastern Cooperative Oncology Group performance status of 2. Six patients (19%) had chronic obstructive pulmonary disease, 9 (31%) had cardiovascular disease, and 17 (58%) had diabetes mellitus. SBRT was delivered over 5 fractions to a median dose of 28 Gy (IQR, 25-33). Twenty-two patients (76%) received induction chemotherapy prior to SBRT, and 9 (31%) received maintenance chemotherapy after SBRT. Median OS was 13 months from diagnosis. Median OS and PFS were 8 and 6 months from SBRT, respectively. Six and 12-month LPFS rates were 91% and 78%, respectively. Patients receiving induction chemotherapy had superior survival from diagnosis than those who did not (14 vs. 7 months, p = 0.01). Three patients (10%) experienced acute grade ≥3 toxicity, and 1 patient (4%) experienced grade ≥3 late toxicity. Symptom relief was achieved at three-month follow-up in 8 of 11 patients (73%) experiencing abdominal pain. These results suggest SBRT may be safe and effective for patients who cannot tolerate surgery.
Highlights
In the United States in 2016, an estimated 53,070 patients were diagnosed with pancreatic ductal adenocarcinoma (PDAC) and 41,780 died of the disease [1]
We report on the outcomes of patients with localized PDAC who were treated with Stereotactic body radiation therapy (SBRT) at our institution after being deemed medically inoperable due to advanced age, medical comorbidities, and/or poor performance status
While most clinical trials for localized PDAC focus on patients who can tolerate aggressive multi-modality therapy including surgery, chemotherapy, and/or radiation, it is important to find treatment options for patients who cannot tolerate existing therapies, especially considering the prevalence of debilitating symptoms associated with PDAC and comorbid conditions in elderly patients [3, 4]
Summary
In the United States in 2016, an estimated 53,070 patients were diagnosed with pancreatic ductal adenocarcinoma (PDAC) and 41,780 died of the disease [1]. A subset of patients (20-30%) with localized disease, are not candidates for surgical therapy due to www.oncotarget.com preexisting comorbid conditions, poor performance status, and/or advanced age [2]. The increased incidence of comorbid conditions in elderly patients may lead to poor performance status and reduced survival outcomes while precluding the possibility of curative-intent multimodality treatment including surgery, chemotherapy, and radiotherapy [4, 5]. Patients deemed ineligible for surgery are often offered either palliative single-agent chemotherapy or supportive care. These patients with limited treatment options have poor survival and may die from painful local and systemic disease progression [6]. For patients who cannot tolerate surgery for localized PDAC, new tumor-directed treatment alternatives offering improved survival and quality of life are needed
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