Abstract
Simple SummaryIn the lack of direct comparative evidence of stereotactic body radiation therapy, we reviewed one of the largest locally advanced pancreatic cancer cohort homogeneously treated in a tertiary cancer center. Our propensity score–matched analysis shows comparable outcomes between stereotactic body radiation therapy and concurrent chemoradiotherapy in terms of survival, local control, and treatment-related toxicities. Considering the advantages of SBRT such as short treatment duration, better tolerance, easy combination with systemic treatment, and the potential for dose escalation, further investigation of the feasibility of SBRT as an alternative to CCRT in treating locally advanced pancreatic cancer is required.In locally advanced pancreatic cancer (LAPC), stereotactic body radiation therapy (SBRT) has been applied as an alternative to concurrent chemoradiotherapy (CCRT); however, direct comparative evidence between these two modalities is scarce. The aim of this study was to compare the clinical outcomes of SBRT with CCRT for LAPC. We retrospectively reviewed the medical records of patients with LAPC who received SBRT (n = 95) or CCRT (n = 66) with a concurrent 5-FU-based regimen between January 2008 and July 2016. The clinical outcomes of freedom from local progression (FFLP), progression-free survival (PFS), overall survival (OS), and toxicities were analyzed before and after propensity score (PS) matching. After a median follow-up duration of 15.5 months (range, 2.3–64.5), the median OS, PFS, and FFLP of the unmatched patients were 17.3 months, 11 months, and 19.6 months, respectively. After PS matching, there were no significant differences between the SBRT and CCRT groups in terms of the 1-year rates of OS (66.7% vs. 80%, p = 0.455), PFS (40.0% vs. 54.2%, p = 0.123), and FFLP (77.2% and 87.1%, p = 0.691). Our results suggest SBRT could be a feasible alternative to CCRT in treating patients with LAPC.
Highlights
Pancreatic cancer is an aggressive malignancy, and only 10–20% of newly diagnosed patients are suitable for complete resection, which is considered the only curative approach [1].Unresectable, or locally advanced pancreatic cancer (LAPC), accounts for about 30% of all pancreatic cancer, and various combinations of chemotherapy and radiotherapy (RT) have been tried to improve the oncologic outcome, patients with LAPC still have a dismal prognosis with a median survival of 5–15 months [2,3]
RT has been widely used for treating LAPCs and has been shown to be effective in achieving local control while preventing pain and obstructive symptoms that deteriorate the quality of life
We reviewed one of the largest LAPC cohorts homogeneously treated in a tertiary cancer center and performed a comparison between Stereotactic body radiotherapy (SBRT) and concurrent chemoradiotherapy (CCRT)
Summary
Unresectable, or locally advanced pancreatic cancer (LAPC), accounts for about 30% of all pancreatic cancer, and various combinations of chemotherapy and radiotherapy (RT) have been tried to improve the oncologic outcome, patients with LAPC still have a dismal prognosis with a median survival of 5–15 months [2,3]. The comparison between conventional concurrent chemoradiotherapy (CCRT) and chemotherapy alone showed contradictory results in several large LAPC trials, including the recent LAP07 study [4–7]. This phase III randomized study failed to show a significant gain in survival after CCRT despite better local control and similar toxicity rates [8]. SBRT is considered to have different tumoricidal mechanisms, such as vascular endothelial destruction and immune modulation [9,10]
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