Upfront Chemotherapy Followed by Stereotactic Body Radiation Therapy with or without Surgery in Older Patients with Localized Pancreatic Cancer: A Single Institution Experience and Review of the Literature.

Abhinav V Reddy,Abhinav V Reddy,Jeffrey Meyer,Shuchi Sehgal,Jin He,Jin He,Joseph M Herman,Colin S Hill,Colin S Hill,Jeffrey Meyer,Lei Zheng,Shuchi Sehgal,Amol K Narang,Amol K Narang

doi:10.3390/curroncol29010028

Abhinav V Reddy, Abhinav V Reddy + Show 12 more

Open Access

https://doi.org/10.3390/curroncol29010028

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Abstract

Objective: To report on clinical outcomes and toxicity in older (age ≥ 70 years) patients with localized pancreatic cancer treated with upfront chemotherapy followed by stereotactic body radiation therapy (SBRT) with or without surgery. Methods: Endpoints included overall survival (OS), local progression-free survival (LPFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and toxicity. Results: A total of 57 older patients were included in the study. Median OS was 19.6 months, with six-month, one-year, and two-year OS rates of 83.4, 66.5, and 42.4%. On MVA, resection status (HR: 0.30, 95% CI 0.12–0.91, p = 0.031) was associated with OS. Patients with surgically resected tumors had improved median OS (29.1 vs. 7.0 months, p < 0.001). On MVA, resection status (HR: 0.40, 95% CI 0.17–0.93, p = 0.034) was also associated with PFS. Patients with surgically resected tumors had improved median PFS (12.9 vs. 1.6 months, p < 0.001). There were 3/57 cases (5.3%) of late grade 3 radiation toxicity and 2/38 cases (5.3%) of Clavien-Dindo grade 3b toxicity in those who underwent resection. Conclusion: Multimodality therapy involving SBRT is safe and feasible in older patients with localized pancreatic cancer. Surgical resection was associated with improved clinical outcomes. As such, older patients who complete chemotherapy should not be excluded from aggressive local therapy when possible.

Highlights

Pancreatic cancer is the third leading cause of cancer-related deaths in the UnitedStates, responsible for over 48,000 deaths each year [1]
We report on a cohort of older patients with borderline resectable pancreatic cancer (BRPC)/locally advanced pancreatic cancer (LAPC) who were treated with upfront chemotherapy followed by five-fraction stereotactic body radiation therapy (SBRT) with or without surgery
We report on clinical outcomes such as overall survival (OS), local progression-free survival (LPFS), distant metastasis-free survival (DMFS), and progression-free survival (PFS), as well as on toxicity

Summary

Introduction

Pancreatic cancer is the third leading cause of cancer-related deaths in the UnitedStates, responsible for over 48,000 deaths each year [1]. It is projected to become the second most common cause of cancer-related deaths by the year 2040 [2]. Treatment of localized disease usually involves a combination of chemotherapy, radiation therapy, and surgical resection [3]. Even with aggressive therapy, outcomes are guarded with a five-year overall survival (OS) rate of less than 15% for borderline resectable and locally advanced pancreatic cancer (BRPC/LAPC) [4]. Pancreatic cancer can be considered a disease of older patients with the median age of diagnosis of 70 years [5]. One study demonstrated that only 44% of patients over 65 years with LAPC received any treatment at all [13]. More information is needed regarding the optimal management of older patients with pancreatic cancer

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