Can Stereotactic Body Radiation Therapy Be a Viable and Efficient Therapeutic Option for Unresectable Locally Advanced Pancreatic Adenocarcinoma? Results of a Phase 2 Study

Comito, Tiziana; Cozzi, Luca; Clerici, Elena; Franzese, Ciro; Tozzi, A.; Iftode, C.; Navarria, Pierina; D'Agostino, Giuseppe Roberto; Rimassa, Lorenza; Carnaghi, Carlo; Personeni, Nicola; Tronconi, Maria Chiara; Rose, F. De; Franceschini, Davide; Ascolese, A.M.; Fogliata, A.; Tomatis, S.; Santoro, Armando; Zerbi, Alessandro; Scorsetti, Marta

doi:10.1177/1533034616650778

Cited by 83 publications

(76 citation statements)

References 26 publications

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“…Many groups have quantified OS in their studies evaluating SBRT, but we are unaware of any to date that have directly compared the survival outcomes of SBRT versus CFRT (6,9,12,21,22). The enhanced survival observed in our study might be explained by the high rates of LC (~72% at 1 year) afforded by dose escalation seen with SBRT (20,23,24). Improved LC is perhaps associated with better OS as LC addresses the modest portion of individuals who die specifically from local disease (25,26).…”

Section: Discussionmentioning

confidence: 80%

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Stereotactic body radiotherapy for locally-advanced unresectable pancreatic cancer—patterns of care and overall survival

Dohopolski¹,

Glaser²,

Vargo³

et al. 2017

J. Gastrointest. Oncol.

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Section: Discussionmentioning

confidence: 80%

“…Our analysis also exposed several positive prognostic factors for OS such as diagnosis after 2010, lower comorbidity score, younger age, tumor size <3 cm, nodal stage zero, and receipt of chemotherapy (P<0.05). Several of these factors have already been discussed in the literature (3,(16)(17)(18)(19)(20).…”

Section: Discussionmentioning

confidence: 99%

Stereotactic body radiotherapy for locally-advanced unresectable pancreatic cancer—patterns of care and overall survival

Dohopolski¹,

Glaser²,

Vargo³

et al. 2017

J. Gastrointest. Oncol.

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“…The introduction of advanced XRT techniques and procedures such as breath-hold, real-time tumour tracking, respiratory motion reconstructions and soft tissue matching have allowed dose escalation to be safely administered. SBRT further refines the target conformality of XRT to feasibly deliver a higher Biologically Effective Dose (BED) in a shorter period in order to improve LC for LAPC patients from 79% to 94%, translating to an increased OS [3,[36][37][38][39][40]. The SBRT chemoradiation trial results summarised in Table 2 are difficult to compare and interpret between studies due to the diversity of fractionation schemes, recording of statistics and inhomogeneity of recruited patients (e.g., respectability and disease status).…”

Section: Stereotactic Body Radiation Therapymentioning

confidence: 99%

“…Previously, larger target margins (median planning target volume of 136 cm 3 ) encompassed more of the duodenal mucosa and increased number of fields resulted in higher incidence of late grade ≥ 2 GI toxicities (up to 94% in Hoyer, et al's [47] multi-fraction SBRT study) [41]. More recently Chuong, et al's [37] and Comito, et al's [40] fractionated SBRT studies demonstrated a lower incidence of acute toxicities (grade 3 ≥ 0) for median planning target volumes of (111.01 and 64.7 cm3, respectively) paired with a high 1-year LC (≥ 81%) and MST (15 and 19 months, respectively) for LAPC patients.…”

Section: Stereotactic Body Radiation Therapymentioning

confidence: 99%

Clinical Limitations of Photon, Proton and Carbon Ion Therapy for Pancreatic Cancer

Dell’Oro

Short

Wilson

et al. 2020

Cancers

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Introduction: Despite improvements in radiation therapy, chemotherapy and surgical procedures over the last 30 years, pancreatic cancer 5-year survival rate remains at 9%. Reduced stroma permeability and heterogeneous blood supply to the tumour prevent chemoradiation from making a meaningful impact on overall survival. Hypoxia-activated prodrugs are the latest strategy to reintroduce oxygenation to radioresistant cells harbouring in pancreatic cancer. This paper reviews the current status of photon and particle radiation therapy for pancreatic cancer in combination with systemic therapies and hypoxia activators. Methods: The current effectiveness of management of pancreatic cancer was systematically evaluated from MEDLINE® database search in April 2019. Results: Limited published data suggest pancreatic cancer patients undergoing carbon ion therapy and proton therapy achieve a comparable median survival time (25.1 months and 25.6 months, respectively) and 1-year overall survival rate (84% and 77.8%). Inconsistencies in methodology, recording parameters and protocols have prevented the safety and technical aspects of particle therapy to be fully defined yet. Conclusion: There is an increasing requirement to tackle unmet clinical demands of pancreatic cancer, particularly the lack of synergistic therapies in the advancing space of radiation oncology.

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“…Stereotactic body radiation therapy (SBRT), an advanced radiotherapy technique delivering ablative doses of radiation in a few fractions, could, due to the tight margins used during treatment delivery, potentially minimize the toxicity of normal surrounding tissues. Also, due to the small number of treatments used when delivering SBRT, its use would minimize interruptions in chemotherapy delivery [17], and data supports its use in select cases for patients with unresectable pancreatic cancer [18,19]. While several single institution studies have reported that SBRT is an attractive neoadjuvant option with margin negative resection rates above 90% and improved survival with mild radiation toxicities [20], there is currently insufficient data to recommend it as a standard treatment regimen.…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant stereotactic body radiation therapy for nonmetastatic pancreatic adenocarcinoma

et al. 2019

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Background: Neoadjuvant therapy is a strategy for resectable and borderline resectable pancreatic cancer, but a consensus approach regarding optimal management is undetermined. Neoadjuvant options include chemotherapy with/without radiotherapy. Stereotactic body radiation therapy (SBRT) is a novel radiation technique that may provide benefit over conventionally fractionated radiation therapy (CFRT) in the neoadjuvant setting. The purpose of the present study is to determine neoadjuvant treatment with SBRT to other neoadjuvant treatment options for patients with resectable pancreatic cancer. Material and methods: The National Cancer Database was queried (2004-2015) for patients with nonmetastatic pancreatic adenocarcinoma receiving neoadjuvant therapy followed by pancreatectomy. Patients were categorized based on the type of neoadjuvant treatment administered. Statistics included temporal trend assessment by annual percent change (APC), predictors for SBRT by multivariable logistic regression, Kaplan-Meier overall survival (OS) analysis without and with propensity matching, and Cox proportional hazards modeling for univariable OS analysis. Results: Of 5828 patients, 332 (5.7%), 3234 (55.5%) and 2262 (38.8%) received neoadjuvant chemo-SBRT, chemotherapy, and chemo-CFRT, respectively. SBRT utilization increased from 0% in 2004 to 9.5% in 2015, with a greater APC after 2010 (p < .001). SBRT was more likely to be utilized in patients with T3-4 and node-positive disease (p < .05 for all). The chemo-SBRT cohort was associated with a higher OS rate before and after propensity matching (p < .05 for both). The rate of R0 resection was higher in radiotherapy groups than the chemotherapy cohort (p < .001). Conclusions: Utilization of neoadjuvant SBRT for pancreatic cancer is increasing. In the neoadjuvant setting, chemo-SBRT may improve R0 resection and OS over chemotherapy and chemo-CFRT, although confirmatory prospective studies are needed for confirmation.

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Can Stereotactic Body Radiation Therapy Be a Viable and Efficient Therapeutic Option for Unresectable Locally Advanced Pancreatic Adenocarcinoma? Results of a Phase 2 Study

Abstract: Stereotactic body radiotherapy is a safe and effective treatment for patients with locally advanced pancreatic cancer with no G3 toxicity or greater and could be a promising therapeutic option in multimodality treatment regimen.

Cited by 83 publications

References 26 publications

Stereotactic body radiotherapy for locally-advanced unresectable pancreatic cancer—patterns of care and overall survival

Stereotactic body radiotherapy for locally-advanced unresectable pancreatic cancer—patterns of care and overall survival

Clinical Limitations of Photon, Proton and Carbon Ion Therapy for Pancreatic Cancer

Neoadjuvant stereotactic body radiation therapy for nonmetastatic pancreatic adenocarcinoma

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