Gemcitabine Chemotherapy and Single-Fraction Stereotactic Body Radiotherapy for Locally Advanced Pancreatic Cancer

Schellenberg, Devin; Goodman, Karyn A.; Lee, Florence; Chang, Stephanie T.; Kuo, Tracy F.; Ford, James M.; Fisher, George A.; Quon, Andrew; Desser, Terry S.; Norton, Jeffrey A.; Greco, Ralph S.; Yang, George P.; Koong, Albert C.

doi:10.1016/j.ijrobp.2008.01.051

Cited by 307 publications

(277 citation statements)

References 35 publications

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“…Although in previous studies of stereotactic radiation therapy lower margins (2-4 mm) were used, 4,14,16 we considered that these larger margins were more reasonable and prudent, with the aim of avoiding marginal misses. In fact, based on the results of a study on organ motion in patients with locally advanced adenocarcinoma of the pancreas, margins of GTV to 10 mm, 7 mm, and 6 mm in the cranio-caudal, anterior-posterior and medial-lateral direction were recommended, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…3 Recently, it has been proposed by some authors to use stereotactic body radiation therapy (SBRT) for the treatment of these tumors. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] The use of stereotactic techniques is theoretically useful to administer high doses of radiation to the tumor with optimum sparing of organs at risk (OARs). Furthermore, SBRT treatment has other advantages and particularly its brevity.…”

Section: Introductionmentioning

confidence: 99%

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Individually optimized stereotactic radiotherapy for pancreatic head tumors: A planning feasibility study

Buwenge

Cilla

Guido

et al. 2016

Reports of Practical Oncology & Radiotherapy

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Individually optimized stereotactic radiotherapy for pancreatic head tumors: A planning feasibility study

Buwenge

Cilla

Guido

et al. 2016

Reports of Practical Oncology & Radiotherapy

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“…One case series demonstrated a 37.5% rate of portal vein (PV) stenosis after neoadjuvant chemoradiotherapy and pancreatectomy (16). Further, early studies of SBRT and single agent chemotherapy in locally advanced pancreatic cancer (LAPC) without pancreatectomy reported intolerably high acute and late toxicity rates not supported by more recent studies (17,18). To explore whether this intensified regimen worsened perioperative or long-term outcomes, we compared resectable patients who underwent upfront resection to patients resected after sufficient response following neoadjuvant treatment with SBRT and chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

Favorable perioperative outcomes after resection of borderline resectable pancreatic cancer treated with neoadjuvant stereotactic radiation and chemotherapy compared with upfront pancreatectomy for resectable cancer

Mellon¹,

Ström²,

Hoffe³

et al. 2016

J. Gastrointest. Oncol.

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Background: Neoadjuvant multi-agent chemotherapy and stereotactic body radiation therapy (SBRT) are utilized to increase margin negative (R0) resection rates in borderline resectable pancreatic cancer (BRPC) or locally advanced pancreatic cancer (LAPC) patients. Concerns persist that these neoadjuvant therapies may worsen perioperative morbidities and mortality.Methods: Upfront resection patients (n=241) underwent resection without neoadjuvant treatment for resectable disease. They were compared to BRPC or LAPC patients (n=61) who underwent resection after chemotherapy and 5 fraction SBRT. Group comparisons were performed by Mann-Whitney U or Fisher's exact test. Overall Survival (OS) was estimated by Kaplan-Meier and compared by log-rank methods.Results: In the neoadjuvant therapy group, there was significantly higher T classification, N classification, and vascular resection/repair rate. Surgical positive margin rate was lower after neoadjuvant therapy (3.3% vs. 16.2%, P=0.006). Post-operative morbidities (39.3% vs. 31.1%, P=0.226) and 90-day mortality (2% vs. 4%, P=0.693) were similar between the groups. Median OS was 33.5 months in the neoadjuvant therapy group compared to 23.1 months in upfront resection patients who received adjuvant treatment (P=0.057). Conclusions:Patients with BRPC or LAPC and sufficient response to neoadjuvant multi-agent chemotherapy and SBRT have similar or improved peri-operative and long-term survival outcomes compared to upfront resection patients.

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“…The median time to progression was 9.7 months, and the median overall survival was 11.4 months. 19 The same group published in 2011 a phase II trial looking at the toxicity, local control, and overall survival in patients treated with sequential gemcitabine and linear accelerator-based SBRT rather than the CyberKnife. Twenty patients completed SBRT and a median of five cycles of gemcitabine.…”

Section: Clinical Outcomes In Patients Treated With Sbrtmentioning

confidence: 99%

Pancreatic cancer and SBRT: A new potential option?

Hajj

Goodman

2015

Reports of Practical Oncology & Radiotherapy

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a b s t r a c tLocal control remains a major issue for patients with unresectable, locally advanced pancreatic cancer (LAPC). The role of radiation therapy in the management of LAPC represents an area of some controversy. Stereotactic body radiotherapy is an emerging treatment option for LAPC as it can provide a therapeutic benefit with significant advantages for patients' quality of life over standard conventional chemoradiation. The objective of this review is to present the rationale for stereotactic body radiotherapy in LAPC, as well as to discuss the potential limitations and caveats of the currently available studies.

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Gemcitabine Chemotherapy and Single-Fraction Stereotactic Body Radiotherapy for Locally Advanced Pancreatic Cancer

Cited by 307 publications

References 35 publications

Individually optimized stereotactic radiotherapy for pancreatic head tumors: A planning feasibility study

Individually optimized stereotactic radiotherapy for pancreatic head tumors: A planning feasibility study

Favorable perioperative outcomes after resection of borderline resectable pancreatic cancer treated with neoadjuvant stereotactic radiation and chemotherapy compared with upfront pancreatectomy for resectable cancer

Pancreatic cancer and SBRT: A new potential option?

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