Phase I Trial of Stereotactic Body Radiation Therapy Dose Escalation in Pancreatic Cancer

Courtney, P Travis; Paravati, Anthony J.; Atwood, Todd; Raja, Nandita X; Zimmerman, Collin; Fanta, Paul T.; Lowy, Andrew M.; Simpson, Daniel R.; Xu, Ronghui; Murphy, James D.

doi:10.1016/j.ijrobp.2021.02.008

Cited by 23 publications

(18 citation statements)

References 48 publications

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“…Compared to prior studies investigating A-RT for pancreatic cancer, our patient cohort was a higher risk group. Specifically, 13 % of our patients had evidence of metastatic disease prior to A-RT (vs 0–10 % in prior reports) [24] , [29] , yet our cohort still achieved an excellent 1-year OS compared to modern A-RT studies (80.0 % vs 40 %-74 %) [24] , [29] . Consistent with prior literature, disease progression in our cohort was mostly distant (1-year cumulative incidence of 47.4 %).…”

Section: Discussionmentioning

confidence: 52%

Stereotactic ablative radiation for pancreatic cancer on a 1.5 Telsa magnetic resonance-linac system

Tringale

Tyagi

Reyngold

et al. 2022

Physics and Imaging in Radiation Oncology

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Section: Discussionmentioning

confidence: 52%

Stereotactic ablative radiation for pancreatic cancer on a 1.5 Telsa magnetic resonance-linac system

Tringale

Tyagi

Reyngold

et al. 2022

Physics and Imaging in Radiation Oncology

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“…8 The 69% of 1-year LPFS observed here was close to 1-year LPFS rates of 70%-87% seen in several studies of fractionated SBRT. 4,17,18 Arcelli A 19 reported a positive impact of SBRT BED 10 ≥ 48 Gy which was correlated with both LC and OS through multivariate analysis. Additionally, our previous study 20 showed that patients can get a better OS with BED 10 ≥60 Gy, and Krishnan 21 also reported that BED 10 > 70 Gy was a positive predictor of better OS as well as better local PFS.…”

Section: Discussionmentioning

confidence: 99%

“…The objective response rate of 31.25% and the median OS of 14.5 months observed in this trial are similar to the median OS of 10.6-20.0 months in prior fractionated SBRT studies. 4,17,18 Moreover, a systematic review including 1009 LAPC patients in 19 studies treated with SBRT, reported the median OS of 17 months and 72.3% 1-year LC. 8 The 69% of 1-year LPFS observed here was close to 1-year LPFS rates of 70%-87% seen in several studies of fractionated SBRT.…”

Section: Discussionmentioning

confidence: 99%

“…With the majority of pancreatic tumors arising in the head, neck, and uncinate process, the GI toxicities may depend not only on the total prescription dose but also the anatomy of the tumor position. 17 SBRT could deliver ablative doses of radiation to the tumor volume with minimal margin, which can bring better clinical benefit and less toxicity for pancreatic head cancer. In our study, the G1 and G3 toxicities of biliary obstruction were observed in four patients, but no G3 or greater GI complications were noticed.…”

Section: Discussionmentioning

confidence: 99%

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Phase I study of dose‐escalated stereotactic body radiation therapy for locally advanced pancreatic head cancers: Initial clinical results

Qing

Zhang

2021

Cancer Medicine

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Pancreatic cancer (PC) is the seventh leading cause of cancer mortality among both genders from Cancer Statistics 2019. Approximately 80% of patients developed with metastatic or locally advanced disease at the time of diagnosis. [1][2][3] The median survival for patients with unresectable locally advanced pancreatic cancer (LAPC) who receive chemoradiotherapy was 11-15 months. [4][5][6] However, the role of radiation for LAPC was controversial, chemoradiation therapy is still considered as one of the effective treatment options for LAPC in NCCN guidelines. 7 The pancreas is anatomically close to the stomach and duodenum. With the advancement in radiotherapy, compared with conventional fractionated radiotherapy, SBRT has dramatically improved the survival benefits by

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“…Over the last decade, modest gains have been realized by intensifying chemotherapy although long-term local control (LC) and overall survival (OS) are rarely achieved (2)(3)(4). Conversely, significantly escalating radiation therapy (RT) to an ablative dose has not been considered feasible for most patients using conventional image guidance because of interfraction anatomic changes and uncertainty in assuring that dose to nearby organs at risk (OARs) is safe prior to delivering each fraction (5).…”

Section: Introductionmentioning

confidence: 99%

Induction Chemotherapy and Ablative Stereotactic Magnetic Resonance Image-Guided Adaptive Radiation Therapy for Inoperable Pancreas Cancer

et al. 2022

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BackgroundRadiation therapy (RT) dose for inoperable pancreatic ductal adenocarcinoma (PDAC) has historically been non-ablative to avoid injuring gastrointestinal (GI) organs at risk (OARs). Accruing data suggest that dose escalation, in select patients, may significantly improve clinical outcomes. Early results of ablative stereotactic magnetic resonance image-guided adaptive radiation therapy (A-SMART) have been encouraging, although long-term outcomes are not well understood.MethodsA single institution retrospective analysis was performed of inoperable non-metastatic PDAC patients who received induction chemotherapy then 5-fraction A-SMART on a 0.35T-MR Linac from 2018-2021.ResultsSixty-two patients were evaluated with a median age of 66 years (range 35-91) and nearly all achieved Eastern Cooperative Oncology Group (ECOG) performance status 0-1 (96.8%). Locally advanced disease was common (72.6%), otherwise borderline resectable (22.6%), or medically inoperable (4.8%). All received induction chemotherapy for a median 4.2 months (range, 0.2-13.3) most commonly FOLFIRINOX (n=43; 69.4%). Median prescribed dose was 50 Gy (range 40-50); median biologically effective dose (BED10) was 100 Gy10. The median local control (LC), progression-free survival (PFS), and overall survival (OS) from diagnosis were not reached, 20 months, and 23 months, respectively. Also, 2-year LC, PFS, and OS were 68.8%, 40.0%, and 45.5%, respectively. Acute and late grade 3+ toxicity rates were 4.8% and 4.8%, respectively.ConclusionsTo our knowledge, this is the largest series of induction chemotherapy followed by ablative 5-fraction SMART delivered on an MR Linac for inoperable PDAC. The potential for this novel treatment strategy is to achieve long-term LC and OS, compared to chemotherapy alone, and warrants prospective evaluation.

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Phase I Trial of Stereotactic Body Radiation Therapy Dose Escalation in Pancreatic Cancer

Cited by 23 publications

References 48 publications

Stereotactic ablative radiation for pancreatic cancer on a 1.5 Telsa magnetic resonance-linac system

Stereotactic ablative radiation for pancreatic cancer on a 1.5 Telsa magnetic resonance-linac system

Phase I study of dose‐escalated stereotactic body radiation therapy for locally advanced pancreatic head cancers: Initial clinical results

Induction Chemotherapy and Ablative Stereotactic Magnetic Resonance Image-Guided Adaptive Radiation Therapy for Inoperable Pancreas Cancer

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