Risk Adapted Ablative Radiotherapy After Intensive Chemotherapy for Locally Advanced Pancreatic Cancer

Rossi, Gabriella; Simoni, N.; Paiella, Salvatore; Rossi, Renato; Venezia, Martina; Micera, R.; Malleo, Giuseppe; Salvia, Roberto; Giuliani, Tommaso; Gioia, Anthony Di; Amato, Alessandra; Milella, Michèle; Guariglia, Stefania; Cavedon, Carlo; Bassi, Claudio; Mazzarotto, Renzo

doi:10.3389/fonc.2021.662205

Cited by 8 publications

(11 citation statements)

References 38 publications

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“…The National Comprehensive Cancer Network (NCCN) classification was used to define LAPC[ 30 ]. As described in the original published study[ 14 ], inclusion criteria for Risk Adapted Ablative Radiation Therapy (RAdAR) were: Histologically-proven pancreatic ductal adenocarcinoma, ECOG performance status < 2, at least 3 mo of chemotherapy (with gemcitabine/nab-paclitaxel or FOLFIRINOX), biochemical response, and absence of disease progression at restaging CT-scan after induction chemotherapy.…”

Section: Methodsmentioning

confidence: 99%

“…Details of the radiation treatment have previously been reported[ 14 ]. Briefly, the RAdAR approach consisted of anatomy- and simultaneous integrated boost (SIB)-based dose prescription strategy.…”

Section: Methodsmentioning

confidence: 99%

“…Technological innovations, such as the use of stereotactic techniques, advanced organ motion management solutions, and accurate image guidance before treatment delivery, have allowed to safely deliver ablative doses to LAPC while sparing the surrounding critical organs at risk (OARs)[ 9 , 10 ]. In addition, different series reported that a multimodal approach, including systemic induction therapy followed by (chemo-) radiotherapy, might represent an effective therapeutic option for LAPC, potentially improving the oncological outcome and the probability of surgical resection, at the price of acceptable postoperative complication rates[ 11 - 14 ]. Thus, there is a strong need to determine the resectability of LAPC for treatment decision-making.…”

Section: Introductionmentioning

confidence: 99%

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Computed tomography-based radiomic to predict resectability in locally advanced pancreatic cancer treated with chemotherapy and radiotherapy

Rossi¹,

Altabella²,

Simoni³

et al. 2022

WJGO

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BACKGROUND Surgical resection after neoadjuvant treatment is the main driver for improved survival in locally advanced pancreatic cancer (LAPC). However, the diagnostic performance of computed tomography (CT) imaging to evaluate the residual tumour burden at restaging after neoadjuvant therapy is low due to the difficulty in distinguishing neoplastic tissue from fibrous scar or inflammation. In this context, radiomics has gained popularity over conventional imaging as a complementary clinical tool capable of providing additional, unprecedented information regarding the intratumor heterogeneity and the residual neoplastic tissue, potentially serving in the therapeutic decision-making process. AIM To assess the capability of radiomic features to predict surgical resection in LAPC treated with neoadjuvant chemotherapy and radiotherapy. METHODS Patients with LAPC treated with intensive chemotherapy followed by ablative radiation therapy were retrospectively reviewed. One thousand six hundred and fifty-five radiomic features were extracted from planning CT inside the gross tumour volume. Both extracted features and clinical data contribute to create and validate the predictive model of resectability status. Patients were repeatedly divided into training and validation sets. The discriminating performance of each model, obtained applying a LASSO regression analysis, was assessed with the area under the receiver operating characteristic curve (AUC). The validated model was applied to the entire dataset to obtain the most significant features. RESULTS Seventy-one patients were included in the analysis. Median age was 65 years and 57.8% of patients were male. All patients underwent induction chemotherapy followed by ablative radiotherapy, and 19 (26.8%) ultimately received surgical resection. After the first step of variable selections, a predictive model of resectability was developed with a median AUC for training and validation sets of 0.862 (95%CI: 0.792-0.921) and 0.853 (95%CI: 0.706-0.960), respectively. The validated model was applied to the entire dataset and 4 features were selected to build the model with predictive performance as measured using AUC of 0.944 (95%CI: 0.892-0.996). CONCLUSION The present radiomic model could help predict resectability in LAPC after neoadjuvant chemotherapy and radiotherapy, potentially integrating clinical and morphological parameters in predicting surgical resection.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Computed tomography-based radiomic to predict resectability in locally advanced pancreatic cancer treated with chemotherapy and radiotherapy

Rossi¹,

Altabella²,

Simoni³

et al. 2022

WJGO

Self Cite

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“…Machine learning algorithms were applied to CT-radiomic features. A model was built to predict surgical resection status and OS with or without surgery, which showed promise but required further validation ( 36 ).…”

Section: Timing Of Radiation Therapymentioning

confidence: 99%

The evolving role of radiation in pancreatic cancer

et al. 2023

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Pancreatic cancer is the fourth leading cause of cancer mortality in the United States. Chemotherapy in resectable pancreatic cancer has improved survival by 10-20%. It only converted 10-30% of the borderline resectable and locally advanced pancreatic cancers to be surgically resectable. Radiation therapy has a documented role in managing localized pancreatic cancer, more so for borderline and locally advanced pancreatic cancer, where it can potentially improve the resectability rate of a given neoadjuvant treatment. The role of radiation therapy in resected pancreatic cancer is controversial, but it is used routinely to treat positive margins after pancreatic cancer surgery. Radiation therapy paradigms continue to evolve with advancements in treatment modalities, delivery techniques, and combination approaches. Despite the advances, there continues to be a controversy on the role of radiation therapy in managing this disease. In this review article, we discuss the recent updates, delivery techniques, and motion management in radiation therapy and dissect the applicability of this therapy in pancreatic cancer.

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“…Most studies have used initial chemotherapy with or without subsequent chemoRT or SBRT, followed by interval assessment for potential resection. Prior studies have reported resection rates of ~10% to 35% (range: 0% to 64%), and among those who ultimately proceed with R0 resection, median survival approaching 20 to 30 months 94,97,105–126 . In those who are not surgical candidates, the addition of RT has demonstrated improved locoregional control but has not definitively shown improvement in OS 68,119 …”

Section: Summary Of Literature Reviewmentioning

confidence: 99%

Executive Summary of the American Radium Society Appropriate Use Criteria for Neoadjuvant Therapy for Nonmetastatic Pancreatic Adenocarcinoma

Jethwa,

Kim,

Berlin

et al. 2023

American Journal of Clinical Oncology

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For patients with locoregionally confined pancreatic ductal adenocarcinoma (PDAC), margin-negative surgical resection is the only known curative treatment; however, the majority of patients are not operable candidates at initial diagnosis. Among patients with resectable disease who undergo surgery alone, the 5-year survival remains poor. Adjuvant therapies, including systemic therapy or chemoradiation, are utilized as they improve locoregional control and overall survival. There has been increasing interest in the use of neoadjuvant therapy to obtain early control of occult metastatic disease, allow local tumor response to facilitate margin-negative resection, and provide a test of time and biology to assist with the selection of candidates most likely to benefit from radical surgical resection. However, limited guidance exists regarding the relative effectiveness of treatment options. In this systematic review, the American Radium Society multidisciplinary gastrointestinal expert panel convened to develop Appropriate Use Criteria evaluating the evidence regarding neoadjuvant treatment for patients with PDAC, including surgery, systemic therapy, and radiotherapy, in terms of oncologic outcomes and quality of life. The evidence was assessed using the Population, Intervention, Comparator, Outcome, and Study (PICOS) design framework and “Preferred Reporting Items for Systematic Reviews and Meta-analyses” 2020 methodology. Eligible studies included phases 2 to 3 trials, meta-analyses, and retrospective analyses published between January 1, 2012 and December 30, 2022 in the Ovid Medline database. A summary of recommendations based on the available literature is outlined to guide practitioners in the management of patients with PDAC.

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Risk Adapted Ablative Radiotherapy After Intensive Chemotherapy for Locally Advanced Pancreatic Cancer

Cited by 8 publications

References 38 publications

Computed tomography-based radiomic to predict resectability in locally advanced pancreatic cancer treated with chemotherapy and radiotherapy

Computed tomography-based radiomic to predict resectability in locally advanced pancreatic cancer treated with chemotherapy and radiotherapy

The evolving role of radiation in pancreatic cancer

Executive Summary of the American Radium Society Appropriate Use Criteria for Neoadjuvant Therapy for Nonmetastatic Pancreatic Adenocarcinoma

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