Stereotactic Body Radiation Therapy for Locally Advanced and Borderline Resectable Pancreatic Cancer Is Effective and Well Tolerated

Chuong, Michael D.; Springett, Gregory M.; Freilich, J.; Park, Catherine K.; Weber, Jill; Mellon, Eric A.; Hodul, Pamela J.; Malafa, Mokenge P.; Meredith, Kenneth; Hoffe, Sarah E.; Shridhar, Ravi

doi:10.1016/j.ijrobp.2013.02.022

Cited by 316 publications

(249 citation statements)

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“…Resected BRPC and LAPC patients comprise the "neoadjuvant therapy" group. Staging methods at our institution have been previously described (19). BRPC and LAPC patients were initially judged medically fit to tolerate resection without probable distant metastases.…”

Section: Initial Staging and Patientsmentioning

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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Section: Initial Staging and Patientsmentioning

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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“…The combination of gemcitabine and nab-paclitaxel showed improved survival over gemcitabine monotherapy in patients with metastatic pancreatic cancer [19,20]. For localised disease, encouraging results from stereotactic body radiation therapy (SBRT), radiofrequency ablation (RFA) and irreversible electroporation (IRE) have been reported, though evidence from randomised trials is still lacking [21][22][23][24]. However, the aforementioned treatments are often taxing to the patient, have high toxicity rates, or are still lacking evidence of efficacy.…”

Section: Introductionmentioning

confidence: 99%

The clinical benefit of hyperthermia in pancreatic cancer: a systematic review

Horst

Versteijne

Besselink

et al. 2017

International Journal of Hyperthermia

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Objective: In pancreatic cancer, which is therapy resistant due to its hypoxic microenvironment, hyperthermia may enhance the effect of radio(chemo)therapy. The aim of this systematic review is to investigate the validity of the hypothesis that hyperthermia added to radiotherapy and/or chemotherapy improves treatment outcome for pancreatic cancer patients. Methods and materials: We searched MEDLINE and Embase, supplemented by handsearching, for clinical studies involving hyperthermia in pancreatic cancer patients. The quality of studies was evaluated using the Oxford Centre for Evidence-Based Medicine levels of evidence. Primary outcome was treatment efficacy; we calculated overall response rate and the weighted estimate of the population median overall survival (m p ) and compared these between hyperthermia and control cohorts. Results: Overall, 14 studies were included, with 395 patients with locally advanced and/or metastatic pancreatic cancer of whom 248 received hyperthermia. Patients were treated with regional (n ¼ 189), intraoperative (n ¼ 39) or whole-body hyperthermia (n ¼ 20), combined with chemotherapy, radiotherapy or both. Quality of the studies was low, with level of evidence 3 (five studies) and 4. The six studies including a control group showed a longer m p in the hyperthermia groups than in the control groups (11.7 vs. 5.6 months). Overall response rate, reported in three studies with a control group, was also better for the hyperthermia groups (43.9% vs. 35.3%). Conclusions: Hyperthermia, when added to chemotherapy and/or radiotherapy, may positively affect treatment outcome for patients with pancreatic cancer. However, the quality of the reviewed studies was limited and future randomised controlled trials are needed to establish efficacy. ARTICLE HISTORY

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“…28 Numerous other published trials have also looked at the role of SBRT in the treatment of locally advanced pancreatic cancer. [29][30][31][32][33][34][35][36] In Table 1, we present a selected number of studies addressing this topic.…”

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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Stereotactic Body Radiation Therapy for Locally Advanced and Borderline Resectable Pancreatic Cancer Is Effective and Well Tolerated

Cited by 316 publications

References 20 publications

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

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

The clinical benefit of hyperthermia in pancreatic cancer: a systematic review

Pancreatic cancer and SBRT: A new potential option?

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