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

Dohopolski, Michael; Glaser, Scott; Vargo, John A.; Balasubramani, Goundappa K.; Beriwal, Sushil

doi:10.21037/jgo.2017.08.04

Cited by 20 publications

(24 citation statements)

References 33 publications

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“…This study included cases spanning over a period of 12 years during which there has been an evolution in systemic chemotherapy regimens, with newer regimens such as mFOLFIRINOX improving resectability and survival compared to a gemcitabine-based regimen [36,37]. Additionally, there has been an evolution in the ability to precisely deliver RT in recent years, which is part of the reason for the increased SBRT utilization demonstrated in the present study and in other similar NCDB studies in more recent time periods [29][30][31]. The potential bias of more effective systemic therapy in the SBRT group due to the increased utilization of SBRT in recent years was controlled by rigorous propensity matching and multivariable analysis, but some differences in chemotherapy regimens in the different groups remained.…”

Section: Discussionmentioning

confidence: 87%

“…The rapid increase in utilization of SBRT is likely due to the maturation of technique, the lack of clear benefit with CFRT, and the minimal toxicity associated with its use. Three NCDB analyses had revealed its use and confirmed its benefit in locally advanced unresectable pancreatic carcinoma from a nationwide review [29][30][31]. Neoadjuvant SBRT has been demonstrated to be correlated with improved survival in single institution studies [20,32,33].…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Neoadjuvant stereotactic body radiation therapy for nonmetastatic pancreatic adenocarcinoma

et al. 2019

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“…Combined with concurrent chemotherapy several SBRT studies experienced a trade-off of LC for late grade ≥ 2 GI toxicities [44]. Though the quick course is favourable for LAPC clinical management, surgery is still the only curative treatment [5,45]. SBRT studies, by Mellon, et al [46] and Chuong et al [37] demonstrated 51% and 56% of borderline resectable patients, respectively, were able to undergo post-SBRT resection with high complete resection rates.…”

Section: Stereotactic Body Radiation Therapymentioning

confidence: 99%

“…Solid LAPC tumours with hypoxic cells not only reduce the effectiveness of photon radiation therapy (XRT) but also limit the intake of chemotherapeutic agents. Conventionally, 3D conformal radiation therapy (3DCRT) has previously proven insufficient in terms of achieving satisfactory tumour control probability (TCP) and normal tissue complication probability (NTCP) [5]. Modulated XRT techniques such as intensity modulated radiation therapy radiation therapy (IMRT) and volume modulated arc radiation therapy (VMAT) are now well established standards of care at reducing NTCP in clinical practice.…”

Section: Introductionmentioning

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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“…A pooled analysis of 19 studies and over 1,000 patients with LAPC treated with SBRT reported promising outcomes, with acceptable rates of toxicity, locoregional control at one year of 72.3%, and median overall survival of 17 months (56). While prospective studies to date have not compared SBRT to conventionally fractionated radiation, independent analyses of the NCDB showed improved survival with SBRT compared to conventionally fractionated radiation (57,58).…”

Section: A B Cmentioning

confidence: 99%

Review and current state of radiation therapy for locally advanced pancreatic adenocarcinoma

Blakaj

Stein

Khan

et al. 2018

J. Gastrointest. Oncol

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Pancreatic cancer is characterized by a high rate of metastatic spread and overall poor prognosis. Yet 30% of patients have progressive local disease at the time of death, and local progression can cause significant morbidity. Approximately 30-40% of patients present with locally advanced pancreatic cancer (LAPC) that is not surgically resectable, and the optimal treatment for these patients continues to evolve. The role of radiation in the management of LAPC is an area of controversy, and the recent LAP07 randomized trial reported no survival benefit of radiation following gemcitabine plus or minus erlotinib. However, the efficacy of modern systemic regimens has improved since the design of the LAP07 study, and radiation therapy may be of greater benefit in the context of more effective systemic therapy. Advances in radiation delivery including the increasing use of stereotactic body radiation therapy (SBRT) have the potential to improve outcomes through dose escalation and better treatment tolerability. In addition, the combination of radiation therapy and immune therapy is an area of promising research. These advances suggest that radiation therapy will continue to play an integral role in the management of LAPC.

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

Cited by 20 publications

References 33 publications

Neoadjuvant stereotactic body radiation therapy for nonmetastatic pancreatic adenocarcinoma

Neoadjuvant stereotactic body radiation therapy for nonmetastatic pancreatic adenocarcinoma

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

Review and current state of radiation therapy for locally advanced pancreatic adenocarcinoma

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