Stereotactic body radiotherapy in the treatment of Pancreatic Adenocarcinoma in elderly patients

Abstract

BackgroundTreatment of pancreatic adenocarcinoma in the elderly is often complicated by comorbidities that preclude surgery, chemotherapy and/or conventional external beam radiation therapy (EBRT). Stereotactic body radiotherapy (SBRT) has thus garnered interest in this setting.MethodsA retrospective review of 26 patients of age ≥ 80 with pancreatic adenocarcinoma treated with definitive SBRT+/-chemotherapy from 2007–2011 was performed. Twenty-seven percent of patients were stage I, 38% were stage II, 27% were stage III and 8% were stage IV. Patients most commonly received 24 Gy/1 fraction or 30-36 Gy/3 fractions. Kaplan-Meier was used to estimate overall survival (OS), local control (LC), cause specific survival (CSS) and freedom-from-metastatic disease (FFMD).ResultsThe median age was 86 (range 80–91), and median follow-up was 11.6 months (3.5-24.6). The median planning target volume was 21.48 cm3 (6.1-85.09). Median OS was 7.6 months with 6/12 month OS rates of 65.4%/34.6%, respectively. Median LC was 11.5 months, 6-month and 12-month actuarial LC rates were 60.1% and 41.2%, respectively. There were no independent predictors for LC, but there was a trend for improved LC with prescription dose greater than 20 Gy (p = 0.063). Median CSS was 6.3 months, and 6-month and 12-month actuarial CSS were 53.8% and 23.1%, respectively. Median FFMD was 8.4 months, and 6-month and 12-month actuarial rates were 62.0% and 41.4%, respectively. Nine patients (47%) had local failures, 11 (58%) had distant metastasis, and 7 (37%) had both. There were no acute or late grade 3+ toxicities.ConclusionsDefinitive SBRT is feasible, safe and effective in elderly patients who have unresectable disease, have comorbidities precluding surgery or decline surgery.

Prognostic role of stereotactic body radiation therapy for elderly patients with advanced and medically inoperable pancreatic cancer

“…However, in our study, there was a trend toward longer survival with higher prescription doses. Similar results were also found in the study investigated by Kim et al, in which patients with prescription doses greater than 20 Gy tended to have improved local control [21]. The correlation between doses and prognosis is still needed to be further investigated.…”

“…One of the underlying reasons may be that patients enrolled in our investigation were younger, who were aged over 65. Besides, fewer patients (58.4%) were treatment naïve in our study than those (65.0%) in Kim et al [21]. However, more patients (22.5%) were diagnosed with metastatic pancreatic cancer at the initial of SBRT in our study than those in previous studies (8.0% and 0%, respectively), which may negatively impact the prognosis.…”

“…In these two studies, there were no acute or late grade 3+ toxicities in Kim et al [21], while Yechieli et al [22] reported that 7 (35%) and 3 (15%) patients had grade 1-2 and grade 3-4 toxicities. Of these three patients, two had dehydration and one with episodes of gastrointestinal bleeding.…”

“…Nevertheless, retrospective analysis still identified SBRT as a viable modality for them in the current best practice and priorities for research in radiation oncology [20]. One study has explored the outcomes of SBRT for 26 patients with age over 80 [21]. Ten patients received SBRT combined with chemotherapy.…”

Neoadjuvant Therapy for Pancreatic Cancer

“…Feasibility and efficacy has been shown in elderly patients, 67 those with many comorbidities, 68 and reirradiation cases. 69 In addition, it is very cost-effective (albeit with no long-term data) and generally well-tolerated, with a good quality of life.…”