Surgical outcomes of patients with pancreatic cancer treated with stereotactic body radiation therapy.

Abstract

341 Background: The surgical outcome of patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma (BRPC/LAPC) treated with stereotactic body radiation therapy (SBRT) is unclear. Methods: A comparative study was performed to determine if surgical outcomes were different among patients receiving neoadjuvant SBRT vs chemoradiation therapy (CRT) vs chemotherapy only. Results: Between 2011 and 2014, 29 patients with BR/LA-PDAC underwent neoadjuvant chemotherapy and SBRT (6.6 Gy x 5 fractions) followed by pancreatectomy. Eighteen of 29 patients (62%) had LAPC. Their outcomes were compared with 82 patients who received neoadjuvant CRT and 26 patients who received neoadjuvant chemotherapy only (Table). When compared to neoadjuvant CRT and chemo only, the neoadjuvant SBRT group had a higher R0 resection rate (90% vs 84% vs 62%, p=0.02) and vascular resection rate (41% vs 13% vs 31%, p=0.005), respectively. Although the vascular resection and complication rates (Clavien grade 3 or above) were higher in the neoadjuvant SBRT group, no in-hospital mortality was encountered. In the SBRT group, the complete pathological response rate (21%) was higher than that of the other groups (4% and 0% respectively, p<0.001). Survival will be updated later as the current median postoperative follow-up is 6 months in the SBRT group. Conclusions: Neoadjuvant chemotherapy and SBRT is associated with improved surgical outcomes and pathologic complete response rates in selected patients with BRPC/LAPC. Longer follow-up is needed to determine its impact on survival. [Table: see text]

Stereotactic Body Radiotherapy (SBRT) of Pancreatic Cancer—A Critical Review and Practical Consideration

“…Although the prescribed doses were higher than in the previous publication, the incidence of late toxicity was the same (~5%). The feasibility of using SBRT for the treatment of BRPC is supported by the results of other studies [ 46 , 47 , 48 ], some with a smaller number of enrolled patients. Based on these results indicating improved LC, a higher rate of R0 resectability, and improved OS, SBRT should be recommended in such cases.…”

“…SBRT is also widely used to treat oligometastatic disease. Treatment of liver metastases with SBRT has shown promising results with a high degree of local control in other primary malignancies, such as colorectal cancer [ 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ]. Data on the SBRT treatment of liver metastases from PC are limited but provide promising results.…”

The Evolving Field of Stereotactic Body Radiation Therapy in Pancreatic Cancer

“…He et al compared surgical outcomes among BRPC/ LAPC patients who received SBRT (n=29), CRT (n=82), or chemotherapy alone (n=26) and reported R0 resection rates of 90%, 84% and 62%, respectively (p=0.02). 19 The PCR rate was notably higher among patients who received SBRT (21% vs. 4% vs. 0%; p<0.001).…”