Stereotactic body radiotherapy in the treatment of advanced adenocarcinoma of the pancreas
American Journal of Clinical Oncology,  Clinical Article

Rwigema JC et al. – SBRT is feasible, with minimal grade ≥3 toxicity. The overall FFLP rate for all patients was 64.8%, comparable to rates with external beam radiotherapy. This shorter treatment course can be delivered without delay in adjuvant systemic therapy.

Methods

  • Reviewed outcomes of 71 patients treated with SBRT for pancreatic cancer between July 2004 and January 2009
  • 40 patients (56%) had locally unresectable disease, 11 patients (16%) had local recurrence following surgical resection, 8 patients (11%) had metastatic disease, and 12 patients (17%) received adjuvant SBRT for positive margins
  • Median dose 24 Gy (18–25 Gy), given in single-fraction SBRT (n = 67) or fractionated SBRT (n = 4)
  • Kaplan-Meyer survival analyses used to estimate freedom from local progression (FFLP) and OS rates

Results
  • Median follow-up among surviving patients was 12.7 months (4–26 months)
  • The median tumor volume was 17 mL (5.1–249 mL)
  • Overall FFLP rates at 6 months/1 year 71.7%/48.5%
  • Among those with macroscopic disease, FFLP achieved in 77.3% of patients with tumor size <15 mL (n = 22), and 59.5% for ≥15 mL (n = 37) (P = 0.02)
  • FFLP achieved in 73% following 24 to 25 Gy, and 45% with 18 to 22 Gy (P = 0.004)
  • Median OS 10.3 months, with 6 month/1 year OS rates of 65.3%/41%, respectively
  • Grade 1–2 acute and late GI toxicity seen in 39.5% of patients
  • 3 patients experienced acute grade 3 toxicities

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