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The Role of Stereotactic Body Radiation Therapy for Pancreatic Cancer: A Single-Institution Experience

Shalini Moningi BA, Avani S. Dholakia BS, Siva P. Raman MD, Amanda Blackford Sc.M, John L. Cameron MD, Dung T. Le MD, Ana M. C. De Jesus-Acosta MD, Amy Hacker-Prietz MS, Lauren M. Rosati BS, Ryan K. Assadi BS, Shirl Dipasquale RN, Timothy M. Pawlik MD, Lei Zheng MD, Matthew J. Weiss MD, Daniel A. Laheru MD, Christopher L. Wolfgang MD, Joseph M. Herman MD
Gastrointestinal Oncology
Volume 22, Issue 7 / July , 2015

Abstract

Background

Stereotactic body radiation therapy (SBRT) is a promising option for patients with pancreatic cancer (PCA); however, limited data support its efficacy. This study reviews our institutional experience of SBRT in the treatment of locally advanced (LAPC) and borderline resectable (BRPC) PCA.

Methods

Charts of all PCA patients receiving SBRT at our institution from 2010 to 2014 were reviewed. Most patients received pre-SBRT chemotherapy. Primary endpoints included overall survival (OS) and local progression-free survival (LPFS). Patients received a total dose of 25–33 Gy in five fractions.

Results

A total of 88 patients were included in the analysis, 74 with LAPC and 14 with BRPC. The median age at diagnosis was 67.2 years, and median follow-up from date of diagnosis for LAPC and BRPC patients was 14.5 and 10.3 months, respectively. Median OS from date of diagnosis was 18.4 months (LAPC, 18.4 mo; BRPC, 14.4 mo) and median PFS was 9.8 months (95 % CI 8.0–12.3). Acute toxicity was minimal with only three patients (3.4 %) experiencing acute grade ≥3 toxicity. Late grade ≥2 gastrointestinal toxicity was seen in five patients (5.7 %). Of the 19 patients (21.6 %) who underwent surgery, 79 % were LAPC patients and 84 % had margin-negative resections.

Conclusions

Chemotherapy followed by SBRT in patients with LAPC and BRPC resulted in minimal acute and late toxicity. A large proportion of patients underwent surgical resection despite limited radiographic response to therapy. Further refinements in the integration of chemotherapy, SBRT, and surgery might offer additional advancements toward optimizing patient outcomes.

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