Stereotactic Body Radiotherapy and Gemcitabine for Locally Advanced Pancreatic Cancer

• Published in: International journal of radiation oncology, biology, physics Vol. 78; no. 3; pp. 735 - 742
• Main Authors: Mahadevan, Anand, M.D, Jain, Sanjay, M.D., Ph.D, Goldstein, Michael, M.D, Miksad, Rebecca, M.D., M.P.H, Pleskow, Douglas, M.D, Sawhney, Mandeep, M.D, Brennan, Darren, M.D, Callery, Mark, M.D, Vollmer, Charles, M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-11-2010; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Antimetabolites, Antineoplastic - therapeutic use; Antineoplastic agents; ANTINEOPLASTIC DRUGS; Biological and medical sciences; BODY; CA-19-9 Antigen - blood; Chemotherapy; Combined Modality Therapy - adverse effects; Combined Modality Therapy - mortality; COMBINED THERAPY; COMPUTERIZED TOMOGRAPHY; Deoxycytidine - analogs & derivatives; Deoxycytidine - therapeutic use; DIAGNOSTIC TECHNIQUES; DIGESTIVE SYSTEM; Disease-Free Survival; DISEASES; Dose Fractionation; DRUGS; Duodenum - diagnostic imaging; ENDOCRINE GLANDS; Female; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; Gemcitabine; GLANDS; Hematology, Oncology and Palliative Medicine; Humans; Hypofractionated stereotactic body radiotherapy; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Locally advanced pancreatic cancer; Male; Medical sciences; MEDICINE; Middle Aged; Movement; NEOPLASMS; NUCLEOSIDES; NUCLEOTIDES; ORGANIC COMPOUNDS; ORGANS; PANCREAS; Pancreatic Neoplasms - blood; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - drug therapy; Pancreatic Neoplasms - mortality; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - surgery; Pharmacology. Drug treatments; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Radiosurgery - adverse effects; Radiosurgery - methods; Radiosurgery - mortality; Retrospective Studies; RIBOSIDES; THERAPY; TOMOGRAPHY; Tomography, X-Ray Computed; Tumors; Chemotherapy; Gemcitabine; Hypofractionated stereotactic body radiotherapy; Locally advanced pancreatic cancer; Antineoplastic agent; Radiosurgery; Malignant tumor; Radiotherapy; Treatment; Antimetabolic; Pancreas cancer; Pyrimidine derivatives; Digestive diseases; Advanced stage; Fluorine Organic compounds; Pyrimidine nucleoside; Cancer; Pancreatic disease
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2009.08.046

Purpose Patients with nonmetastatic locally advanced unresectable pancreatic cancer have a dismal prognosis. Conventional concurrent chemoradiotherapy requires 6 weeks of daily treatment and can be arduous. We explored the safety and effectiveness of a 3-day course of hypofractionated stereotactic body radiotherapy (SBRT) followed by gemcitabine in this population. Patients and Methods A total of 36 patients with nonmetastatic, locally advanced, unresectable pancreatic cancer with ≥12 months of follow-up were included. They received three fractions of 8, 10, or 12 Gy (total dose, 24–36 Gy) of SBRT according to the tumor location in relation to the stomach and duodenum, using fiducial-based respiratory motion tracking on a robotic radiosurgery system. The patients were then offered gemcitabine for 6 months or until tolerance or disease progression. Results With an overall median follow-up of 24 months (range, 12–33), the local control rate was 78%, the median overall survival time was 14.3 months, the median carbohydrate antigen 19-9–determined progression-free survival time was 7.9 months, and the median computed tomography-determined progression-free survival time was 9.6 months. Of the 36 patients, 28 (78%) eventually developed distant metastases. Six patients (17%) were free of progression at the last follow-up visit (range, 13–30 months) as determined by normalized tumor markers with stable computed tomography findings. Nine Grade 2 (25%) and five Grade 3 (14%) toxicities attributable to SBRT occurred. Conclusion Hypofractionated SBRT can be delivered quickly and effectively in patients with nonmetastatic, locally advanced, unresectable pancreatic cancer with acceptable side effects and minimal interference with gemcitabine chemotherapy.