Survival outcomes in the modern era for localized pancreatic cancer with multi-agent chemotherapy and stereotactic body radiation therapy.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 444-444 ◽  
Author(s):  
Shuchi Sehgal ◽  
Colin Hill ◽  
Wei Fu ◽  
Chen Hu ◽  
Amy Hacker-Prietz ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Radiation Therapy ◽  
Stereotactic Body Radiation Therapy ◽  
Performance Status ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Survival Outcomes ◽  
Entire Cohort ◽  
Stereotactic Body Radiation ◽  
Initial Biopsy

444 Background: The benefit of stereotactic body radiation therapy (SBRT) in the neoadjuvant setting for patients with localized pancreatic adenocarcinoma (PDAC) remains an area of active investigation. Herein, we report on surgical, pathologic, and survival outcomes in a modern cohort of borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) patients (pts) who were treated at a high-volume institution with upfront chemotherapy (CTX) followed by SBRT. Methods: A prospectively collected institutional IRB-approved database was reviewed to identify PDAC pts diagnosed between 2015-2018. All pts were seen in our multidisciplinary clinic and treated with multiagent induction CTX followed by 5-fraction SBRT. In general, it was our institutional preference that ECOG 0-1 pts were recommended modified FOLFIRINOX (mFFX), whereas others were recommended gemcitabine/abraxane. Pathological outcomes by stage were characterized. Kaplan-Meier analysis was used to generate survival curves, and factors prognostic for survival were identified. Results: Our cohort consisted of 156 pts, including 92 LAPC pts (59%) and 63 BRPC pts (41%). Median follow-up from diagnosis was 21.0 months (range 4-49 mos). Of the entire cohort, 117 (75%) received mFFX and 37 (24%) received gemcitabine/abraxane. Median duration of upfront CTX before SBRT was 4.0 months, with 126 pts (80.8%) receiving greater than 4 months. After SBRT, 130 pts (84%) were surgically explored with 106 pts (68%) successfully resected. Of 106 pts who were resected, 97 pts (92%) achieved negative margins, 63 pts (59%) were node-negative, and eight pts (8%) achieved a pathological complete response (pCR). Among 63 BRPC pts, 49 pts (78%) underwent resection, of whom 47 pts (96%) achieved margin negative resection. Among 92 LAPC pts, 57 pts (62%) underwent resection, of whom 50 pts (88%) achieved margin negative resection. For the entire cohort, median overall survival (mOS) from diagnosis was 25.4 mos (95% CI: 22.2 to NR) and 17.6 mos from SBRT (95% CI: 16.1 to NR). ECOG 0-1, initial biopsy grade (well-to-moderately differentiated), duration of neaodjuvant CTX (≥ 4 mos), surgical resection, and receipt of adjuvant CTX were all associated with improved survival from diagnosis (all p < 0.05), but stage (BR vs. LAPC) was not ( p = 0.43). Conclusions: In a modern cohort of patients receiving mFFX (75%) followed by SBRT, a high proportion of pts were successfully resected with favorable pathologic outcomes. Interestingly, OS was not significantly different for BRPC vs LAPC. Factors that proved to be important with respect to OS included duration of neoaduvant CTX, performance status, initial biopsy grade, and receipt of adjuvant CTX, After maximal multiagent CTX, factors other than stage should be considered in determining which pts will benefit from SBRT and/or subsequent surgery.

Patient- versus physician-reported outcomes in patients enrolled in a prospective study involving stereotactic body radiation therapy in unresectable or recurrent pancreatic cancer.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 84-84
Author(s):  
Lauren M. Rosati ◽  
Zhi Cheng ◽  
Scott P. Robertson ◽  
Megan N. Kummerlowe ◽  
Amy Hacker-Prietz ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Radiation Therapy ◽  
Stereotactic Body Radiation Therapy ◽  
Performance Status ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Future Health ◽  
Personalized Care ◽  
Stereotactic Body Radiation ◽  
Patient Reported

84 Background: Prospective evaluation of correlations between patient- (PROs) and physician-reported outcomes (PhROs) was conducted among a group of patients receiving stereotactic body radiation therapy (SBRT) for recurrent or locally advanced pancreatic cancer (PCA). Methods: Forty-two patients were treated with 25-33 Gy using SBRT in 5 fractions on a single-institution study. Eight outcomes (performance status, fatigue, pain, anorexia, nausea, vomiting, constipation, and diarrhea) were consistently evaluated by patients and providers prior to SBRT and 4-6 weeks post-SBRT. Patient-reported quality of life (QOL) metrics were assessed using the EORTC QLQ-C30 and QLQ-PAN26, while physician-reported toxicities were graded using the NCI CTCAE v4.0.A Pearson’s correlation was used to determine the relationship between PROs and PhROs. Results: Of the 42 enrolled patients, 36 had both PROs and PhROs collected before (median, 2.9 weeks) SBRT. Physician-reported pain, nausea, constipation, and diarrhea did not show a correlation with patient-reported overall health or QOL. Physician-reported fatigue showed a correlation with patient-reported pain (r > 0.5, p < 0.001) and QOL (r > -0.5, p < 0.001) but not fatigue (r < 0.3, p > 0.05). Nausea and constipation were the only PROs that did not correlate with their respective PhROs (nausea, r < 0.3, p > 0.05; constipation, r < 0.5, p = 0.07) or any of the other 7 PhROs. Only 24 had both PROs and PhROs collected 4-6 weeks after (median, 5.1 weeks) SBRT. Vomiting, constipation, and diarrhea were PhROs that demonstrated no correlation with patient-reported overall health or QOL. Physician-reported vomiting did not correlate with patient-reported vomiting (r < 0.3, p > 0.05) or any of the 7 other PROs. The correlation between patient- and physician-reported pain increased from pre- (r > 0.3, p = 0.03) to post- (r > 0.7, p < 0.0001) SBRT. Conclusions: Discrepancies among PROs and PhROs appear to exist in pancreatic-specific outcomes of interest such as constipation and diarrhea. Future health care teams may find it helpful to consider PROs to better manage symptoms and deliver more personalized care. Clinical trial information: NCT01781728.

scholarly journals Stereotactic body radiation therapy for locally advanced pancreatic cancer

PLoS ONE ◽  
2019 ◽  
Vol 14 (4) ◽  
pp. e0214970 ◽  
Author(s):  
Jinhong Jung ◽  
Sang Min Yoon ◽  
Jin-hong Park ◽  
Dong-Wan Seo ◽  
Sang Soo Lee ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Radiation Therapy ◽  
Stereotactic Body Radiation Therapy ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Locally Advanced Pancreatic Cancer ◽  
Stereotactic Body Radiation

scholarly journals Chemotherapy-based split stereotactic body radiation therapy for borderline resectable and locally advanced pancreatic cancer: study protocol of a prospective, single-arm phase II trial

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e039900
Author(s):  
Rong Zheng ◽  
Congfei Wang ◽  
Xiaoxue Huang ◽  
Qingliang Lin ◽  
Daxin Huang ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Radiation Therapy ◽  
Study Protocol ◽  
Intravenous Infusion ◽  
Stereotactic Body Radiation Therapy ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Advanced Pancreatic Cancer ◽  
Borderline Resectable ◽  
Stereotactic Body Radiation

IntroductionThe question of how to administer adequate chemotherapy to synchronise stereotactic body radiation therapy (SBRT) treatment strategy to maximise the benefits of neoadjuvant therapy for the improved prognosis of patients with borderline resectable (BRPC) and locally advanced (LAPC) pancreatic cancer is a challenging and debatable issue. No studies have yet evaluated the efficacy of split-course SBRT as the neoadjuvant chemoradiotherapy regimen. We aimed to study whether neoadjuvant chemotherapy plus split-course SBRT results in better outcomes in BRPC and LAPC patients.Methods and analysisTreatment-naïve patients with radiographically confirmed BRPC or LAPC, supporting biopsy results and no severe comorbidities will be enrolled. They will be treated with nab-paclitaxel plus gemcitabine (nab-P+Gem) chemotherapy plus split-course SBRT, followed by an investigator’s choice of continuation of treatment with nab-P+Gem or surgery. nab-P+Gem chemotherapy will commence on day 1 for each of six cycles: nab-paclitaxel 125 mg/m2 intravenous infusion over approximately 30–45 min, followed by gemcitabine 1000 mg/m2 intravenous infusion over about 30 min on days 1 and 15 of each 28-day cycle. During the first and second cycles of chemotherapy, SBRT will be given as a single irradiation of 10 Gy four times (days 2 and 16 of each 28-day cycle). The primary endpoint is progression-free survival; while the secondary outcomes are the time to treatment failure, disease control rate, overall response rate, overall survival, R0 resection rate and incidence of adverse effects.Ethics and disseminationThe study protocol was approved by the Ethics Committee of Xiehe Affiliated Hospital of Fujian Medical University (No. 2019YF015-01). Results from our study will be disseminated in international peer-reviewed journals. All study procedures were developed in order to assure data protection and confidentiality.Trial registration numberNCT04289792.

Stereotactic body radiation therapy for pancreatic cancer: Assessing motion with and without abdominal compression.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 234-234 ◽  
Author(s):  
Priscilla K. Stumpf ◽  
Bernard Jones ◽  
Supriya K. Jain ◽  
Arya Amini ◽  
Dale A. Thornton ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Radiation Therapy ◽  
Stereotactic Body Radiation Therapy ◽  
Organs At Risk ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Free Breathing ◽  
Tumor Motion ◽  
Abdominal Compression ◽  
Stereotactic Body Radiation

234 Background: Stereotactic body radiation therapy (SBRT) is an emerging treatment option for locally advanced pancreatic cancer. This ablative therapy requires highly accurate delivery due to nearby organs at risk. To minimize tumor motion, our institution applies abdominal compression during computed tomography (CT) simulation. The purpose of this study is to evaluate the effect of compression in the context of pancreatic SBRT. Methods: In the last 6 months, 32 patients who completed SBRT to the pancreas at our institution were selected for analysis. In each patient, two 4DCT images were acquired, one with and one without abdominal compression. Abdominal compression was achieved with an indexed compression belt with a customized degree of inflation. Each patient had fiducial markers implanted in or near the pancreatic tumor prior to simulation. These fiducials were contoured on both planning CT scans for each gated phase. Motion was assessed by fiducial position changes throughout each gated phase. Results: In the anterior to posterior, transverse, and superior to inferior dimension, compression decreased motion in 19 of 32 cases (59%), 21 of 32 cases (66%), and 28 of 32 cases (88%) respectively. In the anterior to posterior (AP) dimension compression decreased motion by a mean of 0.43mm ± 1.7mm with a range of -2.1-6.5mm (p = 0.16). The mean decrease in motion with compression in the transverse dimension was 0.93mm ± 1.9mm with a range of -1.6-8.6mm (p = 0.01). In the superior to inferior dimension, compression decreased motion by a mean of 2.72mm ± 2.8mm with a range of -1.2-11.5mm (p < 0.001). Displacement of tissue due to compression led to increased patient AP separation at the level of T12 by a mean of 9.1±5.8mm (p < 0.001). Conclusions: Abdominal compression significantly reduced tumor motion in the superior to inferior and transverse directions for patients undergoing SBRT to the pancreas. This decrease in motion allows for significant reductions in the size of the volume necessary to treat the tumor. Given our findings, we would recommend using abdominal compression over free-breathing for pancreatic SBRT.

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