Hostname: page-component-848d4c4894-nmvwc Total loading time: 0 Render date: 2024-07-01T05:48:24.616Z Has data issue: false hasContentIssue false
  • English
  • Français

Association of survival with stereotactic body radiation therapy following induction chemotherapy for unresected locally advanced pancreatic cancer

Published online by Cambridge University Press:  14 April 2021

Sung Jun Ma ,
Lucas M. Serra ,
Austin J. Bartl ,
Hye Ri Han ,
Fatemeh Fekrmandi ,
Austin J. Iovoli ,
Kavitha M. Prezzano ,
Gregory M. Hermann ,
Han Yu  and
Anurag K. Singh Open the ORCID record for Anurag K. Singh [Opens in a new window]
Sung Jun Ma
Affiliation:
Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
Lucas M. Serra
Affiliation:
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
Austin J. Bartl
Affiliation:
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
Hye Ri Han
Affiliation:
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY, USA
Fatemeh Fekrmandi
Affiliation:
Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
Austin J. Iovoli
Affiliation:
Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
Kavitha M. Prezzano
Affiliation:
Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
Gregory M. Hermann
Affiliation:
Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
Han Yu
Affiliation:
Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
Anurag K. Singh*
Affiliation:
Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
*
Author for correspondence: Dr Anurag K. Singh, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY 14203, USA. Tel: 716 845 5715. Fax: 716 845 7616. E-mail: anurag.singh@roswellpark.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Aim:

Induction chemotherapy (iC) followed by concurrent chemoradiation has been shown to improve overall survival (OS) for locally advanced pancreatic cancer (LAPC). However, the survival benefit of stereotactic body radiation therapy (SBRT) versus conventionally fractionated radiation therapy (CFRT) following iC remains unclear.

Materials and methods:

The National Cancer Database (NCDB) was queried for primary stage III, cT4N0-1M0 LAPC (2004–15). Kaplan–Meier analysis, Cox proportional hazards method and propensity score matching were used.

Results:

Among 872 patients, 738 patients underwent CFRT and 134 patients received SBRT. Median follow-up was 24·3 and 22·9 months for the CFRT and SBRT cohorts, respectively. The use of SBRT showed improved survival in both the multivariate analysis (hazards ratio 0·78, p = 0·025) and 120 propensity-matched pairs (median OS 18·1 versus 15·9 months, p = 0·004) compared to the CFRT.

Findings:

This NCDB analysis suggests survival benefit with the use of SBRT versus CFRT following iC for the LAPC.

Keywords

National Cancer DatabasepancreasSABRSBRT
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 21 , Issue 3 , September 2022 , pp. 403 - 410
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Siegel, R L, Miller, K D, Jemal, A. Cancer statistics, 2018. CA Cancer J Clin 2018; 68: 7–30.CrossRefGoogle ScholarPubMed
McGuigan, A, Kelly, P, Turkington, R C, Jones, C, Coleman, H G, McCain, R S. Pancreatic cancer: a review of clinical diagnosis, epidemiology, treatment and outcomes. World J Gastroenterol 2018; 24: 4846–4861.CrossRefGoogle Scholar
Weledji, E P, Enoworock, G, Mokake, M, Sinju, M. How grim is pancreatic cancer? Oncol Rev 2016; 10: 294.Google ScholarPubMed
Willett, C G, Czito, B G, Bendell, J C, Ryan, D P. Locally advanced pancreatic cancer. J Clin Oncol 2005; 23: 4538–4544.CrossRefGoogle ScholarPubMed
Torgeson, A, Lloyd, S, Boothe, D et al. Multiagent induction chemotherapy followed by chemoradiation is associated with improved survival in locally advanced pancreatic cancer. Cancer 2017; 123: 3816–3824.CrossRefGoogle ScholarPubMed
Hammel, P, Huguet, F, van Laethem, J L et al. Effect of chemoradiotherapy versus chemotherapy on survival in patients with locally advanced pancreatic cancer controlled after 4 months of gemcitabine with or without erlotinib: the LAP07 randomized clinical trial. J Am Med Assoc 2016; 315: 1844–1853.CrossRefGoogle ScholarPubMed
Krishnan, S, Rana, V, Janjan, N A et al. Induction chemotherapy selects patients with locally advanced, unresectable pancreatic cancer for optimal benefit from consolidative chemoradiation therapy. Cancer 2007; 110: 47–55.CrossRefGoogle ScholarPubMed
Huguet, F, Andre, T, Hammel, P et al. Impact of chemoradiotherapy after disease control with chemotherapy in locally advanced pancreatic adenocarcinoma in GERCOR phase II and III studies. J Clin Oncol 2007; 25: 326–331.CrossRefGoogle ScholarPubMed
Koong, A C, Le, Q T, Ho, A et al. Phase I study of stereotactic radiosurgery in patients with locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 2004; 58: 1017–1021.CrossRefGoogle ScholarPubMed
Petrelli, F, Comito, T, Ghidini, A, Torri, V, Scorsetti, M, Barni, S. Stereotactic body radiation therapy for locally advanced pancreatic cancer: a systematic review and pooled analysis of 19 trials. Int J Radiat Oncol Biol Phys 2017; 97: 313–322.CrossRefGoogle ScholarPubMed
Tchelebi, L T, Lehrer, E J, Trifiletti, D M et al. Conventionally fractionated radiation therapy versus stereotactic body radiation therapy for locally advanced pancreatic cancer (CRiSP): an international systematic review and meta-analysis. Cancer 2020; 126: 2120–2131.CrossRefGoogle ScholarPubMed
Ch’ang, H J, Lin, Y L, Wang, H P et al. Induction chemotherapy with gemcitabine, oxaliplatin, and 5-fluorouracil/leucovorin followed by concomitant chemoradiotherapy in patients with locally advanced pancreatic cancer: a Taiwan cooperative oncology group phase II study. Int J Radiat Oncol Biol Phys 2011; 81: e749–e757.CrossRefGoogle ScholarPubMed
Mahadevan, A, Miksad, R, Goldstein, M et al. Induction gemcitabine and stereotactic body radiotherapy for locally advanced nonmetastatic pancreas cancer. Int J Radiat Oncol Biol Phys 2011; 81: e615–e622.CrossRefGoogle ScholarPubMed
Mellon, E A, Hoffe, S E, Springett, G M et al. Long-term outcomes of induction chemotherapy and neoadjuvant stereotactic body radiotherapy for borderline resectable and locally advanced pancreatic adenocarcinoma. Acta Oncol 2015; 54: 979–985.CrossRefGoogle ScholarPubMed
Herman, J M, Chang, D T, Goodman, K A et al. Phase 2 multi-institutional trial evaluating gemcitabine and stereotactic body radiotherapy for patients with locally advanced unresectable pancreatic adenocarcinoma. Cancer 2015; 121: 1128–1137.CrossRefGoogle ScholarPubMed
Kim, J S, Lim, J H, Kim, J H et al. Phase II clinical trial of induction chemotherapy with fixed dose rate gemcitabine and cisplatin followed by concurrent chemoradiotherapy with capecitabine for locally advanced pancreatic cancer. Cancer Chemother Pharmacol 2012; 70: 381–389.CrossRefGoogle ScholarPubMed
Crane, C H, Varadhachary, G R, Yordy, J S et al. Phase II trial of cetuximab, gemcitabine, and oxaliplatin followed by chemoradiation with cetuximab for locally advanced (T4) pancreatic adenocarcinoma: correlation of Smad4(Dpc4) immunostaining with pattern of disease progression. J Clin Oncol 2011; 29: 3037–3043.CrossRefGoogle ScholarPubMed
Quan, K, Sutera, P, Xu, K et al. Results of a prospective phase 2 clinical trial of induction gemcitabine/capecitabine followed by stereotactic ablative radiation therapy in borderline resectable or locally advanced pancreatic adenocarcinoma. Pract Radiat Oncol 2018; 8: 95–106.CrossRefGoogle ScholarPubMed
Moningi, S, Dholakia, A S, Raman, S P et al. The role of stereotactic body radiation therapy for pancreatic cancer: a single-institution experience. Ann Surg Oncol 2015; 22: 2352–2358.CrossRefGoogle ScholarPubMed
Zhong, J, Patel, K, Switchenko, J et al. Outcomes for patients with locally advanced pancreatic adenocarcinoma treated with stereotactic body radiation therapy versus conventionally fractionated radiation. Cancer 2017; 123: 3486–3493.CrossRefGoogle ScholarPubMed
Dohopolski, M J, Glaser, S M, Vargo, J A, Balasubramani, G K, Beriwal, S. Stereotactic body radiotherapy for locally-advanced unresectable pancreatic cancer-patterns of care and overall survival. J Gastrointest Oncol 2017; 8: 766–777.CrossRefGoogle ScholarPubMed
Bilimoria, K Y, Stewart, A K, Winchester, D P, Ko, C Y. The National Cancer Data Base: a powerful initiative to improve cancer care in the United States. Ann Surg Oncol 2008; 15: 683–690.CrossRefGoogle ScholarPubMed
Colbert, L E, Rebueno, N, Moningi, S et al. Dose escalation for locally advanced pancreatic cancer: how high can we go? Adv Radiat Oncol 2018; 3: 693–700.CrossRefGoogle Scholar
Sutera, P A, Bernard, M E, Gill, B S et al. One- versus three-fraction pancreatic stereotactic body radiation therapy for pancreatic carcinoma: single institution retrospective review. Front Oncol 2017; 7: 272.CrossRefGoogle Scholar
Krishnan, S, Chadha, A S, Suh, Y et al. Focal radiation therapy dose escalation improves overall survival in locally advanced pancreatic cancer patients receiving induction chemotherapy and consolidative chemoradiation. Int J Radiat Oncol Biol Phys 2016; 94: 755–765.CrossRefGoogle ScholarPubMed
Hall, W A, Colbert, L E, Nickleach, D et al. The influence of radiation therapy dose escalation on overall survival in unresectable pancreatic adenocarcinoma. J Gastrointest Oncol 2014; 5: 77–85.Google ScholarPubMed
Barraclough, H, Govindan, R. Biostatistics primer: what a clinician ought to know: subgroup analyses. J Thorac Oncol 2010; 5: 741–746.CrossRefGoogle ScholarPubMed
Austin, P C. Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat 2011; 10: 150–161.CrossRefGoogle ScholarPubMed
Rosati, L M, Herman, J M. Role of stereotactic body radiotherapy in the treatment of elderly and poor performance status patients with pancreatic cancer. J Oncol Pract 2017; 13: 157–166.CrossRefGoogle ScholarPubMed
Neoptolemos, J P, Palmer, D H, Ghaneh, P et al. Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. Lancet 2017; 389: 1011–1024.CrossRefGoogle ScholarPubMed
Sultana, A, Smith, C T, Cunningham, D, Starling, N, Neoptolemos, J P, Ghaneh, P. Meta-analyses of chemotherapy for locally advanced and metastatic pancreatic cancer. J Clin Oncol 2007; 25: 2607–2615.CrossRefGoogle ScholarPubMed