Stereotactic body radiotherapy and gemcitabine for locally advanced pancreatic cancer

Anand Mahadevan, Sanjay Jain, Michael Goldstein, Rebecca Miksad, Douglas Pleskow, Mandeep Sawhney, Darren Brennan, Mark Callery, Charles Vollmer

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)735-742
Number of pages8
JournalInternational Journal of Radiation Oncology, Biology, Physics
Volume78
Issue number3
DOIs
StatePublished - 2010
Externally publishedYes

Fingerprint

gemcitabine
Radiosurgery
Pancreatic Neoplasms
radiation therapy
cancer
progressions
Disease-Free Survival
grade
tumors
tomography
Tomography
stomach
prognosis
carbohydrates
Robotics
Chemoradiotherapy
metastasis
antigens
chemotherapy
Tumor Biomarkers

Keywords

  • Chemotherapy
  • Gemcitabine
  • Hypofractionated stereotactic body radiotherapy
  • Locally advanced pancreatic cancer

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research
  • Medicine(all)

Cite this

Stereotactic body radiotherapy and gemcitabine for locally advanced pancreatic cancer. / Mahadevan, Anand; Jain, Sanjay; Goldstein, Michael; Miksad, Rebecca; Pleskow, Douglas; Sawhney, Mandeep; Brennan, Darren; Callery, Mark; Vollmer, Charles.

In: International Journal of Radiation Oncology, Biology, Physics, Vol. 78, No. 3, 2010, p. 735-742.

Research output: Contribution to journalArticle

Mahadevan, A, Jain, S, Goldstein, M, Miksad, R, Pleskow, D, Sawhney, M, Brennan, D, Callery, M & Vollmer, C 2010, 'Stereotactic body radiotherapy and gemcitabine for locally advanced pancreatic cancer', International Journal of Radiation Oncology, Biology, Physics, vol. 78, no. 3, pp. 735-742. https://doi.org/10.1016/j.ijrobp.2009.08.046
Mahadevan, Anand ; Jain, Sanjay ; Goldstein, Michael ; Miksad, Rebecca ; Pleskow, Douglas ; Sawhney, Mandeep ; Brennan, Darren ; Callery, Mark ; Vollmer, Charles. / Stereotactic body radiotherapy and gemcitabine for locally advanced pancreatic cancer. In: International Journal of Radiation Oncology, Biology, Physics. 2010 ; Vol. 78, No. 3. pp. 735-742.
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abstract = "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.",
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AU - Sawhney, Mandeep

AU - Brennan, Darren

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AB - 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.

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