Skip to main content
Top
Published in: Radiation Oncology 1/2012

Open Access 01-12-2012 | Research

Stereotactic body radiation therapy for reirradiation of localized adenocarcinoma of the pancreas

Authors: Chris E Lominska, Keith Unger, Nadim M Nasr, Nadim Haddad, Greg Gagnon

Published in: Radiation Oncology | Issue 1/2012

Login to get access

Abstract

Background

Local control rates are poor in the treatment of pancreatic cancer. We investigated the role of hypofractionated stereotactic body radiation therapy (SBRT) for salvage or boost treatment after conventional doses of external beam radiation therapy.

Methods

All patients treated with SBRT for pancreatic adenocarcinoma at Georgetown University from June 2002 through July 2007 were examined. Eligible patients had prior external beam radiation therapy to the pancreas. Treatment parameters and clinical and radiographic follow-up were evaluated.

Results

Twenty-eight patients were identified who received SBRT after a median prior external beam radiotherapy dose of 50.4 Gy. The median patient age was 63 years old and the median follow-up was 5.9 months. Twelve of fourteen (85.7%) evaluable patients were free from local progression, with three partial responses and nine patients with stable disease. Toxicity consisted of one case of acute Grade II nausea/vomiting, and two cases of Grade III late GI toxicity. The median overall survival was 5.9 months, with 18% survival and 70% freedom from local progression at one year.

Conclusions

Hypofractionated SBRT reirradiation of localized pancreatic cancer is a well-tolerated treatment. Most patients are free from local progression, albeit with limited follow-up, but overall survival remains poor.
Appendix
Available only for authorised users
Literature
1.
go back to reference Griffin JF, Smalley SR, Jewell W, et al.: Patterns of failure after curative resection of pancreatic carcinoma. Cancer 1990, 66: 56-61. 10.1002/1097-0142(19900701)66:1<56::AID-CNCR2820660112>3.0.CO;2-6CrossRefPubMed Griffin JF, Smalley SR, Jewell W, et al.: Patterns of failure after curative resection of pancreatic carcinoma. Cancer 1990, 66: 56-61. 10.1002/1097-0142(19900701)66:1<56::AID-CNCR2820660112>3.0.CO;2-6CrossRefPubMed
2.
go back to reference Tepper J, Nardi G, Sutt H: Carcinoma of the pancreas: review of MGH experience from 1963 to 1973, Analysis of surgical failure and implications for radiation therapy. Cancer 1976, 37: 1519-1524. 10.1002/1097-0142(197603)37:3<1519::AID-CNCR2820370340>3.0.CO;2-OCrossRefPubMed Tepper J, Nardi G, Sutt H: Carcinoma of the pancreas: review of MGH experience from 1963 to 1973, Analysis of surgical failure and implications for radiation therapy. Cancer 1976, 37: 1519-1524. 10.1002/1097-0142(197603)37:3<1519::AID-CNCR2820370340>3.0.CO;2-OCrossRefPubMed
3.
go back to reference Kalser MH, Ellenberg SS: Pancreatic cancer. Adjuvant combined radiation and chemotherapy following curative resection. Arch Surg 1985, 120: 899-903. 10.1001/archsurg.1985.01390320023003CrossRefPubMed Kalser MH, Ellenberg SS: Pancreatic cancer. Adjuvant combined radiation and chemotherapy following curative resection. Arch Surg 1985, 120: 899-903. 10.1001/archsurg.1985.01390320023003CrossRefPubMed
4.
go back to reference Neoptolemos JP, Stocken DD, Friess H, et al.: A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 2004, 350: 1200-1210. 10.1056/NEJMoa032295CrossRefPubMed Neoptolemos JP, Stocken DD, Friess H, et al.: A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 2004, 350: 1200-1210. 10.1056/NEJMoa032295CrossRefPubMed
5.
go back to reference Klinkenbijl JH, Jeekel J, Sahmoud T, et al.: Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase III trial of the EORTC gastrointestinal tract cancer cooperative group. Ann Surg 1999, 230: 776-782. discussion 782–774 10.1097/00000658-199912000-00006PubMedCentralCrossRefPubMed Klinkenbijl JH, Jeekel J, Sahmoud T, et al.: Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase III trial of the EORTC gastrointestinal tract cancer cooperative group. Ann Surg 1999, 230: 776-782. discussion 782–774 10.1097/00000658-199912000-00006PubMedCentralCrossRefPubMed
6.
go back to reference Garofalo MC, Regine WF, Tan MT: On statistical reanalysis, the EORTC trial is a positive trial for adjuvant chemoradiation in pancreatic cancer. Ann Surg 2006, 244: 332-333. author reply 333 10.1097/01.sla.0000229980.81505.44PubMedCentralCrossRefPubMed Garofalo MC, Regine WF, Tan MT: On statistical reanalysis, the EORTC trial is a positive trial for adjuvant chemoradiation in pancreatic cancer. Ann Surg 2006, 244: 332-333. author reply 333 10.1097/01.sla.0000229980.81505.44PubMedCentralCrossRefPubMed
7.
go back to reference Martin A, Gaya A: Stereotactic Body Radiotherapy: A Review. Clin Oncol (R Coll Radiol) 2010, 22: 157-172. 10.1016/j.clon.2009.12.003CrossRef Martin A, Gaya A: Stereotactic Body Radiotherapy: A Review. Clin Oncol (R Coll Radiol) 2010, 22: 157-172. 10.1016/j.clon.2009.12.003CrossRef
8.
go back to reference Koong AC, Christofferson E, Le QT, et al.: Phase II study to assess the efficacy of conventionally fractionated radiotherapy followed by a stereotactic radiosurgery boost in patients with locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 2005, 63: 320-323. 10.1016/j.ijrobp.2005.07.002CrossRefPubMed Koong AC, Christofferson E, Le QT, et al.: Phase II study to assess the efficacy of conventionally fractionated radiotherapy followed by a stereotactic radiosurgery boost in patients with locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 2005, 63: 320-323. 10.1016/j.ijrobp.2005.07.002CrossRefPubMed
9.
go back to reference Adler JR, Chang SD, Murphy MJ, et al.: The Cyberknife: a frameless robotic system for radiosurgery. Stereotact Funct Neurosurg 1997, 69: 124-128. 10.1159/000099863CrossRefPubMed Adler JR, Chang SD, Murphy MJ, et al.: The Cyberknife: a frameless robotic system for radiosurgery. Stereotact Funct Neurosurg 1997, 69: 124-128. 10.1159/000099863CrossRefPubMed
10.
go back to reference Pishvaian AC, Collins B, Gagnon G, et al.: EUS-guided fiducial placement for CyberKnife radiotherapy of mediastinal and abdominal malignancies. Gastrointest Endosc 2006, 64: 412-417. 10.1016/j.gie.2006.01.048CrossRefPubMed Pishvaian AC, Collins B, Gagnon G, et al.: EUS-guided fiducial placement for CyberKnife radiotherapy of mediastinal and abdominal malignancies. Gastrointest Endosc 2006, 64: 412-417. 10.1016/j.gie.2006.01.048CrossRefPubMed
11.
go back to reference Shaw E, Kline R, Gillin M, et al.: Radiation Therapy Oncology Group: radiosurgery quality assurance guidelines. Int J Radiat Oncol Biol Phys 1993, 27: 1231-1239. 10.1016/0360-3016(93)90548-ACrossRefPubMed Shaw E, Kline R, Gillin M, et al.: Radiation Therapy Oncology Group: radiosurgery quality assurance guidelines. Int J Radiat Oncol Biol Phys 1993, 27: 1231-1239. 10.1016/0360-3016(93)90548-ACrossRefPubMed
12.
go back to reference Oettle H, Post S, Neuhaus P, et al.: Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA 2007, 297: 267-277. 10.1001/jama.297.3.267CrossRefPubMed Oettle H, Post S, Neuhaus P, et al.: Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA 2007, 297: 267-277. 10.1001/jama.297.3.267CrossRefPubMed
13.
go back to reference Regine WF, Winter KA, Abrams RA, et al.: Fluorouracil vs gemcitabine chemotherapy before and after fluorouracil-based chemoradiation following resection of pancreatic adenocarcinoma: a randomized controlled trial. JAMA 2008, 299: 1019-1026. 10.1001/jama.299.9.1019CrossRefPubMed Regine WF, Winter KA, Abrams RA, et al.: Fluorouracil vs gemcitabine chemotherapy before and after fluorouracil-based chemoradiation following resection of pancreatic adenocarcinoma: a randomized controlled trial. JAMA 2008, 299: 1019-1026. 10.1001/jama.299.9.1019CrossRefPubMed
14.
go back to reference Loehrer PJ, Powell ME, Cardenes HR, et al.: A randomized phase III study of gemcitabine in combination with radiation therapy versus gemcitabine alone in patients with localized, unresectable pancreatic cancer. J Clin Oncol 2011, 29: 4105-4112. 10.1200/JCO.2011.34.8904PubMedCentralCrossRefPubMed Loehrer PJ, Powell ME, Cardenes HR, et al.: A randomized phase III study of gemcitabine in combination with radiation therapy versus gemcitabine alone in patients with localized, unresectable pancreatic cancer. J Clin Oncol 2011, 29: 4105-4112. 10.1200/JCO.2011.34.8904PubMedCentralCrossRefPubMed
15.
go back to reference Chang DT, Schellenberg D, Shen J, et al.: Stereotactic radiotherapy for unresectable adenocarcinoma of the pancreas. Cancer 2009, 115: 665-672. 10.1002/cncr.24059CrossRefPubMed Chang DT, Schellenberg D, Shen J, et al.: Stereotactic radiotherapy for unresectable adenocarcinoma of the pancreas. Cancer 2009, 115: 665-672. 10.1002/cncr.24059CrossRefPubMed
16.
go back to reference Koong AC, Le QT, 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. 10.1016/j.ijrobp.2003.11.004CrossRefPubMed Koong AC, Le QT, 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. 10.1016/j.ijrobp.2003.11.004CrossRefPubMed
17.
go back to reference Schellenberg D, Goodman KA, Lee F, et al.: Gemcitabine chemotherapy and single-fraction stereotactic body radiotherapy for locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 2008, 72: 678-686. 10.1016/j.ijrobp.2008.01.051CrossRefPubMed Schellenberg D, Goodman KA, Lee F, et al.: Gemcitabine chemotherapy and single-fraction stereotactic body radiotherapy for locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 2008, 72: 678-686. 10.1016/j.ijrobp.2008.01.051CrossRefPubMed
18.
go back to reference Hoyer M, Roed H, Sengelov L, et al.: Phase-II study on stereotactic radiotherapy of locally advanced pancreatic carcinoma. Radiother Oncol 2005, 76: 48-53. 10.1016/j.radonc.2004.12.022CrossRefPubMed Hoyer M, Roed H, Sengelov L, et al.: Phase-II study on stereotactic radiotherapy of locally advanced pancreatic carcinoma. Radiother Oncol 2005, 76: 48-53. 10.1016/j.radonc.2004.12.022CrossRefPubMed
19.
go back to reference Mahadevan A, Jain S, Goldstein M, et al.: Stereotactic Body Radiotherapy and Gemcitabine for Locally Advanced Pancreatic Cancer. Int J Radiat Oncol Biol Phys 2010, 78: 735-742. 10.1016/j.ijrobp.2009.08.046CrossRefPubMed Mahadevan A, Jain S, Goldstein M, et al.: Stereotactic Body Radiotherapy and Gemcitabine for Locally Advanced Pancreatic Cancer. Int J Radiat Oncol Biol Phys 2010, 78: 735-742. 10.1016/j.ijrobp.2009.08.046CrossRefPubMed
20.
go back to reference Rwigema JC, Parikh SD, Heron DE, et al.: Stereotactic Body Radiotherapy in the Treatment of Advanced Adenocarcinoma of the Pancreas. Am J Clin Oncol 2011, 34: 63-69. 10.1097/COC.0b013e3181d270b4CrossRefPubMed Rwigema JC, Parikh SD, Heron DE, et al.: Stereotactic Body Radiotherapy in the Treatment of Advanced Adenocarcinoma of the Pancreas. Am J Clin Oncol 2011, 34: 63-69. 10.1097/COC.0b013e3181d270b4CrossRefPubMed
21.
go back to reference Seo Y, Kim M, Yoo S, et al.: Stereotactic Body Radiation Therapy Boost in Locally Advanced Pancreatic Cancer. Int J Radiat Oncol Biol Phys 2009, 75: 1456-1461. 10.1016/j.ijrobp.2009.01.042CrossRefPubMed Seo Y, Kim M, Yoo S, et al.: Stereotactic Body Radiation Therapy Boost in Locally Advanced Pancreatic Cancer. Int J Radiat Oncol Biol Phys 2009, 75: 1456-1461. 10.1016/j.ijrobp.2009.01.042CrossRefPubMed
22.
go back to reference Schellenberg D, Quon A, Minn AY, et al.: (18)Fluorodeoxyglucose PET Is Prognostic of Progression-Free and Overall Survival in Locally Advanced Pancreas Cancer Treated With Stereotactic Radiotherapy. Int J Radiat Oncol Biol Phys 2010, 77: 1420-1425. 10.1016/j.ijrobp.2009.06.049CrossRefPubMed Schellenberg D, Quon A, Minn AY, et al.: (18)Fluorodeoxyglucose PET Is Prognostic of Progression-Free and Overall Survival in Locally Advanced Pancreas Cancer Treated With Stereotactic Radiotherapy. Int J Radiat Oncol Biol Phys 2010, 77: 1420-1425. 10.1016/j.ijrobp.2009.06.049CrossRefPubMed
Metadata
Title
Stereotactic body radiation therapy for reirradiation of localized adenocarcinoma of the pancreas
Authors
Chris E Lominska
Keith Unger
Nadim M Nasr
Nadim Haddad
Greg Gagnon
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2012
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/1748-717X-7-74

Other articles of this Issue 1/2012

Radiation Oncology 1/2012 Go to the issue