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Research Article
Predictors of outcome in patients receiving stereotactic body radiation therapy for borderline resectable and locally advanced pancreatic cancers
1 Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India
2 Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India
3 Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
4 Department of Radiodiagnosis, Tata Memorial Centre, Mumbai, India
5 Department of Pathology, Tata Memorial Hospital, Mumbai, India
Address correspondence to:
Reena Engineer
Professor, Department of Radiation Oncology, Tata Memorial Hospital, Dr E. Borges Road, Parel, Mumbai, 400012,
India
Message to Corresponding Author
Article ID: 100098Z04AA2022
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How to cite this article
Anup A, Bhandare M, Chaudhari V, Krishnatry R, Shrikhande S, Ostwal V, Ramaswamy A, Baheti A, Ramadwar M, Engineer R. Predictors of outcome in patients receiving stereotactic body radiation therapy for borderline resectable and locally advanced pancreatic cancers. Int J Hepatobiliary Pancreat Dis 2022;12:100098Z04AA2022.ABSTRACT
Aims: To evaluate the outcomes in borderline resectable (BRPC) and locally advanced pancreatic cancer (LAPC) receiving neoadjuvant chemotherapy (NACT) and stereotactic body radiotherapy (SBRT) followed by surgery when feasible.
Methods: Consecutive patients of BRPC and LAPC treated from May 2015 to December 2019 were included. All underwent NACT with FOLFIRINOX/Gem Nabpacli 4–6 cycles, followed by SBRT with differential planning target volume (PTV) dose of 36–46 Gy over 5–6 fractions. Local progression-free survival (LPFS), distant metastasis free survival (DMFS), overall survival (OS) were estimated.
Results: Eighty-nine (50 BRPC and 39 LAPC) patients with a median follow-up of 26.0 months were identified. Of the 33 (37%) patients surgically explored and 19 (47.5%) BRPC and 4 (10.2%) LAPC patients underwent surgery, 21 (91.6%) had R0 resection. The median OS and disease free survival (DFS) of patients who underwent surgery was 28.4 ± 3.4 and 23 ± 5 months, respectively. The patients who did not undergo surgery the median OS and LPFS was 19 ± 1.4 and 12 ± 1 months, respectively. Patients who underwent surgery in BRPC cohort had significantly better DFS (23 vs 12 months, p=0.001) and OS (28 vs 19 months, p=0.035). On multivariate analysis, Eastern Cooperative Oncology Group (ECOG) < 2 [hazard ratio (HR): 2.77 (1.2–6.2; 0.014)], head location [3.7 (1.44–9.6; 0.007)], and radiological response post-NACT-SBRT [4.38 (1.08–17.7; 0.039)] were significant predictors of outcome in both the cohorts. No grade ≥3 late radiotherapy (RT)-related toxicities were seen.
Conclusion: Stereotactic body radiotherapy is safe and effective for local control and aids in improving the outcomes in pancreatic cancers.
Keywords: Neoadjuvant chemoradiation, Pancreatic cancer, Stereotactic body radiotherapy
SUPPORTING INFORMATION
Author Contributions
Akanksha Anup - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Manisha Bhandare - Acquisition of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Vikram Chaudhari - Acquisition of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Rahul Krishnatry - Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Shailesh Shrikhande - Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Vikas Ostwal - Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Anant Ramaswamy - Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Akshay Baheti - Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Mukta Ramadwar - Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Reena Engineer - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2022 Akanksha Anup et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
