Abstract
Objective
To evaluate the efficacy and the feasibility of SBRT for selected patients with isolated
local recurrence of pancreatic cancer after radical surgery.
Methods
A retrospective analysis was performed on patients treated with SBRT for isolated
local recurrence from resected pancreatic adenocarcinoma, after multidisciplinary
board evaluation. Prescription dose was 45 Gy in 6 fractions for all patients. Primary
end-point was freedom from local progression (FFLP). Secondary end-points were overall
survival (OS), progression free survival (PFS) and toxicity. Local control was defined
according to RECIST criteria. Acute and late toxicity was scored according to the
NCI Common Terminology Criteria for Adverse Events (CTCAE) v4.0.
Results
Between January 2011 and February 2015, 31 patients with isolated local recurrence
of resected pancreatic cancer were treated with SBRT. Pancreato-duodenectomy (PD)
was performed on 24 patients and distal pancreatectomy (DP) in 7 cases, all with radical
resection (R0). Median local recurrence disease free interval (DFI) was 14 months.
Median follow-up was 12 months. FFLP was 91% and 82% at 1 and 2-years, respectively.
Median PFS was 9 months. Median OS was 18 months. At univariate analysis, OS was correlated
with a DFI>18 months. No cases of acute G3 toxicity or greater occurred.
Conclusions
SBRT seems to be an effective and safe therapeutic option for isolated local recurrence
of pancreatic cancer after surgery. Encouraging local control rate, very low toxicity
profile and effective pain control suggest the crucial role of SBRT in the treatment
of these long-survivors selected patients.
Keywords
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References
- Epidemiology of pancreatic cancer: an overview.Nat Rev Gastroenterol Hepatol. 2009; 6: 699-708
- Cancer statistics, 2013.CA Cancer J Clin. 2013; 63: 11-30
- Patterns of recurrence after curative resection of pancreatic ductal adenocarcinoma.Eur J Surg Oncol. 2009; 35: 600
- Loco-recurrence after resection for ductal adenocarcinoma of the pancreas: predictors and implications for adjuvant chemoradiotherapy.J Cancer Res Clin Oncol. 2012; 138: 1063-1107
- Surgery for recurrent pancreatic ductal adenocarcinoma.Ann Surg. 2007; 245: 566-572
- Chemoradiation in patients with isolated recurrent pancreatic cancer therapeutical efficacy and probability of re-resection.Radiat Oncol. 2013; 8: 27
- Combined chemoradiotherapy for isolated local recurrence after primary resection of pancreatic cancer.JOP. 2006; 7: 34-40
- Radiotherapy for patients with isolated local recurrence of primary resected pancreatic cancer.Strahlenther Onkol. 2014; 190: 485-490
- SBRT in pancreatic cancer: what is the therapeutic windows?.Radiother Oncol. 2015; 114: 109-116
- SBRT in unresectable advanced pancreatic cancer: preliminary results of a mono-institutional experience.Radiat Oncol. 2013; 8: 148
- New response evaluation criteria in solid tumors: revised RECIST guideline (version 1.1).Eur J Cancer. 2009; 45: 228-247
- DPC4 gene status of the primary carcinoma correlates with patterns of failure in patients with pancreatic cancer.J Clin Oncol. 2009; 27: 1806-1813
- The natural history of resected pancreatic cancer without adjuvant chemotherapy.Am Surg. 2010; 76: 480e5
- Surgery for recurrence of periampullary malignancies.J Gastrointest Surg. 2009; 13: 760e7
- The prognostic factors of pancreatic cancer can be different according to clinical stages.Korean J Gastroenterol. 2008; 51: 181e9
- Chemoradiation of unresectable pancreatic carcinoma: impact of pretreatment hemoglobin level on patterns of failure.Strahlenther Onkol. 2003; 179: 87e92
- 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.JCO. 2011; 29: 22
- Do recurrent and metastatic pancreatic cancer patients have the same outcomes with gemcitabine treatment?.Oncology. 2009; 77: 217-223
- Unresectable locally advanced pancreatic cancer: a multimodal treatment using neoadjuvant chemoradiotherapy (gemcitabine plus stereotactic radiosurgery) and subsequent surgical exploration.Ann Surg Oncol. 2010; 17: 2092-2101
- Re-resection for isolated local recurrence of pancreatic cancer is feasible, safe, and associated with encouraging survival.Ann Surg Oncol. 2013 Mar; 20: 964-972
Article info
Publication history
Published online: January 16, 2017
Accepted:
December 1,
2016
Identification
Copyright
© 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
