skip to main content
OSTI.GOV title logo U.S. Department of Energy
Office of Scientific and Technical Information

Title: Radiotherapy for Pancreatic Neuroendocrine Tumors

Abstract

Purpose: Pancreatic neuroendocrine tumors (PNTs) are rare malignant neoplasms considered to be resistant to radiotherapy (RT), although data on efficacy are scarce. We reviewed our institutional experience to further delineate the role of RT for patients with PNTs. Methods and Materials: Between 1986 and 2006, 36 patients with PNTs were treated with RT to 49 sites. Of these 36 patients, 23 had radiographic follow-up data, which were used to determine the tumor response rate and freedom from local progression. Long-term toxicity was graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events. Results: The overall response rate to RT was 39% (13% complete response, 26% partial response, 56% stable disease, and 4% progressive disease). A significant difference in the freedom from local progression between the groups receiving either greater than or less than the median 2 Gy/fraction biologically equivalent dose of 49.6 Gy was found, with all radiographic progression occurring in patients who had received <=32 Gy. The actuarial 3-year local freedom from progression rate was 49%. Palliation was achieved in 90% of patients, with either improvement or resolution of symptoms after RT. Of 35 patients, 33 had metastatic disease at their referral for RT, and themore » median overall survival for this patient population was 2 years. Three long-term Grade 3 or greater toxicities were recorded. Conclusion: RT is an effective modality for achieving local control in patients with PNTs. RT produces high rates of symptomatic palliation and freedom from local progression. Prospective trials of radiotherapy for PNTs are warranted.« less

Authors:
 [1];  [2];  [1]; ;  [3];  [1];  [1]
  1. Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States)
  2. Comprehensive Cancer Center Biostatistics Unit, University of Michigan, Ann Arbor, MI (United States)
  3. Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, Ann Arbor, MI (United States)
Publication Date:
OSTI Identifier:
21367521
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 75; Journal Issue: 4; Other Information: DOI: 10.1016/j.ijrobp.2008.12.044; PII: S0360-3016(09)00018-2; Copyright (c) 2009 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; NEOPLASMS; PANCREAS; RADIOTHERAPY; BODY; DIGESTIVE SYSTEM; DISEASES; ENDOCRINE GLANDS; GLANDS; MEDICINE; NUCLEAR MEDICINE; ORGANS; RADIOLOGY; THERAPY

Citation Formats

Contessa, Joseph N., Griffith, Kent A., Wolff, Elizabeth, Ensminger, William, Zalupski, Mark, Lawrence, Theodore S., and Ben-Josef, Edgar, E-mail: edgarb@med.umich.ed. Radiotherapy for Pancreatic Neuroendocrine Tumors. United States: N. p., 2009. Web. doi:10.1016/j.ijrobp.2008.12.044.
Contessa, Joseph N., Griffith, Kent A., Wolff, Elizabeth, Ensminger, William, Zalupski, Mark, Lawrence, Theodore S., & Ben-Josef, Edgar, E-mail: edgarb@med.umich.ed. Radiotherapy for Pancreatic Neuroendocrine Tumors. United States. doi:10.1016/j.ijrobp.2008.12.044.
Contessa, Joseph N., Griffith, Kent A., Wolff, Elizabeth, Ensminger, William, Zalupski, Mark, Lawrence, Theodore S., and Ben-Josef, Edgar, E-mail: edgarb@med.umich.ed. 2009. "Radiotherapy for Pancreatic Neuroendocrine Tumors". United States. doi:10.1016/j.ijrobp.2008.12.044.
@article{osti_21367521,
title = {Radiotherapy for Pancreatic Neuroendocrine Tumors},
author = {Contessa, Joseph N. and Griffith, Kent A. and Wolff, Elizabeth and Ensminger, William and Zalupski, Mark and Lawrence, Theodore S. and Ben-Josef, Edgar, E-mail: edgarb@med.umich.ed},
abstractNote = {Purpose: Pancreatic neuroendocrine tumors (PNTs) are rare malignant neoplasms considered to be resistant to radiotherapy (RT), although data on efficacy are scarce. We reviewed our institutional experience to further delineate the role of RT for patients with PNTs. Methods and Materials: Between 1986 and 2006, 36 patients with PNTs were treated with RT to 49 sites. Of these 36 patients, 23 had radiographic follow-up data, which were used to determine the tumor response rate and freedom from local progression. Long-term toxicity was graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events. Results: The overall response rate to RT was 39% (13% complete response, 26% partial response, 56% stable disease, and 4% progressive disease). A significant difference in the freedom from local progression between the groups receiving either greater than or less than the median 2 Gy/fraction biologically equivalent dose of 49.6 Gy was found, with all radiographic progression occurring in patients who had received <=32 Gy. The actuarial 3-year local freedom from progression rate was 49%. Palliation was achieved in 90% of patients, with either improvement or resolution of symptoms after RT. Of 35 patients, 33 had metastatic disease at their referral for RT, and the median overall survival for this patient population was 2 years. Three long-term Grade 3 or greater toxicities were recorded. Conclusion: RT is an effective modality for achieving local control in patients with PNTs. RT produces high rates of symptomatic palliation and freedom from local progression. Prospective trials of radiotherapy for PNTs are warranted.},
doi = {10.1016/j.ijrobp.2008.12.044},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 4,
volume = 75,
place = {United States},
year = 2009,
month =
}
  • Purpose: Pancreatic neuroendocrine tumors (pNET) are rare neoplasms associated with poor outcomes without resection, and involved surgical margins are associated with a worse prognosis. The role of adjuvant radiotherapy (RT) in these patients has not been characterized. Methods and Materials: We retrospectively evaluated 46 consecutive patients with positive or close (<1 mm) margins after pNET resection, treated from 1983 to 2010, 16 of whom received adjuvant RT. Median RT dose was 50.4 Gy in 1.8-Gy fractions; half the patients received concurrent chemotherapy with 5-fluorouracil or capecitabine. No patients received adjuvant chemotherapy. Cox multivariate analysis (MVA) was used to analyze factorsmore » associated with overall survival (OS). Results: Median age at diagnosis was 56 years, and 52% of patients were female. Median tumor size was 38 mm, 57% of patients were node-positive, and 11% had a resected solitary liver metastasis. Patients who received RT were more likely to have larger tumors (median, 54 mm vs. 30 mm, respectively, p = 0.002) and node positivity (81% vs. 33%, respectively, p = 0.002) than those not receiving RT. Median follow-up was 39 months. Actuarial 5-year OS was 62% (95% confidence interval [CI], 41%-77%). In the group that did not receive RT, 3 patients (10%) experienced local recurrence (LR) and 5 patients (18%) developed new distant metastases, while in the RT group, 1 patient (6%) experienced LR and 5 patients (38%) developed distant metastases. Of all recurrences, 29% were LR. On MVA, male gender (adjusted hazard ratio [AHR] = 3.81; 95% CI, 1.21-11.92; p = 0.02) and increasing tumor size (AHR = 1.02; 95% CI, 1.01-1.04; p = 0.007) were associated with decreased OS. Conclusions: Long-term survival is common among patients with involved-margin pNET. Despite significantly worse pathologic features among patients receiving adjuvant RT, rates of LR between groups were similar, suggesting that RT might aid local control, and merits further evaluation.« less
  • Purpose: Pancreatic neuroendocrine tumors (NET) are rare and have better disease-related outcomes compared with pancreatic adenocarcinoma. Surgical resection remains the standard of care, although many patients present with locally advanced or metastatic disease. Little is known regarding the use of radiotherapy in the prevention of local recurrence after resection. To better define the role of radiotherapy, we performed an analysis of resected patients at our institution. Methods: Between 1994 and 2009, 33 patients with NET of the pancreatic head and neck underwent treatment with curative intent at Duke University Medical Center. Sixteen patients were treated with surgical resection alone whilemore » an additional 17 underwent resection with adjuvant or neoadjuvant radiation therapy, usually with concurrent fluoropyrimidine-based chemotherapy (CMT). Median radiation dose was 50.4 Gy and median follow-up 28 months. Results: Thirteen patients (39%) experienced treatment failure. Eleven of the initial failures were distant, one was local only and one was local and distant. Two-year overall survival was 77% for all patients. Two-year local control for all patients was 87%: 85% for the CMT group and 90% for the surgery alone group (p = 0.38). Two-year distant metastasis-free survival was 56% for all patients: 46% and 69% for the CMT and surgery patients, respectively (p = 0.10). Conclusions: The primary mode of failure is distant which often results in mortality, with local failure occurring much less commonly. The role of radiotherapy in the adjuvant management of NET remains unclear.« less
  • We describe the use of ultrasound-guided high-intensity focused ultrasound (HIFU) for ablation of two pancreatic neuroendocrine tumours (NETs; insulinomas) in two inoperable young female patients. Both suffered from episodes of severe nightly hypoglycemia that was not efficiently controlled by medical treatment. After HIFU ablation, local disease control and symptom relief were achieved without postinterventional complications. The patients remained free of symptoms during 9-month follow-up. The lesions appeared to be decreased in volume, and there was decreased enhancing pattern in the multidetector computed tomography control (MDCT). HIFU is likely to be a valid alternative for symptoms control in patients with pancreaticmore » NETs. However, currently the procedure should be reserved for inoperable patients for whom symptoms cannot be controlled by medical therapy.« less
  • Within the group of Gastro-Entero-Pancreatic Neuroendocrine tumours (GEP-NETs), several heterogeneous malignancies are included with a variety of clinical manifestations and imaging characteristics. Often these cases are inoperable and minimal invasive treatment offered by image-guided procedures appears to be the only option. Interventional radiology offers a valid solution in the management of primary and metastatic GEP-NETs. The purpose of this review article is to describe the current status of the role of Interventional Radiology in the management of GEP-NETs.
  • During the past 6 years, we have performed approximately 300 scans for neuroendocrine tumors in an extremely varied patient base, with 65% of patients receiving I-123 mIBG and 35%, I-131 mIBG. Imaging was performed at 24-72 hr, depending upon the isotope used. The most common clinical indication was for pheochromocytoma (>90%), followed by neuroblastoma, paraganglioma, medullary carcinoma of the thyroid, and carcinoid tumors. Radiolabeling was performed by a modification of Mock`s procedure. The radioiodide was added to a very stable {open_quotes}cold kit{close_quotes} developed in-house. The kit contains 1 ml of water for injection, 2 mg of mIBG hemisulfate, and 12more » mg of ammonium sulfate. After 2 heating cycles, a yield >85% and a radiochemical purity {>=}96% were routinely obtained. Overall preparation time, including determination of radiochemical purity, is approximately 2.5 hr. The only equipment required is a thermostatically controlled block heater. Biodistribution of our I-131 product was indistinguishable from that distributed by the Nuclear Pharmacy at the University of Michigan, as was the radiochemical purity; the diagnostic efficacy matched that reported in the literature. The image quality obtained using I-123 mIBG was definitely superior, due to both the much higher count rate and the ideal imaging energy of I-123. On one occasion, the I-131 scan was equivocal, whereas the I-123 scan in the same patient was clearly positive. Retrospectively, for studies performed with I-123 mIBG using the {open_quotes}cold kit{close_quotes} method, the specificity and sensitivity both exceed 90%, correlating well with multiple studies reported in the literature. The preparation of I-123 mIBG in-house using this technique is recommended.« less