Single-Fraction Stereotactic Body Radiation Therapy and Sequential Gemcitabine for the Treatment of Locally Advanced Pancreatic Cancer

Journal Article · Thu Sep 01 00:00:00 EDT 2011 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2010.05.006· OSTI ID:21587713

Schellenberg, Devin ^[1]; Kim, Jeff; Christman-Skieller, Claudia; Chun, Carlene L; Columbo, Laurie Ann ^[2]; Ford, James M; Fisher, George A; Kunz, Pamela L ^[3]; Van Dam, Jacques ^[4]; Quon, Andrew; Desser, Terry S ^[5]; Norton, Jeffrey ^[6]; Hsu, Annie; Maxim, Peter G; Xing, Lei ^[2]; Goodman, Karyn A ^[7]; Chang, Daniel T ^[2]

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1. Department of Radiation Oncology, BC Cancer Agency, Surrey, British Columbia (Canada)
2. Department of Radiation Oncology, Stanford Cancer Center, Stanford, CA (United States)
3. Department of Medicine, Division of Medical Oncology, Stanford Cancer Center, Stanford, CA (United States)
4. Department of Medicine, Division of Gastroenterology, Stanford Cancer Center, Stanford, CA (United States)
5. Department of Radiology, Stanford Cancer Center, Stanford, CA (United States)
6. Department of Surgery, Division of General Surgery, Stanford Cancer Center, Stanford, CA (United States)
7. Department of Radiation Oncology, Memorial Sloan Kettering, New York, NY (United States)

Purpose: This Phase II trial evaluated the toxicity, local control, and overall survival in patients treated with sequential gemcitabine and linear accelerator-based single-fraction stereotactic body radiotherapy (SBRT). Methods and Materials: Twenty patients with locally advanced, nonmetastatic pancreatic adenocarcinoma were enrolled on this prospective single-institution, institutional review board-approved study. Gemcitabine was administered on Days 1, 8, and 15, and SBRT on Day 29. Gemcitabine was restarted on Day 43 and continued for 3-5 cycles. SBRT of 25 Gy in a single fraction was delivered to the internal target volume with a 2- 3-mm margin using a nine-field intensity-modulated radiotherapy technique. Respiratory gating was used to account for breathing motion. Follow-up evaluations occurred at 4-6 weeks, 10-12 weeks, and every 3 months after SBRT. Results: All patients completed SBRT and a median of five cycles of chemotherapy. Follow-up for the 2 remaining alive patients was 25.1 and 36.4 months. No acute Grade 3 or greater nonhematologic toxicity was observed. Late Grade 3 or greater toxicities occurred in 1 patient (5%) and consisted of a duodenal perforation (G4). Three patients (15%) developed ulcers (G2) that were medically managed. Overall, median survival was 11.8 months, with 1-year survival of 50% and 2-year survival of 20%. Using serial computed tomography, the freedom from local progression was 94% at 1 year. Conclusion: Linear accelerator-delivered SBRT with sequential gemcitabine resulted in excellent local control of locally advanced pancreatic cancer. Future studies will address strategies for reducing long-term duodenal toxicity associated with SBRT.

• OSTI ID: 21587713
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Vol. 81, Issue 1; Other Information: DOI: 10.1016/j.ijrobp.2010.05.006; PII: S0360-3016(10)00641-3; Copyright (c) 2011 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
• Country of Publication: United States
• Language: English

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RADIOTHERAPY
SMALL INTESTINE
TOXICITY
ULCERS
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