Resected Pancreatic Neuroendocrine Tumors: Patterns of Failure and Disease-Related Outcomes With or Without Radiotherapy

Journal Article · Sun Jul 15 04:00:00 EDT 2012 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2011.09.041· OSTI ID:22058949

Zagar, Timothy M ^[1]; White, Rebekah R ^[2]; Willett, Christopher G ^[3]; Tyler, Douglas S ^[2]; Papavassiliou, Paulie ^[4]; Papalezova, Katia T ^[2]; Guy, Cynthia D ^[4]; Broadwater, Gloria ^[5]; Clough, Robert W ^[3]

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1. Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC (United States)
2. Department of Surgery, Duke University Medical Center, Durham, NC (United States)
3. Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States)
4. Department of Pathology, Duke University Medical Center, Durham, NC (United States)
5. Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC (United States)

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 while 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.

• OSTI ID: 22058949
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 4 Vol. 83; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
CARCINOMAS
CHEMOTHERAPY
FAILURES
HEAD
METASTASES
MORTALITY
NECK
PANCREAS
PATIENTS
RADIATION DOSES
RADIOTHERAPY
SURGERY