Moningi Shalini, Dholakia Avani S, Raman Siva P, Blackford Amanda, Cameron John L, Le Dung T, De Jesus-Acosta Ana M C, Hacker-Prietz Amy, Rosati Lauren M, Assadi Ryan K, Dipasquale Shirl, Pawlik Timothy M, Zheng Lei, Weiss Matthew J, Laheru Daniel A, Wolfgang Christopher L, Herman Joseph M
Department of Radiation Oncology & Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Ann Surg Oncol. 2015 Jul;22(7):2352-8. doi: 10.1245/s10434-014-4274-5. Epub 2015 Jan 7.
Stereotactic body radiation therapy (SBRT) is a promising option for patients with pancreatic cancer (PCA); however, limited data support its efficacy. This study reviews our institutional experience of SBRT in the treatment of locally advanced (LAPC) and borderline resectable (BRPC) PCA.
Charts of all PCA patients receiving SBRT at our institution from 2010 to 2014 were reviewed. Most patients received pre-SBRT chemotherapy. Primary endpoints included overall survival (OS) and local progression-free survival (LPFS). Patients received a total dose of 25-33 Gy in five fractions.
A total of 88 patients were included in the analysis, 74 with LAPC and 14 with BRPC. The median age at diagnosis was 67.2 years, and median follow-up from date of diagnosis for LAPC and BRPC patients was 14.5 and 10.3 months, respectively. Median OS from date of diagnosis was 18.4 months (LAPC, 18.4 mo; BRPC, 14.4 mo) and median PFS was 9.8 months (95 % CI 8.0-12.3). Acute toxicity was minimal with only three patients (3.4 %) experiencing acute grade ≥3 toxicity. Late grade ≥2 gastrointestinal toxicity was seen in five patients (5.7 %). Of the 19 patients (21.6 %) who underwent surgery, 79 % were LAPC patients and 84 % had margin-negative resections.
Chemotherapy followed by SBRT in patients with LAPC and BRPC resulted in minimal acute and late toxicity. A large proportion of patients underwent surgical resection despite limited radiographic response to therapy. Further refinements in the integration of chemotherapy, SBRT, and surgery might offer additional advancements toward optimizing patient outcomes.
立体定向体部放射治疗（SBRT）是胰腺癌（PCA）患者的一种有前景的治疗选择；然而，支持其疗效的数据有限。本研究回顾了我们机构在局部晚期（LAPC）和边界可切除（BRPC）的PCA患者中应用SBRT的经验。
回顾了2010年至2014年在我们机构接受SBRT的所有PCA患者的病历。大多数患者在SBRT前接受了化疗。主要终点包括总生存期（OS）和局部无进展生存期（LPFS）。患者接受25 - 33 Gy的总剂量，分5次给予。
共有88例患者纳入分析，74例为LAPC患者，14例为BRPC患者。诊断时的中位年龄为67.2岁，LAPC和BRPC患者从诊断日期起的中位随访时间分别为14.5个月和10.3个月。从诊断日期起的中位OS为18.4个月（LAPC，18.4个月；BRPC，14.4个月），中位PFS为9.8个月（95%CI 8.0 - 12.3）。急性毒性极小，仅有3例患者（3.4%）出现急性3级及以上毒性。5例患者（5.7%）出现晚期2级及以上胃肠道毒性。在接受手术的19例患者（21.6%）中，79%为LAPC患者，84%的手术切缘阴性。
LAPC和BRPC患者先化疗后行SBRT导致的急性和晚期毒性极小。尽管对治疗的影像学反应有限，但很大一部分患者接受了手术切除。在化疗、SBRT和手术的联合应用方面进一步优化可能会为改善患者预后带来更多进展。
