Department of Radiation Oncology, the University of Texas Southwestern Medical Center, Dallas, Texas.
Department of Surgery, the University of Texas Southwestern Medical Center, Dallas, Texas.
Int J Radiat Oncol Biol Phys. 2022 Nov 15;114(4):792-802. doi: 10.1016/j.ijrobp.2022.07.019. Epub 2022 Jul 24.
The oligometastatic state is observed in patients across many malignancies, with increased recognition regarding improved outcomes after local therapies. However, there is limited data specifically regarding pancreatic ductal adenocarcinoma. We hypothesized that an oligometastatic pancreatic ductal adenocarcinoma (OPanc) phenotype would benefit from stereotactic ablative radiation therapy (SABR) to all active metastatic sites. Here, we report our institutional experience of SABR-treated OPanc to evaluate the feasibility of the approach.
A retrospective review of patients with synchronous or metachronous OPanc (1 to 5 metastases) who received SABR to all active metastatic sites was performed. We identified a comparable group of patients with similar metastatic burden, range of CA19-9 levels, and no progression for at least 5 months who did not receive SABR. We compared overall survival as the primary outcome, and polyprogression-free survival and time off chemotherapy as the secondary exploratory assessments. A third group presenting with stage IV pancreatic ductal adenocarcinoma and more than 5 distant lesions (polymetastatic) was identified to help define expected outcomes after polyprogression.
Our study included 20 patients with OPanc receiving SABR and 21 who did not. SABR was delivered to 38 metastatic tumors. Out of the 20 SABR-treated OPanc patients, 17 (85%) had 6 or more months of time off chemotherapy, compared with 7 patients (33.3%) among the chemotherapy-treated group. Median polyprogression-free survival was 40 and 14 months (hazard ratio = 0.2; 95% confidence interval, 0.07-0.54; P = .0009), and overall survival was 42 and 18 months (hazard ratio = 0.21; 95% confidence interval, 0.08-0.53; P = .0003), for SABR- and chemotherapy-treated cohorts, respectively.
Management of OPanc with SABR as local regional therapy could improve outcomes in a selected population and warrants prospective evaluation.
寡转移状态可见于多种恶性肿瘤患者中，人们越来越认识到局部治疗后可改善预后。然而，专门针对胰腺导管腺癌的数据有限。我们假设，具有寡转移胰腺导管腺癌（OPanc）表型的患者将从所有活性转移部位的立体定向消融放疗（SABR）中获益。在此，我们报告了我们机构治疗 OPanc 的 SABR 经验，以评估该方法的可行性。
对接受 SABR 治疗所有活性转移部位的同步或异时性 OPanc（1-5 个转移灶）患者进行回顾性研究。我们确定了一组具有相似转移负担、CA19-9 水平范围和至少 5 个月无进展的可比患者，他们未接受 SABR。我们将总生存期作为主要结局，将多进展无进展生存期和化疗停药时间作为次要探索性评估进行比较。为了帮助定义多进展后预期的结果，还确定了第三组表现为 IV 期胰腺导管腺癌且远处转移灶超过 5 个（多发转移）的患者。
我们的研究包括 20 例接受 SABR 治疗的 OPanc 患者和 21 例未接受 SABR 治疗的患者。SABR 用于治疗 38 个转移灶。在 20 例接受 SABR 治疗的 OPanc 患者中，17 例（85%）有 6 个月或更长时间的化疗停药，而化疗组中仅有 7 例（33.3%）。多进展无进展生存期分别为 40 个月和 14 个月（风险比为 0.2；95%置信区间，0.07-0.54；P=.0009），总生存期分别为 42 个月和 18 个月（风险比为 0.21；95%置信区间，0.08-0.53；P=.0003），分别为 SABR 治疗组和化疗治疗组。
采用 SABR 作为局部区域治疗管理 OPanc 可能会改善特定人群的预后，值得进行前瞻性评估。
Zotero 插件