Kamel Randa, Dennis Kristopher, Doody Janice, Pantarotto Jason
Department of Radiation Oncology, UZ Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussel, Belgium.
Department of Radiation Oncology, The Ottawa Hospital, Smyth Road 501, Ottawa, ON K1H 8L6, Canada.
Cancers (Basel). 2023 Jun 1;15(11):3016. doi: 10.3390/cancers15113016.
We studied the dose-local control (LC) relationship in ablative vs. non-ablative radiotherapy in a non-radical treatment setting of "locally advanced pancreatic cancer (LAPC)" by comparing our patients (n = 89) treated with SBRT on the CyberKnife unit vs. conventional radiation between January 2005 and January 2021, and by reviewing the literature. A systematic search was performed leveraging Medline for references on SBRT use in pancreatic cancer without date terms or language restrictions. A total of 3702 references were identified and the search was then repeated in Embase and the Cochrane database. Ultimately, 12 studies were eligible for inclusion, which either compared SBRT to conventional radiation, or SBRT use in dose escalation for primary LAPC in a non-neoadjuvant setting. Our cohort's median overall survival was 152 days (CI 95%, 118-185); including 371 days (CI 95%, 230-511) vs. 126 days (CI 95%, 90-161) favoring SBRT, = 0.004. The median time to local progression was 170 days (48-923) for SBRT vs. 107 days (27-489) for the non-ablative group. In our SBRT patients, no local progressions were seen with BED > 60 Gy. Even when palliating LAPC, SBRT should be considered as an alternative to conventional radiation, especially in patients with a low disease burden. BED ≥ 60-70 Gy offers better local control without increasing toxicity rates. Less local progression may provide a better quality of life to those patients who already have a short life expectancy.
我们通过比较2005年1月至2021年1月期间在射波刀设备上接受立体定向体部放疗（SBRT）的患者（n = 89）与接受传统放疗的患者，并回顾文献，研究了在“局部晚期胰腺癌（LAPC）”的非根治性治疗环境中，消融性放疗与非消融性放疗的剂量-局部控制（LC）关系。利用Medline进行了系统检索，以查找关于胰腺癌中使用SBRT的参考文献，无日期限制和语言限制。共识别出3702篇参考文献，然后在Embase和Cochrane数据库中重复检索。最终，有12项研究符合纳入标准，这些研究要么比较了SBRT与传统放疗，要么在非新辅助治疗环境中比较了SBRT在原发性LAPC剂量递增中的应用。我们队列的中位总生存期为152天（95%置信区间，118 - 185）；其中支持SBRT的为371天（95%置信区间，230 - 511）对比126天（95%置信区间90 - 161），P = 0.004）。SBRT组的局部进展中位时间为170天（48 - 923），非消融组为107天（27 - 489）天。在我们接受SBRT治疗的患者中，生物等效剂量（BED）>60 Gy时未观察到局部进展。即使是缓解LAPC，SBRT也应被视为传统放疗的替代方案，特别是在疾病负担较低的患者中。BED≥60 - 70 Gy可提供更好的局部控制，而不增加毒性发生率。较少的局部进展可能会为那些预期寿命较短的患者提供更好的生活质量
