Single-fraction stereotactic body radiation therapy and sequential gemcitabine for the treatment of locally advanced pancreatic cancer Journal Article
| Authors: | Schellenberg, D.; Kim, J.; Christman-Skieller, C.; Chun, C. L.; Columbo, L. A.; Ford, J. M.; Fisher, G. A.; Kunz, P. L.; Van Dam, J.; Quon, A.; Desser, T. S.; Norton, J.; Hsu, A.; Maxim, P. G.; Xing, L.; Goodman, K. A.; Chang, D. T.; Koong, A. C. |
| Article Title: | Single-fraction stereotactic body radiation therapy and sequential gemcitabine for the treatment of locally advanced pancreatic cancer |
| Abstract: | 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. Copyright © 2011 Elsevier Inc. |
| Keywords: | adult; cancer chemotherapy; cancer survival; clinical article; aged; survival rate; overall survival; drug tolerability; advanced cancer; cancer growth; drug dose reduction; gemcitabine; radiation dose; chemotherapy; follow up; prospective study; progression free survival; computer assisted tomography; multiple cycle treatment; pain; phase 2 clinical trial; nausea; radiotherapy; patient monitoring; survival time; feasibility study; intensity-modulated radiotherapy; computerized tomography; tomography; stomach ulcer; pancreas adenocarcinoma; pancreatic adenocarcinoma; local control; pancreatic cancer; stereotactic body radiotherapy; toxicity; stereotactic body radiation therapy; phase ii; diseases; median survival; computed tomography; breathing motions; breathing; image-guided radiotherapy; image guided radiotherapy; internal target volume; nonhematologic toxicity; pancreatic cancers; respiratory gatings; linear accelerators; duodenum perforation |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 81 |
| Issue: | 1 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2011-09-01 |
| Start Page: | 181 |
| End Page: | 188 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2010.05.006 |
| PROVIDER: | scopus |
| PUBMED: | 21549517 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 3 October 2011" - "CODEN: IOBPD" - "Source: Scopus" |
