Association of ablative radiation therapy with survival among patients with inoperable pancreatic cancer Journal Article

Authors: Reyngold, M.; O'Reilly, E. M.; Varghese, A. M.; Fiasconaro, M.; Zinovoy, M.; Romesser, P. B.; Wu, A.; Hajj, C.; Cuaron, J. J.; Tuli, R.; Hilal, L.; Khalil, D.; Park, W.; Yorke, E. D.; Zhang, Z.; Yu, K. H.; Crane, C. H.
Article Title: Association of ablative radiation therapy with survival among patients with inoperable pancreatic cancer
Abstract: IMPORTANCE Surgical resection has been considered the only curative option for patients with pancreatic cancer. Nonoperative local treatment options that can provide a similar benefit are needed. Emerging radiation techniques that address organ motion have enabled curative radiation doses to be given in patients with inoperable disease. OBJECTIVE To determine the association of hypofractionated ablative radiation therapy (A-RT) with survival for patients with locally advanced pancreatic cancer (LAPC) treated with a novel radiation planning and delivery technique. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 119 consecutive patients treated with A-RT between June 2016 and February 2019 and enrolled in a prospectively maintained database. Patients were treated with a standardized technique within a large academic cancer center regional network. All patients with localized, unresectable, or medically inoperable pancreatic cancer with tumors of any size and less than 5 cm luminal abutment with the primary tumor were eligible. INTERVENTIONS Ablative RT (98 Gy biologically effective dose) was delivered using standard equipment. Respiratory gating, soft tissue image guidance, and selective adaptive planning were used to address organ motion and limit the dose to surrounding luminal organs. MAIN OUTCOMES AND MEASURES The primary outcome was overall survival (OS). Secondary outcomes included incidence of local progression and progression-free survival. RESULTS Between 2016 and 2019, 119 patients (59 men, median age 67 years) received A-RT, including 99 with T3/T4 and 53 with node-positive disease, with a median carbohydrate antigen 19-9 (CA19-9) level greater than 167 U/mL. Most (116 [97.5%]) received induction chemotherapy for a median of 4 months (0.5-18.4). Median OS from diagnosis and A-RT were 26.8 and 18.4 months, respectively. Respective 12- and 24-month OS from A-RT were 74% (95% CI, 66%-83%) and 38% (95% CI, 27%-52%). Twelve- and 24-month cumulative incidence of locoregional failure were 17.6% (95% CI, 10.4%-24.9%) and 32.8% (95% CI, 21.6%-44.1%), respectively. Postinduction CA19-9 decline was associated with improved locoregional control and survival. Grade 3 upper gastrointestinal bleeding occurred in 10 patients (8%) with no grade 4 to 5 events. CONCLUSIONS AND RELEVANCE This cohort study of patients with inoperable LAPC found that A-RT following multiagent induction therapy for LAPC was associated with durable locoregional tumor control and favorable survival. Prospective randomized trials in patients with LAPC are warranted. © 2021 American Medical Association.
Keywords: adult; cancer survival; aged; major clinical study; overall survival; fluorouracil; gastrointestinal hemorrhage; gemcitabine; paclitaxel; cancer radiotherapy; pancreas cancer; cancer staging; prospective study; tumor volume; ca 19-9 antigen; cohort analysis; irinotecan; cancer center; disease severity; folinic acid; inoperable cancer; cancer control; oxaliplatin; fluoropyrimidine; induction chemotherapy; respiratory gated imaging; hypofractionated radiotherapy; human; male; female; article; local progression free survival
Journal Title: JAMA Oncology
Volume: 7
Issue: 5
ISSN: 2374-2437
Publisher: American Medical Association  
Date Published: 2021-05-01
Start Page: 735
End Page: 738
Language: English
DOI: 10.1001/jamaoncol.2021.0057
PUBMED: 33704353
PROVIDER: scopus
PMCID: PMC7953335
Notes: Article -- Export Date: 1 July 2021 -- Source: Scopus
Citation Impact
MSK Authors
  1. Melissa Remis Zinovoy
    14 Zinovoy
  2. Zhigang Zhang
    317 Zhang
  3. Kenneth Ho-Ming Yu
    124 Yu
  4. Marsha Laufer
    45 Laufer
  5. Abraham Jing-Ching Wu
    279 Wu
  6. Ellen D Yorke
    385 Yorke
  7. Eileen O'Reilly
    518 O'Reilly
  8. Carla Hajj
    47 Hajj
  9. Danny Nejad Khalil
    29 Khalil
  10. John Jacob Cuaron
    65 Cuaron
  11. Christopher   Crane
    94 Crane
  12. Wungki Park
    26 Park
  13. Richard Tuli
    23 Tuli
  14. Lara Hilal
    5 Hilal