Salvage ablative radiotherapy for isolated local recurrence of pancreatic adenocarcinoma following definitive surgery Journal Article


Authors: Dee, E. C.; Ng, V. C.; O’Reilly, E. M.; Wei, A. C.; Lobaugh, S. M.; Varghese, A. M.; Zinovoy, M.; Romesser, P. B.; Wu, A. J.; Hajj, C.; Cuaron, J. J.; Khalil, D. N.; Park, W.; Yu, K. H.; Zhang, Z.; Drebin, J. A.; Jarnagin, W. R.; Crane, C. H.; Reyngold, M.
Article Title: Salvage ablative radiotherapy for isolated local recurrence of pancreatic adenocarcinoma following definitive surgery
Abstract: Introduction: The rate of isolated locoregional recurrence after surgery for pancreatic adenocarcinoma (PDAC) approaches 25%. Ablative radiation therapy (A-RT) has improved outcomes for locally advanced disease in the primary setting. We sought to evaluate the outcomes of salvage A-RT for isolated locoregional recurrence and examine the relationship between subsequent patterns of failure, radiation dose, and treatment volume. Methods: We conducted a retrospective analysis of all consecutive participants who underwent A-RT for an isolated locoregional recurrence of PDAC after prior surgery at our institution between 2016 and 2021. Treatment consisted of ablative dose (BED10 98–100 Gy) to the gross disease with an additional prophylactic low dose (BED10 < 50 Gy), with the elective volume covering a 1.5 cm isotropic expansion around the gross disease and the circumference of the involved vessels. Local and locoregional failure (LF and LRF, respectively) estimated by the cumulative incidence function with competing risks, distant metastasis-free and overall survival (DMFS and OS, respectively) estimated by the Kaplan–Meier method, and toxicities scored by CTCAE v5.0 are reported. Location of recurrence was mapped to the dose region on the initial radiation plan. Results: Among 65 participants (of whom two had two A-RT courses), the median age was 67 (range 37–87) years, 36 (55%) were male, and 53 (82%) had undergone pancreaticoduodenectomy with a median disease-free interval to locoregional recurrence of 16 (range, 6–71) months. Twenty-seven participants (42%) received chemotherapy prior to A-RT. With a median follow-up of 35 months (95%CI, 26–56 months) from diagnosis of recurrence, 24-month OS and DMFS were 57% (95%CI, 46–72%) and 22% (95%CI, 14–37%), respectively, while 24-month cumulative incidence of in-field LF and total LRF were 28% (95%CI, 17–40%) and 36% (95%CI 24–48%), respectively. First failure after A-RT was distant in 35 patients (53.8%), locoregional in 12 patients (18.5%), and synchronous distant and locoregional in 10 patients (15.4%). Most locoregional failures occurred in elective low-dose volumes. Acute and chronic grade 3–4 toxicities were noted in 1 (1.5%) and 5 patients (7.5%), respectively. Conclusions: Salvage A-RT achieves favorable OS and local control outcomes in participants with an isolated locoregional recurrence of PDAC after surgical resection. Consideration should be given to extending high-dose fields to include adjacent segments of at-risk vessels beyond direct contact with the gross disease. © 2024 by the authors.
Keywords: adult; controlled study; human tissue; aged; treatment failure; major clinical study; overall survival; fatigue; cancer recurrence; salvage therapy; cisplatin; fluorouracil; diarrhea; gastrointestinal hemorrhage; gemcitabine; paclitaxel; radiation dose; follow up; anorexia; pancreaticoduodenectomy; nausea; retrospective study; distant metastasis; irinotecan; gastrointestinal toxicity; folinic acid; pancreas adenocarcinoma; disease free interval; radiation therapy; pancreatic adenocarcinoma; pancreatic cancer; oxaliplatin; stereotactic body radiation therapy; sbrt; distant metastasis free survival; human; male; female; article; isolated local recurrence; ablative radiation; sabr; a-rt; hypofractionated rt
Journal Title: Journal of Clinical Medicine
Volume: 13
Issue: 9
ISSN: 2077-0383
Publisher: MDPI  
Date Published: 2024-05-01
Start Page: 2631
Language: English
DOI: 10.3390/jcm13092631
PROVIDER: scopus
PMCID: PMC11084663
PUBMED: 38731159
DOI/URL:
Notes: Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PubMed and PDF -- MSK corresponding author is Marsha Reyngold -- Source: Scopus
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MSK Authors
  1. Melissa Remis Zinovoy
    50 Zinovoy
  2. Zhigang Zhang
    431 Zhang
  3. Anna Mary Varghese
    146 Varghese
  4. Kenneth Ho-Ming Yu
    165 Yu
  5. William R Jarnagin
    910 Jarnagin
  6. Marsha Reyngold
    104 Reyngold
  7. Abraham Jing-Ching Wu
    404 Wu
  8. Eileen O'Reilly
    793 O'Reilly
  9. Carla Hajj
    165 Hajj
  10. Danny Nejad Khalil
    66 Khalil
  11. Paul Bernard Romesser
    194 Romesser
  12. John Jacob Cuaron
    143 Cuaron
  13. Christopher   Crane
    205 Crane
  14. Jeffrey Adam Drebin
    168 Drebin
  15. Wungki Park
    99 Park
  16. Alice Chia-Chi Wei
    207 Wei
  17. Stephanie Marie Lobaugh
    57 Lobaugh
  18. Victor C Ng
    11 Ng
  19. Edward Christopher Dee
    285 Dee