Efficacy and Safety of Reirradiation with Stereotactic Body Radiation Therapy for Locally Recurrent Pancreatic Adenocarcinoma

A V Reddy; C S Hill; S Sehgal; J He; L Zheng; J M Herman; J Meyer; A K Narang

doi:10.1016/j.clon.2021.12.014

Efficacy and Safety of Reirradiation with Stereotactic Body Radiation Therapy for Locally Recurrent Pancreatic Adenocarcinoma

Clin Oncol (R Coll Radiol). 2022 Jun;34(6):386-394. doi: 10.1016/j.clon.2021.12.014. Epub 2021 Dec 31.

Authors

A V Reddy¹, C S Hill², S Sehgal², J He³, L Zheng⁴, J M Herman⁵, J Meyer², A K Narang²

Affiliations

¹ Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, Maryland, USA. Electronic address: aredd1990@gmail.com.
² Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, Maryland, USA.
³ Department of Surgery, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, Maryland, USA.
⁴ Department of Oncology, Johns Hopkins University School of Medicine, Sidney Kimmel Cancer Center, Baltimore, Maryland, USA.
⁵ Department of Radiation Oncology, Northwell Health, New Hyde Park, New York, USA.

PMID: 34974972
DOI: 10.1016/j.clon.2021.12.014

Abstract

Aims: The purpose of this study was to report on outcomes of a cohort of patients who were treated with reirradiation with stereotactic body radiation therapy (SBRT) for locally recurrent pancreatic adenocarcinoma.

Materials and methods: Patients treated with SBRT reirradiation for locally recurrent pancreatic adenocarcinoma from December 2009 to April 2020 were included in the study. Descriptive statistics were used to record patient demographics, tumour and treatment characteristics. Kaplan-Meier analysis was used to evaluate overall survival, local progression-free survival (LPFS), distant metastasis-free survival and progression-free survival (PFS).

Results: In total, 27 patients were included in the study. The median follow-up time from local recurrence was 19.7 months (range 4.2-43.1 months). Most patients received five-fraction SBRT (26/27, 96%). The median overall survival after local recurrence treatment was 18.3 months (range 3.0-42.6 months), with 6-month, 1-year and 2-year overall survival rates of 88.5%, 73.1% and 33.6%. The median LPFS after local recurrence treatment was 16.2 months (range 2.3-33.6 months), with 6-month, 1-year and 2-year LPFS rates of 95.8%, 62.9% and 27.2%. Peri-SBRT chemotherapy improved LPFS (median 17.5 versus 8.5 months; P = 0.010) and overall survival (median 19.3 versus 5.5 months; P = 0.049). Tumours ≤ 3 cm in the greatest dimension showed better local control (median LPFS 19.2 versus 10.2 months; P = 0.130). There was one case (4%) of acute grade 3 pain and one case (4%) of late grade 3 gastrointestinal toxicity.

Conclusions: Reirradiation with five-fraction SBRT is safe, but local control remains suboptimal. Patients with smaller tumours experienced improved outcomes, as did patients whose treatment plan included the administration of peri-SBRT chemotherapy.

Keywords: Locally recurrent pancreatic adenocarcinoma; SBRT; pancreatic cancer; reirradiation; stereotactic body radiation therapy.

MeSH terms

Adenocarcinoma* / pathology
Humans
Neoplasm Recurrence, Local / pathology
Pancreatic Neoplasms* / pathology
Pancreatic Neoplasms* / radiotherapy
Radiosurgery* / adverse effects
Radiosurgery* / methods
Re-Irradiation* / adverse effects
Re-Irradiation* / methods
Retrospective Studies