Stereotactic body radiotherapy for pancreatic cancer - A systematic review of prospective data

Mohamed A Shouman; Frederik Fuchs; Franziska Walter; Stefanie Corradini; C Benedikt Westphalen; Marlies Vornhülz; Georg Beyer; Dorian Andrade; Claus Belka; Maximilian Niyazi; Paul Rogowski

doi:10.1016/j.ctro.2024.100738

Stereotactic body radiotherapy for pancreatic cancer - A systematic review of prospective data

Clin Transl Radiat Oncol. 2024 Jan 28:45:100738. doi: 10.1016/j.ctro.2024.100738. eCollection 2024 Mar.

Authors

Mohamed A Shouman^{1

2}, Frederik Fuchs¹, Franziska Walter¹, Stefanie Corradini¹, C Benedikt Westphalen³, Marlies Vornhülz^{2

4}, Georg Beyer^{2

4}, Dorian Andrade⁵, Claus Belka^{1

2

6}, Maximilian Niyazi^{1

7

8}, Paul Rogowski¹

Affiliations

¹ Department of Radiation Oncology, University Hospital LMU, Munich, Germany.
² Bavarian Cancer Research Center (BZKF), Munich, Germany.
³ Department of Medicine III and Comprehensive Cancer Center (CCC Munich LMU), University Hospital LMU, Munich, Germany.
⁴ Department of Internal Medicine II, LMU University Hospital, Munich, Germany.
⁵ Department of General, Visceral, and Transplant Surgery, University Hospital LMU, Munich, Germany.
⁶ German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.
⁷ Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany.
⁸ German Cancer Consortium (DKTK), Partner Site Tübingen, Germany.

Abstract

Purpose: This systematic review aims to comprehensively summarize the current prospective evidence regarding Stereotactic Body Radiotherapy (SBRT) in various clinical contexts for pancreatic cancer including its use as neoadjuvant therapy for borderline resectable pancreatic cancer (BRPC), induction therapy for locally advanced pancreatic cancer (LAPC), salvage therapy for isolated local recurrence (ILR), adjuvant therapy after radical resection, and as a palliative treatment. Special attention is given to the application of magnetic resonance-guided radiotherapy (MRgRT).

Methods: Following PRISMA guidelines, a systematic review of the Medline database via PubMed was conducted focusing on prospective studies published within the past decade. Data were extracted concerning study characteristics, outcome measures, toxicity profiles, SBRT dosage and fractionation regimens, as well as additional systemic therapies.

Results and conclusion: 31 studies with in total 1,571 patients were included in this review encompassing 14 studies for LAPC, 9 for neoadjuvant treatment, 2 for adjuvant treatment, 2 for ILR, with an additional 4 studies evaluating MRgRT. In LAPC, SBRT demonstrates encouraging results, characterized by favorable local control rates. Several studies even report conversion to resectable disease with substantial resection rates reaching 39%. The adoption of MRgRT may provide a solution to the challenge to deliver ablative doses while minimizing severe toxicities. In BRPC, select prospective studies combining preoperative ablative-dose SBRT with modern induction systemic therapies have achieved remarkable resection rates of up to 80%. MRgRT also holds potential in this context. Adjuvant SBRT does not appear to confer relevant advantages over chemotherapy. While prospective data for SBRT in ILR and for palliative pain relief are limited, they corroborate positive findings from retrospective studies.

Keywords: BRPC; LAPC; PDAC; Pancreatic cancer; Radiotherapy; SBRT; SMART; local recurrence, MRgRT.