Stereotactic Body Radiotherapy (SBRT) Reirradiation for Recurrent Pancreas Cancer

Objectives: After adjuvant or definitive radiation for pancreas cancer, there are limited conventional treatment options for recurrent pancreas cancer. We explored the role of (Stereotactic Body Radiotherapy) SBRT for reirradiation of recurrent pancreas Cancer. Methods: This is a retrospective study of patients reirradiated with SBRT for recurrent pancreas cancer. All patients were deemed unresectable and treated with systemic therapy. Fiducial gold markers were used. CT simulation was performed with oral and IV contrast and patients were treated with respiratory motion tracking in the CyberknifeTM system. Results: 30 patients (17 men and 13 women) with a median age of 67 years were included in the study. The median target volume was 41.29cc. The median prescription dose was 25Gy (24-36Gy) in a median of 5 fractions prescribed to a mean 78% isodose line. The median overall survival was 14 months. The 1 and 2 year local control was 78%. The worst toxicity included 3/30(10%) Grade III acute toxicity for pain, bleeding and vomiting. There was 2/30 (7%) Grade III long-term bowel obstructions. Conclusions: SBRT can be a useful and tolerable option for patients with recurrent pancreas cancer after prior radiation.

[1]  T. Chiba,et al.  Comparative Outcomes Between Initially Unresectable and Recurrent Cases of Advanced Pancreatic Cancer Following Palliative Chemotherapy , 2014, Pancreas.

[2]  M. Yoshimura,et al.  Radiotherapy for patients with isolated local recurrence of primary resected pancreatic cancer , 2014, Strahlentherapie und Onkologie.

[3]  M. Miyazaki,et al.  Repeat pancreatectomy for pancreatic ductal cancer recurrence in the remnant pancreas after initial pancreatectomy: is it worthwhile? , 2014, Surgery.

[4]  S. Gill,et al.  Chemotherapy regimens for advanced pancreatic cancer: a systematic review and network meta-analysis , 2014, BMC Cancer.

[5]  P. Bondiau,et al.  Multi institutional phase II study of concomitant stereotactic reirradiation and cetuximab for recurrent head and neck cancer. , 2013, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[6]  Shidong Li,et al.  Repeat stereotactic body radiation therapy for patients with pulmonary malignancies who had previously received SBRT to the same or an adjacent tumor site. , 2013, Journal of cancer research and therapeutics.

[7]  Seung June Lee,et al.  5-Fluorouracil/Leucovorin Combined with Irinotecan and Oxaliplatin (FOLFIRINOX) as Second-Line Chemotherapy in Patients with Advanced Pancreatic Cancer Who Have Progressed on Gemcitabine-Based Therapy , 2013, Chemotherapy.

[8]  P. Patel,et al.  Reirradiation for recurrent head and neck cancer , 2012, Expert review of anticancer therapy.

[9]  N. Nasr,et al.  Stereotactic body radiation therapy for reirradiation of localized adenocarcinoma of the pancreas , 2012, Radiation oncology.

[10]  J. Sanabria,et al.  Stereotactic body radiation therapy for nonresectable tumors of the pancreas. , 2012, The Journal of surgical research.

[11]  E. Kasper,et al.  Stereotactic body radiotherapy reirradiation for recurrent epidural spinal metastases. , 2011, International journal of radiation oncology, biology, physics.

[12]  G. Papageorgiou,et al.  Local recurrence of pancreatic cancer after primary surgical intervention: how to deal with this devastating scenario? , 2011, Surgical oncology.

[13]  Tara Kent,et al.  Induction gemcitabine and stereotactic body radiotherapy for locally advanced nonmetastatic pancreas cancer. , 2011, International journal of radiation oncology, biology, physics.

[14]  Pierre Michel,et al.  FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. , 2011, The New England journal of medicine.

[15]  Dwight E Heron,et al.  Stereotactic Body Radiotherapy in the Treatment of Advanced Adenocarcinoma of the Pancreas , 2011, American journal of clinical oncology.

[16]  D. Pleskow,et al.  Stereotactic body radiotherapy and gemcitabine for locally advanced pancreatic cancer. , 2010, International journal of radiation oncology, biology, physics.

[17]  L. Collette,et al.  Adjuvant gemcitabine alone versus gemcitabine-based chemoradiotherapy after curative resection for pancreatic cancer: a randomized EORTC-40013-22012/FFCD-9203/GERCOR phase II study. , 2010, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[18]  N. Neerchal,et al.  Image-Guided Stereotactic Radiosurgery for Locally Advanced Pancreatic Adenocarcinoma Results of First 85 Patients , 2010, Journal of Gastrointestinal Surgery.

[19]  A. Rosemurgy,et al.  The Natural History of Resected Pancreatic Cancer without Adjuvant Chemotherapy , 2010, The American surgeon.

[20]  Mi-Sook Kim,et al.  Stereotactic body radiation therapy boost in locally advanced pancreatic cancer. , 2009, International journal of radiation oncology, biology, physics.

[21]  H. Ueno,et al.  Do Recurrent and Metastatic Pancreatic Cancer Patients Have the Same Outcomes with Gemcitabine Treatment? , 2009, Oncology.

[22]  B. Topal,et al.  Patterns of recurrence after curative resection of pancreatic ductal adenocarcinoma. , 2009, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[23]  Daniel T Chang,et al.  Stereotactic radiotherapy for unresectable adenocarcinoma of the pancreas , 2009, Cancer.

[24]  A. Piccoli,et al.  Recurrence after resection for ductal adenocarcinoma of the pancreas , 1997, World Journal of Surgery.

[25]  P. Bachellier,et al.  Surgery for Recurrence of Periampullary Malignancies , 2009, Journal of Gastrointestinal Surgery.

[26]  R. Abrams,et al.  Fluorouracil vs gemcitabine chemotherapy before and after fluorouracil-based chemoradiation following resection of pancreatic adenocarcinoma: a randomized controlled trial. , 2008, JAMA.

[27]  K. Lillemoe,et al.  Pancreatic cancer--progress made. , 2007, Journal of the American College of Surgeons.

[28]  H. Friess,et al.  Surgery for Recurrent Pancreatic Ductal Adenocarcinoma , 2007, Annals of surgery.

[29]  Peter Neuhaus,et al.  Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. , 2007, JAMA.

[30]  E. Dühmke,et al.  Combined chemoradiotherapy for isolated local recurrence after primary resection of pancreatic cancer. , 2005, JOP : Journal of the pancreas.

[31]  Quynh-Thu Le,et al.  Phase II study to assess the efficacy of conventionally fractionated radiotherapy followed by a stereotactic radiosurgery boost in patients with locally advanced pancreatic cancer. , 2005, International journal of radiation oncology, biology, physics.

[32]  H. von der Maase,et al.  Phase-II study on stereotactic radiotherapy of locally advanced pancreatic carcinoma. , 2005, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[33]  Helen Hickey,et al.  A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. , 2004, The New England journal of medicine.

[34]  Albert C Koong,et al.  Phase I study of stereotactic radiosurgery in patients with locally advanced pancreatic cancer. , 2004, International journal of radiation oncology, biology, physics.

[35]  D. V. Von Hoff,et al.  Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancer: a randomized trial. , 1997, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[36]  N. Dubrawsky.  Cancer statistics , 1989, CA: a cancer journal for clinicians.

[37]  M. Kalser,et al.  Further evidence of effective adjuvant combined radiation and chemotherapy following curative resection of pancreatic cancer , 1987, Cancer.