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Single- versus Multifraction Stereotactic Body Radiation Therapy for Pancreatic Adenocarcinoma: Outcomes and Toxicity.

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Title: Single- versus Multifraction Stereotactic Body Radiation Therapy for Pancreatic Adenocarcinoma: Outcomes and Toxicity.
Authors: Pollom, Erqi L.1, Alagappan, Muthuraman1, von Eyben, Rie1, Kunz, Pamela L.2, Fisher, George A.2, Ford, James A.2, Poultsides, George A.3, Visser, Brendan C.3, Norton, Jeffrey A.3, Kamaya, Aya4, Cox, Veronica L.4, Columbo, Laurie A.1, Koong, Albert C.1, Chang, Daniel T.1 dtchang@stanford.edu
Source: International Journal of Radiation Oncology, Biology, Physics. Nov2014, Vol. 90 Issue 4, p918-925. 8p.
Subjects: Stereotactic radiotherapy, Pancreatic cancer treatment, Cancer chemotherapy, Pancreatic cancer diagnosis, Disease incidence, Health outcome assessment
Abstract: Purpose We report updated outcomes of single- versus multifraction stereotactic body radiation therapy (SBRT) for unresectable pancreatic adenocarcinoma. Methods and Materials We included 167 patients with unresectable pancreatic adenocarcinoma treated at our institution from 2002 to 2013, with 1-fraction (45.5% of patient) or 5-fraction (54.5% of patients) SBRT. The majority of patients (87.5%) received chemotherapy. Results Median follow-up was 7.9 months (range: 0.1-63.6). The 6- and 12-month cumulative incidence rates (CIR) of local recurrence for patients treated with single-fraction SBRT were 5.3% (95% confidence interval [CI], 0.2%-10.4%) and 9.5% (95% CI, 2.7%-16.2%), respectively. The 6- and 12-month CIR with multifraction SBRT were 3.4% (95% CI, 0.0-7.2%) and 11.7% (95% CI, 4.8%-18.6%), respectively. Median survival from diagnosis for all patients was 13.6 months (95% CI, 12.2-15.0 months). The 6- and 12- month survival rates from SBRT for the single-fraction group were 67.0% (95% CI, 57.2%-78.5%) and 30.8% (95% CI, 21.9%-43.6%), respectively. The 6- and 12- month survival rates for the multifraction group were 75.7% (95% CI, 67.2%-85.3%) and 34.9% (95% CI, 26.1%-46.8%), respectively. There were no differences in CIR or survival rates between the single- and multifraction groups. The 6- and 12-month cumulative incidence rates of gastrointestinal toxicity grade ≥3 were 8.1% (95% CI, 1.8%-14.4%) and 12.3% (95% CI, 4.7%-20.0%), respectively, in the single-fraction group, and both were 5.6% (95% CI, 0.8%-10.5%) in the multifraction group. There were significantly fewer instances of toxicity grade ≥2 with multifraction SBRT ( P =.005). Local recurrence and toxicity grade ≥2 were independent predictors of worse survival. Conclusions Multifraction SBRT for pancreatic cancer significantly reduces gastrointestinal toxicity without compromising local control. [ABSTRACT FROM AUTHOR]
Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Single- versus Multifraction Stereotactic Body Radiation Therapy for Pancreatic Adenocarcinoma: Outcomes and Toxicity.
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  Data: <searchLink fieldCode="AR" term="%22Pollom%2C+Erqi+L%2E%22">Pollom, Erqi L.</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Alagappan%2C+Muthuraman%22">Alagappan, Muthuraman</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22von+Eyben%2C+Rie%22">von Eyben, Rie</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Kunz%2C+Pamela+L%2E%22">Kunz, Pamela L.</searchLink><relatesTo>2</relatesTo><br /><searchLink fieldCode="AR" term="%22Fisher%2C+George+A%2E%22">Fisher, George A.</searchLink><relatesTo>2</relatesTo><br /><searchLink fieldCode="AR" term="%22Ford%2C+James+A%2E%22">Ford, James A.</searchLink><relatesTo>2</relatesTo><br /><searchLink fieldCode="AR" term="%22Poultsides%2C+George+A%2E%22">Poultsides, George A.</searchLink><relatesTo>3</relatesTo><br /><searchLink fieldCode="AR" term="%22Visser%2C+Brendan+C%2E%22">Visser, Brendan C.</searchLink><relatesTo>3</relatesTo><br /><searchLink fieldCode="AR" term="%22Norton%2C+Jeffrey+A%2E%22">Norton, Jeffrey A.</searchLink><relatesTo>3</relatesTo><br /><searchLink fieldCode="AR" term="%22Kamaya%2C+Aya%22">Kamaya, Aya</searchLink><relatesTo>4</relatesTo><br /><searchLink fieldCode="AR" term="%22Cox%2C+Veronica+L%2E%22">Cox, Veronica L.</searchLink><relatesTo>4</relatesTo><br /><searchLink fieldCode="AR" term="%22Columbo%2C+Laurie+A%2E%22">Columbo, Laurie A.</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Koong%2C+Albert+C%2E%22">Koong, Albert C.</searchLink><relatesTo>1</relatesTo><br /><searchLink fieldCode="AR" term="%22Chang%2C+Daniel+T%2E%22">Chang, Daniel T.</searchLink><relatesTo>1</relatesTo><i> dtchang@stanford.edu</i>
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  Data: <searchLink fieldCode="JN" term="%22International+Journal+of+Radiation+Oncology%2C+Biology%2C+Physics%22">International Journal of Radiation Oncology, Biology, Physics</searchLink>. Nov2014, Vol. 90 Issue 4, p918-925. 8p.
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  Data: <searchLink fieldCode="DE" term="%22Stereotactic+radiotherapy%22">Stereotactic radiotherapy</searchLink><br /><searchLink fieldCode="DE" term="%22Pancreatic+cancer+treatment%22">Pancreatic cancer treatment</searchLink><br /><searchLink fieldCode="DE" term="%22Cancer+chemotherapy%22">Cancer chemotherapy</searchLink><br /><searchLink fieldCode="DE" term="%22Pancreatic+cancer+diagnosis%22">Pancreatic cancer diagnosis</searchLink><br /><searchLink fieldCode="DE" term="%22Disease+incidence%22">Disease incidence</searchLink><br /><searchLink fieldCode="DE" term="%22Health+outcome+assessment%22">Health outcome assessment</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Purpose We report updated outcomes of single- versus multifraction stereotactic body radiation therapy (SBRT) for unresectable pancreatic adenocarcinoma. Methods and Materials We included 167 patients with unresectable pancreatic adenocarcinoma treated at our institution from 2002 to 2013, with 1-fraction (45.5% of patient) or 5-fraction (54.5% of patients) SBRT. The majority of patients (87.5%) received chemotherapy. Results Median follow-up was 7.9 months (range: 0.1-63.6). The 6- and 12-month cumulative incidence rates (CIR) of local recurrence for patients treated with single-fraction SBRT were 5.3% (95% confidence interval [CI], 0.2%-10.4%) and 9.5% (95% CI, 2.7%-16.2%), respectively. The 6- and 12-month CIR with multifraction SBRT were 3.4% (95% CI, 0.0-7.2%) and 11.7% (95% CI, 4.8%-18.6%), respectively. Median survival from diagnosis for all patients was 13.6 months (95% CI, 12.2-15.0 months). The 6- and 12- month survival rates from SBRT for the single-fraction group were 67.0% (95% CI, 57.2%-78.5%) and 30.8% (95% CI, 21.9%-43.6%), respectively. The 6- and 12- month survival rates for the multifraction group were 75.7% (95% CI, 67.2%-85.3%) and 34.9% (95% CI, 26.1%-46.8%), respectively. There were no differences in CIR or survival rates between the single- and multifraction groups. The 6- and 12-month cumulative incidence rates of gastrointestinal toxicity grade ≥3 were 8.1% (95% CI, 1.8%-14.4%) and 12.3% (95% CI, 4.7%-20.0%), respectively, in the single-fraction group, and both were 5.6% (95% CI, 0.8%-10.5%) in the multifraction group. There were significantly fewer instances of toxicity grade ≥2 with multifraction SBRT ( P =.005). Local recurrence and toxicity grade ≥2 were independent predictors of worse survival. Conclusions Multifraction SBRT for pancreatic cancer significantly reduces gastrointestinal toxicity without compromising local control. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: <i>Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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