Ablative Radiation Therapy Improves survival in pancreatic cancer: JAMA Oncology
Surgical resection has been considered the only curative option for patients with pancreatic cancer. Nonoperative local treatment options that can provide a similar benefit are needed. Emerging radiation techniques that address organ motion have enabled curative radiation doses to be given in patients with inoperable disease.
A recent study on patients with inoperable LAPC found that A-RT following multiagent induction therapy for locally advanced pancreatic cancer was associated with durable locoregional tumor control and favorable survival.The findings have been put forth in JAMA Oncology.
Ablative RT combines stereotactic technology for precise RT delivery with innovative solutions for internal organ motion and radiation science-informed fractionation to achieve an ablative dose to the target while sparing the adjacent luminal gastrointestinal tract.
Researchers undertook the current study to determine the association of hypofractionated ablative radiation therapy (A-RT) with survival for patients with locally advanced pancreatic cancer (LAPC) treated with a novel radiation planning and delivery technique.
This cohort study included 119 consecutive patients treated with A-RT between June 2016 and February 2019 and enrolled in a prospectively maintained database. Patients were treated with a standardized technique within a large academic cancer center regional network. All patients with localized, unresectable, or medically inoperable pancreatic cancer with tumors of any size and less than 5 cm luminal abutment with the primary tumor were eligible. Ablative RT (98 Gy biologically effective dose) was delivered using standard equipment. Respiratory gating, soft tissue image guidance, and selective adaptive planning were used to address organ motion and limit the dose to surrounding luminal organs.
The primary outcome was overall survival (OS). Secondary outcomes included incidence of local progression and progression-free survival.
Data analysis revealed the following facts.
- Between 2016 and 2019, 119 patients (59 men, median age 67 years) received A-RT, including 99 with T3/T4 and 53 with node-positive disease, with a median carbohydrate antigen 19-9 (CA19-9) level greater than 167 U/mL.
- Most (116 [97.5%]) received induction chemotherapy for a median of 4 months (0.5-18.4). Median OS from diagnosis and A-RT were 26.8 and 18.4 months, respectively.
- Respective 12- and 24-month OS from A-RT were 74% (95% CI, 66%-83%) and 38% (95% CI, 27%-52%).
- Twelve- and 24-month cumulative incidence of locoregional failure were 17.6% (95% CI, 10.4%-24.9%) and 32.8% (95% CI, 21.6%-44.1%), respectively.
- Postinduction CA19-9 decline was associated with improved locoregional control and survival. Grade 3 upper gastrointestinal bleeding occurred in 10 patients (8%) with no grade 4 to 5 events.
Observing the results, the team concluded, "Ablative RT (98 Gy BED) following induction systemic therapy for LAPC was safe and associated with durable local tumor control, which could have contributed to a longer survival duration."
For the full article follow the link: 10.1001/jamaoncol.2021.0057
Primary source: JAMA Oncology