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Int J Radiat Oncol Biol Phys. 2014 Nov 15;90(4):918-25. doi: 10.1016/j.ijrobp.2014.06.066. Epub 2014 Oct 18.

Single- versus multifraction stereotactic body radiation therapy for pancreatic adenocarcinoma: outcomes and toxicity.

Author information

1
Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.
2
Department of Medicine, Stanford University School of Medicine, Stanford, California.
3
Department of Surgery, Stanford University School of Medicine, Stanford, California.
4
Department of Radiology, Stanford University School of Medicine, Stanford, California.
5
Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California. Electronic address: dtchang@stanford.edu.

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.

PMID:
25585785
DOI:
10.1016/j.ijrobp.2014.06.066
[Indexed for MEDLINE]

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