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Strahlenther Onkol. 2017 Jun;193(6):433-443. doi: 10.1007/s00066-017-1099-8. Epub 2017 Jan 30.

Stereotactic body radiotherapy (SBRT) in recurrent or oligometastatic pancreatic cancer : A toxicity review of simultaneous integrated protection (SIP) versus conventional SBRT.

Author information

1
Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Str. 3, 79106, Freiburg im Breisgau, Germany. eleni.gkika@uniklinik-freiburg.de.
2
Department of Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Str. 3, 79106, Freiburg im Breisgau, Germany.
3
German Cancer Consortium (DKTK), Heidelberg (partner site Freiburg), Germany.
4
Division of Medical Physics, Department of Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany.
5
Department of Hematology, Oncology and Stem-Cell Transplantation, University Medical Center Freiburg, Freiburg, Germany.
6
Department of General and Visceral Surgery, University Medical Center Freiburg, Freiburg, Germany.
7
Faculty of Medicine, University of Freiburg, Freiburg, Germany.

Abstract

BACKGROUND:

Stereotactic body radiotherapy (SBRT) in pancreatic cancer can be limited by its proximity to organs at risk (OAR). In this analysis, we evaluated the toxicity and efficacy of two different treatment approaches in patients with locally recurrent or oligometastatic pancreatic cancer.

MATERIALS AND METHODS:

According to the prescription method, patients were divided in two cohorts (C1 and C2). The planning target volume (PTV) was created through a 4 mm expansion of the internal target volume. In C2, a subvolume was additionally created, a simultaneous integrated protection (SIP), which is the overlap of the PTV with the planning risk volume of an OAR to which we prescribed a reduced dose.

RESULTS:

In all, 18 patients were treated (7 with local recurrences, 9 for oligometastases, 2 for both). Twelve of 23 lesions were treated without SIP (C1) and 11 with SIP (C2). The median follow-up was 12.8 months. Median overall survival (OS) was 13.2 (95% confidence interval [CI] 9.8-14.6) months. The OS rates at 6 and 12 months were 87 and 58%, respectively. Freedom from local progression for combined cohorts at 6 and 12 months was 93 and 67% (95% CI 15-36), respectively. Local control was not statistically different between the two groups. One patient in C2 experienced grade ≥3 acute toxicities and 1 patient in C1 experienced a grade ≥3 late toxicity.

CONCLUSION:

The SIP approach is a useful prescription method for abdominal SBRT with a favorable toxicity profile which does not compromise local control and overall survival despite dose sacrifices in small subvolumes.

KEYWORDS:

Local progression; Overall survival; Prognosis; Radiation therapy; Toxicity

PMID:
28138949
DOI:
10.1007/s00066-017-1099-8
[Indexed for MEDLINE]

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