Stereotactic body radiotherapy in the treatment of Pancreatic Adenocarcinoma in elderly patients

Carolyn H. Kim, Diane C. Ling, Rodney E. Wegner, John C. Flickinger, Dwight E. Heron, Herbert Zeh, Arthur J. Moser, Steven A. Burton

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background: Treatment of pancreatic adenocarcinoma in the elderly is often complicated by comorbidities that preclude surgery, chemotherapy and/or conventional external beam radiation therapy (EBRT). Stereotactic body radiotherapy (SBRT) has thus garnered interest in this setting.Methods: A retrospective review of 26 patients of age ≥ 80 with pancreatic adenocarcinoma treated with definitive SBRT+/-chemotherapy from 2007-2011 was performed. Twenty-seven percent of patients were stage I, 38% were stage II, 27% were stage III and 8% were stage IV. Patients most commonly received 24 Gy/1 fraction or 30-36 Gy/3 fractions. Kaplan-Meier was used to estimate overall survival (OS), local control (LC), cause specific survival (CSS) and freedom-from-metastatic disease (FFMD).Results: The median age was 86 (range 80-91), and median follow-up was 11.6 months (3.5-24.6). The median planning target volume was 21.48 cm3 (6.1-85.09). Median OS was 7.6 months with 6/12 month OS rates of 65.4%/34.6%, respectively. Median LC was 11.5 months, 6-month and 12-month actuarial LC rates were 60.1% and 41.2%, respectively. There were no independent predictors for LC, but there was a trend for improved LC with prescription dose greater than 20 Gy (p = 0.063). Median CSS was 6.3 months, and 6-month and 12-month actuarial CSS were 53.8% and 23.1%, respectively. Median FFMD was 8.4 months, and 6-month and 12-month actuarial rates were 62.0% and 41.4%, respectively. Nine patients (47%) had local failures, 11 (58%) had distant metastasis, and 7 (37%) had both. There were no acute or late grade 3+ toxicities.Conclusions: Definitive SBRT is feasible, safe and effective in elderly patients who have unresectable disease, have comorbidities precluding surgery or decline surgery.

Original languageEnglish (US)
Article number240
JournalRadiation Oncology
Volume8
Issue number1
DOIs
StatePublished - Oct 16 2013
Externally publishedYes

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Radiosurgery
Adenocarcinoma
Survival
Comorbidity
Therapeutics
Drug Therapy
Prescriptions
Radiotherapy
Survival Rate
Neoplasm Metastasis

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Kim, C. H., Ling, D. C., Wegner, R. E., Flickinger, J. C., Heron, D. E., Zeh, H., ... Burton, S. A. (2013). Stereotactic body radiotherapy in the treatment of Pancreatic Adenocarcinoma in elderly patients. Radiation Oncology, 8(1), [240]. https://doi.org/10.1186/1748-717X-8-240

Stereotactic body radiotherapy in the treatment of Pancreatic Adenocarcinoma in elderly patients. / Kim, Carolyn H.; Ling, Diane C.; Wegner, Rodney E.; Flickinger, John C.; Heron, Dwight E.; Zeh, Herbert; Moser, Arthur J.; Burton, Steven A.

In: Radiation Oncology, Vol. 8, No. 1, 240, 16.10.2013.

Research output: Contribution to journalArticle

Kim, CH, Ling, DC, Wegner, RE, Flickinger, JC, Heron, DE, Zeh, H, Moser, AJ & Burton, SA 2013, 'Stereotactic body radiotherapy in the treatment of Pancreatic Adenocarcinoma in elderly patients', Radiation Oncology, vol. 8, no. 1, 240. https://doi.org/10.1186/1748-717X-8-240
Kim, Carolyn H. ; Ling, Diane C. ; Wegner, Rodney E. ; Flickinger, John C. ; Heron, Dwight E. ; Zeh, Herbert ; Moser, Arthur J. ; Burton, Steven A. / Stereotactic body radiotherapy in the treatment of Pancreatic Adenocarcinoma in elderly patients. In: Radiation Oncology. 2013 ; Vol. 8, No. 1.
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abstract = "Background: Treatment of pancreatic adenocarcinoma in the elderly is often complicated by comorbidities that preclude surgery, chemotherapy and/or conventional external beam radiation therapy (EBRT). Stereotactic body radiotherapy (SBRT) has thus garnered interest in this setting.Methods: A retrospective review of 26 patients of age ≥ 80 with pancreatic adenocarcinoma treated with definitive SBRT+/-chemotherapy from 2007-2011 was performed. Twenty-seven percent of patients were stage I, 38{\%} were stage II, 27{\%} were stage III and 8{\%} were stage IV. Patients most commonly received 24 Gy/1 fraction or 30-36 Gy/3 fractions. Kaplan-Meier was used to estimate overall survival (OS), local control (LC), cause specific survival (CSS) and freedom-from-metastatic disease (FFMD).Results: The median age was 86 (range 80-91), and median follow-up was 11.6 months (3.5-24.6). The median planning target volume was 21.48 cm3 (6.1-85.09). Median OS was 7.6 months with 6/12 month OS rates of 65.4{\%}/34.6{\%}, respectively. Median LC was 11.5 months, 6-month and 12-month actuarial LC rates were 60.1{\%} and 41.2{\%}, respectively. There were no independent predictors for LC, but there was a trend for improved LC with prescription dose greater than 20 Gy (p = 0.063). Median CSS was 6.3 months, and 6-month and 12-month actuarial CSS were 53.8{\%} and 23.1{\%}, respectively. Median FFMD was 8.4 months, and 6-month and 12-month actuarial rates were 62.0{\%} and 41.4{\%}, respectively. Nine patients (47{\%}) had local failures, 11 (58{\%}) had distant metastasis, and 7 (37{\%}) had both. There were no acute or late grade 3+ toxicities.Conclusions: Definitive SBRT is feasible, safe and effective in elderly patients who have unresectable disease, have comorbidities precluding surgery or decline surgery.",
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AU - Ling, Diane C.

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AU - Flickinger, John C.

AU - Heron, Dwight E.

AU - Zeh, Herbert

AU - Moser, Arthur J.

AU - Burton, Steven A.

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N2 - Background: Treatment of pancreatic adenocarcinoma in the elderly is often complicated by comorbidities that preclude surgery, chemotherapy and/or conventional external beam radiation therapy (EBRT). Stereotactic body radiotherapy (SBRT) has thus garnered interest in this setting.Methods: A retrospective review of 26 patients of age ≥ 80 with pancreatic adenocarcinoma treated with definitive SBRT+/-chemotherapy from 2007-2011 was performed. Twenty-seven percent of patients were stage I, 38% were stage II, 27% were stage III and 8% were stage IV. Patients most commonly received 24 Gy/1 fraction or 30-36 Gy/3 fractions. Kaplan-Meier was used to estimate overall survival (OS), local control (LC), cause specific survival (CSS) and freedom-from-metastatic disease (FFMD).Results: The median age was 86 (range 80-91), and median follow-up was 11.6 months (3.5-24.6). The median planning target volume was 21.48 cm3 (6.1-85.09). Median OS was 7.6 months with 6/12 month OS rates of 65.4%/34.6%, respectively. Median LC was 11.5 months, 6-month and 12-month actuarial LC rates were 60.1% and 41.2%, respectively. There were no independent predictors for LC, but there was a trend for improved LC with prescription dose greater than 20 Gy (p = 0.063). Median CSS was 6.3 months, and 6-month and 12-month actuarial CSS were 53.8% and 23.1%, respectively. Median FFMD was 8.4 months, and 6-month and 12-month actuarial rates were 62.0% and 41.4%, respectively. Nine patients (47%) had local failures, 11 (58%) had distant metastasis, and 7 (37%) had both. There were no acute or late grade 3+ toxicities.Conclusions: Definitive SBRT is feasible, safe and effective in elderly patients who have unresectable disease, have comorbidities precluding surgery or decline surgery.

AB - Background: Treatment of pancreatic adenocarcinoma in the elderly is often complicated by comorbidities that preclude surgery, chemotherapy and/or conventional external beam radiation therapy (EBRT). Stereotactic body radiotherapy (SBRT) has thus garnered interest in this setting.Methods: A retrospective review of 26 patients of age ≥ 80 with pancreatic adenocarcinoma treated with definitive SBRT+/-chemotherapy from 2007-2011 was performed. Twenty-seven percent of patients were stage I, 38% were stage II, 27% were stage III and 8% were stage IV. Patients most commonly received 24 Gy/1 fraction or 30-36 Gy/3 fractions. Kaplan-Meier was used to estimate overall survival (OS), local control (LC), cause specific survival (CSS) and freedom-from-metastatic disease (FFMD).Results: The median age was 86 (range 80-91), and median follow-up was 11.6 months (3.5-24.6). The median planning target volume was 21.48 cm3 (6.1-85.09). Median OS was 7.6 months with 6/12 month OS rates of 65.4%/34.6%, respectively. Median LC was 11.5 months, 6-month and 12-month actuarial LC rates were 60.1% and 41.2%, respectively. There were no independent predictors for LC, but there was a trend for improved LC with prescription dose greater than 20 Gy (p = 0.063). Median CSS was 6.3 months, and 6-month and 12-month actuarial CSS were 53.8% and 23.1%, respectively. Median FFMD was 8.4 months, and 6-month and 12-month actuarial rates were 62.0% and 41.4%, respectively. Nine patients (47%) had local failures, 11 (58%) had distant metastasis, and 7 (37%) had both. There were no acute or late grade 3+ toxicities.Conclusions: Definitive SBRT is feasible, safe and effective in elderly patients who have unresectable disease, have comorbidities precluding surgery or decline surgery.

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