One- vs. Three-Fraction Pancreatic Stereotactic Body Radiation Therapy for Pancreatic Carcinoma: Single Institution Retrospective Review
Background/introductionEarly reports of stereotactic body radiation therapy (SBRT) for pancreatic ductal adenocarcinoma (PDAC) used single fraction, but eventually shifted to multifraction regimens. We conducted a single institution review of our patients treated with single- or multifraction SBRT t...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2017-11-01
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| Series: | Frontiers in Oncology |
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| Online Access: | http://journal.frontiersin.org/article/10.3389/fonc.2017.00272/full |
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| author | Philip Anthony Sutera Mark E. Bernard Beant S. Gill Kamran K. Harper Kimmen Quan Nathan Bahary Steven A. Burton Herbert Zeh Dwight E. Heron |
| author_facet | Philip Anthony Sutera Mark E. Bernard Beant S. Gill Kamran K. Harper Kimmen Quan Nathan Bahary Steven A. Burton Herbert Zeh Dwight E. Heron |
| author_sort | Philip Anthony Sutera |
| collection | DOAJ |
| description | Background/introductionEarly reports of stereotactic body radiation therapy (SBRT) for pancreatic ductal adenocarcinoma (PDAC) used single fraction, but eventually shifted to multifraction regimens. We conducted a single institution review of our patients treated with single- or multifraction SBRT to determine whether any outcome differences existed.Methods and materialsPatients treated with SBRT in any setting for PDAC at our facility were included, from 2004 to 2014. Overall survival (OS), local control (LC), regional control (RC), distant metastasis (DM), and late grade 3 or greater radiation toxicities from the time of SBRT were calculated using Kaplan–Meier estimation to either the date of last follow-up/death or local/regional/distant failure.ResultsWe identified 289 patients (291 lesions) with pathologically confirmed PDAC. Median age was 69 (range, 33–90) years. Median gross tumor volume was 12.3 (8.6–21.3) cm3 and planning target volume 17.9 (12–27) cm3. Single fraction was used in 90 (30.9%) and multifraction in 201 (69.1%) lesions. At a median follow-up of 17.3 months (IQR 10.1–29.3 months), the median survival for the entire cohort 17.8 months with a 2-year OS of 35.3%. Univariate analysis showed multifraction schemes to have a higher 2-year OS 30.5% vs. 37.5% (p = 0.019), it did not hold significance on MVA. Multifractionation schemes were found to have a higher LC on MVA (HR = 0.53, 95% CI, 0.33–0.85, p = 0.009). At 2 years, late grade 3+ toxicity was 2.5%. Post-SBRT CA19-9 was found on MVA to be a prognostic factor for OS (HR = 1.01, 95% CI, 1.01–1.01, p = 0.009), RC (HR = 1.01, 95% CI 1.01–1.01, p = 0.02), and DM (HR = 1.01, 95% CI, 1.01–1.01, p = 0.001).ConclusionOur single institution retrospective review is the largest to date comparing single and multifraction SBRT and the first to show multifraction regimen SBRT to have a higher LC than single fractionation. Additionally, we show low rates of severe late toxicity with SBRT. |
| first_indexed | 2024-12-19T21:03:22Z |
| format | Article |
| id | doaj.art-587c916592664513bbd1c523e5c1ca27 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-19T21:03:22Z |
| publishDate | 2017-11-01 |
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| series | Frontiers in Oncology |
| spelling | doaj.art-587c916592664513bbd1c523e5c1ca272022-12-21T20:05:45ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2017-11-01710.3389/fonc.2017.00272306456One- vs. Three-Fraction Pancreatic Stereotactic Body Radiation Therapy for Pancreatic Carcinoma: Single Institution Retrospective ReviewPhilip Anthony Sutera0Mark E. Bernard1Beant S. Gill2Kamran K. Harper3Kimmen Quan4Nathan Bahary5Steven A. Burton6Herbert Zeh7Dwight E. Heron8Department of Radiation Oncology, Hillman Cancer Center, Pittsburgh, PA, United StatesDepartment of Radiation Medicine, University of Kentucky, Lexington KYDepartment of Radiation Oncology, Hillman Cancer Center, Pittsburgh, PA, United StatesDepartment of Radiation Oncology, Hillman Cancer Center, Pittsburgh, PA, United StatesDepartment of Radiation Oncology, Hillman Cancer Center, Pittsburgh, PA, United StatesDepartment of Medical Oncology, Hillman Cancer Center, Pittsburgh, PA, United StatesDepartment of Radiation Oncology, Hillman Cancer Center, Pittsburgh, PA, United StatesDepartment of Surgical Oncology, Hillman Cancer Center, Pittsburgh, PA, United StatesDepartment of Radiation Oncology, Hillman Cancer Center, Pittsburgh, PA, United StatesBackground/introductionEarly reports of stereotactic body radiation therapy (SBRT) for pancreatic ductal adenocarcinoma (PDAC) used single fraction, but eventually shifted to multifraction regimens. We conducted a single institution review of our patients treated with single- or multifraction SBRT to determine whether any outcome differences existed.Methods and materialsPatients treated with SBRT in any setting for PDAC at our facility were included, from 2004 to 2014. Overall survival (OS), local control (LC), regional control (RC), distant metastasis (DM), and late grade 3 or greater radiation toxicities from the time of SBRT were calculated using Kaplan–Meier estimation to either the date of last follow-up/death or local/regional/distant failure.ResultsWe identified 289 patients (291 lesions) with pathologically confirmed PDAC. Median age was 69 (range, 33–90) years. Median gross tumor volume was 12.3 (8.6–21.3) cm3 and planning target volume 17.9 (12–27) cm3. Single fraction was used in 90 (30.9%) and multifraction in 201 (69.1%) lesions. At a median follow-up of 17.3 months (IQR 10.1–29.3 months), the median survival for the entire cohort 17.8 months with a 2-year OS of 35.3%. Univariate analysis showed multifraction schemes to have a higher 2-year OS 30.5% vs. 37.5% (p = 0.019), it did not hold significance on MVA. Multifractionation schemes were found to have a higher LC on MVA (HR = 0.53, 95% CI, 0.33–0.85, p = 0.009). At 2 years, late grade 3+ toxicity was 2.5%. Post-SBRT CA19-9 was found on MVA to be a prognostic factor for OS (HR = 1.01, 95% CI, 1.01–1.01, p = 0.009), RC (HR = 1.01, 95% CI 1.01–1.01, p = 0.02), and DM (HR = 1.01, 95% CI, 1.01–1.01, p = 0.001).ConclusionOur single institution retrospective review is the largest to date comparing single and multifraction SBRT and the first to show multifraction regimen SBRT to have a higher LC than single fractionation. Additionally, we show low rates of severe late toxicity with SBRT.http://journal.frontiersin.org/article/10.3389/fonc.2017.00272/fullpancreatic adenocarcinomastereotactic body radiation therapyoverall survivallocal controlfractionationtoxicity |
| spellingShingle | Philip Anthony Sutera Mark E. Bernard Beant S. Gill Kamran K. Harper Kimmen Quan Nathan Bahary Steven A. Burton Herbert Zeh Dwight E. Heron One- vs. Three-Fraction Pancreatic Stereotactic Body Radiation Therapy for Pancreatic Carcinoma: Single Institution Retrospective Review Frontiers in Oncology pancreatic adenocarcinoma stereotactic body radiation therapy overall survival local control fractionation toxicity |
| title | One- vs. Three-Fraction Pancreatic Stereotactic Body Radiation Therapy for Pancreatic Carcinoma: Single Institution Retrospective Review |
| title_full | One- vs. Three-Fraction Pancreatic Stereotactic Body Radiation Therapy for Pancreatic Carcinoma: Single Institution Retrospective Review |
| title_fullStr | One- vs. Three-Fraction Pancreatic Stereotactic Body Radiation Therapy for Pancreatic Carcinoma: Single Institution Retrospective Review |
| title_full_unstemmed | One- vs. Three-Fraction Pancreatic Stereotactic Body Radiation Therapy for Pancreatic Carcinoma: Single Institution Retrospective Review |
| title_short | One- vs. Three-Fraction Pancreatic Stereotactic Body Radiation Therapy for Pancreatic Carcinoma: Single Institution Retrospective Review |
| title_sort | one vs three fraction pancreatic stereotactic body radiation therapy for pancreatic carcinoma single institution retrospective review |
| topic | pancreatic adenocarcinoma stereotactic body radiation therapy overall survival local control fractionation toxicity |
| url | http://journal.frontiersin.org/article/10.3389/fonc.2017.00272/full |
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