Stereotactic body radiation therapy for locally advanced pancreatic cancer

Jinhong Jung; Sang Min Yoon; Jin hong Park; Dong Wan Seo; Sang Soo Lee; Myung Hwan Kim; Sung Koo Lee; Do Hyun Park; Tae Jun Song; Baek Yeol Ryoo; Heung Moon Chang; Kyu pyo Kim; Changhoon Yoo; Jae Ho Jeong; Song Cheol Kim; Dae Wook Hwang; Jae Hoon Lee; Ki Byung Song; Yoon Young Jo; Jongmoo Park; Jong Hoon Kim

doi:10.1371/journal.pone.0214970

Stereotactic body radiation therapy for locally advanced pancreatic cancer

Jinhong Jung, Sang Min Yoon, Jin hong Park, Dong Wan Seo, Sang Soo Lee, Myung Hwan Kim, Sung Koo Lee, Do Hyun Park, Tae Jun Song, Baek Yeol Ryoo, Heung Moon Chang, Kyu pyo Kim, Changhoon Yoo, Jae Ho Jeong, Song Cheol Kim, Dae Wook Hwang, Jae Hoon Lee, Ki Byung Song, Yoon Young Jo, Jongmoo ParkJong Hoon Kim

Department of Medicine

University of Ulsan

Research output: Contribution to journal › Article › peer-review

48 Scopus citations

Abstract

Purpose Stereotactic body radiation therapy (SBRT) is a promising treatment modality for locally advanced pancreatic cancer (LAPC). We evaluated the clinical outcomes of SBRT in patients with LAPC. Patients and methods We retrospectively analyzed the medical records of patients with LAPC who underwent SBRT at our institution between April 2011 and July 2016. Fiducial markers were implanted using endoscopic ultrasound guidance one week prior to 4-dimensional computed tomography (CT) simulation and daily cone beam CT was used for image guidance. Patients received volumetric modulated arc therapy or intensity modulated radiotherapy using respiratory gating technique. A median dose of 28 Gy (range, 24–36 Gy) was given over four consecutive fractions delivered within one week. Survival outcomes including freedom from local disease progression (FFLP), progression-free survival (PFS), and overall survival (OS) were analyzed. Acute and late toxicities related to SBRT were assessed. Results A total of 95 patients with LAPC were analyzed, 52 of which (54.7%) had pancreatic head cancers. Most (94.7%) had received gemcitabine-based chemotherapy. The 1-year FFLP rate was 80.1%. Median OS and PFS were 16.7 months and 10.2 months, respectively; the 1-year OS and PFS rates were 67.4% and 42.9%, respectively. Among 79 patients who experienced failure, the sites of first failures were isolated local progressions in 12 patients (15.2%), distant metastasis in 55 patients (69.6%), and both in 12 patients (15.2%). Seven patients (7.4%) were able to undergo surgical resection after SBRT and four had margin-negative resections. Three patients (3.2%) had grade 3 nausea/vomiting during SBRT, and late grade 3 toxicity was observed in another three patients. Conclusions LAPC patients who received chemotherapy and SBRT had favorable FFLP and OS with minimal treatment-related toxicity. The most common pattern of failure was distant metastasis, which warrants further studies on the optimal scheme of chemotherapy and SBRT.

Original language	English
Article number	e0214970
Journal	PLoS ONE
Volume	14
Issue number	4
DOIs	https://doi.org/10.1371/journal.pone.0214970
State	Published - Apr 2019

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Jung, J., Yoon, S. M., Park, J. H., Seo, D. W., Lee, S. S., Kim, M. H., Lee, S. K., Park, D. H., Song, T. J., Ryoo, B. Y., Chang, H. M., Kim, K. P., Yoo, C., Jeong, J. H., Kim, S. C., Hwang, D. W., Lee, J. H., Song, K. B., Jo, Y. Y., ... Kim, J. H. (2019). Stereotactic body radiation therapy for locally advanced pancreatic cancer. PLoS ONE, 14(4), Article e0214970. https://doi.org/10.1371/journal.pone.0214970

@article{9e2888b4bf7a4a8b8f2e682a04dd835d,

title = "Stereotactic body radiation therapy for locally advanced pancreatic cancer",

abstract = "Purpose Stereotactic body radiation therapy (SBRT) is a promising treatment modality for locally advanced pancreatic cancer (LAPC). We evaluated the clinical outcomes of SBRT in patients with LAPC. Patients and methods We retrospectively analyzed the medical records of patients with LAPC who underwent SBRT at our institution between April 2011 and July 2016. Fiducial markers were implanted using endoscopic ultrasound guidance one week prior to 4-dimensional computed tomography (CT) simulation and daily cone beam CT was used for image guidance. Patients received volumetric modulated arc therapy or intensity modulated radiotherapy using respiratory gating technique. A median dose of 28 Gy (range, 24–36 Gy) was given over four consecutive fractions delivered within one week. Survival outcomes including freedom from local disease progression (FFLP), progression-free survival (PFS), and overall survival (OS) were analyzed. Acute and late toxicities related to SBRT were assessed. Results A total of 95 patients with LAPC were analyzed, 52 of which (54.7%) had pancreatic head cancers. Most (94.7%) had received gemcitabine-based chemotherapy. The 1-year FFLP rate was 80.1%. Median OS and PFS were 16.7 months and 10.2 months, respectively; the 1-year OS and PFS rates were 67.4% and 42.9%, respectively. Among 79 patients who experienced failure, the sites of first failures were isolated local progressions in 12 patients (15.2%), distant metastasis in 55 patients (69.6%), and both in 12 patients (15.2%). Seven patients (7.4%) were able to undergo surgical resection after SBRT and four had margin-negative resections. Three patients (3.2%) had grade 3 nausea/vomiting during SBRT, and late grade 3 toxicity was observed in another three patients. Conclusions LAPC patients who received chemotherapy and SBRT had favorable FFLP and OS with minimal treatment-related toxicity. The most common pattern of failure was distant metastasis, which warrants further studies on the optimal scheme of chemotherapy and SBRT.",

author = "Jinhong Jung and Yoon, {Sang Min} and Park, {Jin hong} and Seo, {Dong Wan} and Lee, {Sang Soo} and Kim, {Myung Hwan} and Lee, {Sung Koo} and Park, {Do Hyun} and Song, {Tae Jun} and Ryoo, {Baek Yeol} and Chang, {Heung Moon} and Kim, {Kyu pyo} and Changhoon Yoo and Jeong, {Jae Ho} and Kim, {Song Cheol} and Hwang, {Dae Wook} and Lee, {Jae Hoon} and Song, {Ki Byung} and Jo, {Yoon Young} and Jongmoo Park and Kim, {Jong Hoon}",

note = "Publisher Copyright: {\textcopyright} 2019 Jung et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

year = "2019",

month = apr,

doi = "10.1371/journal.pone.0214970",

language = "English",

volume = "14",

journal = "PLoS ONE",

issn = "1932-6203",

publisher = "Public Library of Science",

number = "4",

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TY - JOUR

T1 - Stereotactic body radiation therapy for locally advanced pancreatic cancer

AU - Jung, Jinhong

AU - Yoon, Sang Min

AU - Park, Jin hong

AU - Seo, Dong Wan

AU - Lee, Sang Soo

AU - Kim, Myung Hwan

AU - Lee, Sung Koo

AU - Park, Do Hyun

AU - Song, Tae Jun

AU - Ryoo, Baek Yeol

AU - Chang, Heung Moon

AU - Kim, Kyu pyo

AU - Yoo, Changhoon

AU - Jeong, Jae Ho

AU - Kim, Song Cheol

AU - Hwang, Dae Wook

AU - Lee, Jae Hoon

AU - Song, Ki Byung

AU - Jo, Yoon Young

AU - Park, Jongmoo

AU - Kim, Jong Hoon

N1 - Publisher Copyright: © 2019 Jung et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2019/4

Y1 - 2019/4

N2 - Purpose Stereotactic body radiation therapy (SBRT) is a promising treatment modality for locally advanced pancreatic cancer (LAPC). We evaluated the clinical outcomes of SBRT in patients with LAPC. Patients and methods We retrospectively analyzed the medical records of patients with LAPC who underwent SBRT at our institution between April 2011 and July 2016. Fiducial markers were implanted using endoscopic ultrasound guidance one week prior to 4-dimensional computed tomography (CT) simulation and daily cone beam CT was used for image guidance. Patients received volumetric modulated arc therapy or intensity modulated radiotherapy using respiratory gating technique. A median dose of 28 Gy (range, 24–36 Gy) was given over four consecutive fractions delivered within one week. Survival outcomes including freedom from local disease progression (FFLP), progression-free survival (PFS), and overall survival (OS) were analyzed. Acute and late toxicities related to SBRT were assessed. Results A total of 95 patients with LAPC were analyzed, 52 of which (54.7%) had pancreatic head cancers. Most (94.7%) had received gemcitabine-based chemotherapy. The 1-year FFLP rate was 80.1%. Median OS and PFS were 16.7 months and 10.2 months, respectively; the 1-year OS and PFS rates were 67.4% and 42.9%, respectively. Among 79 patients who experienced failure, the sites of first failures were isolated local progressions in 12 patients (15.2%), distant metastasis in 55 patients (69.6%), and both in 12 patients (15.2%). Seven patients (7.4%) were able to undergo surgical resection after SBRT and four had margin-negative resections. Three patients (3.2%) had grade 3 nausea/vomiting during SBRT, and late grade 3 toxicity was observed in another three patients. Conclusions LAPC patients who received chemotherapy and SBRT had favorable FFLP and OS with minimal treatment-related toxicity. The most common pattern of failure was distant metastasis, which warrants further studies on the optimal scheme of chemotherapy and SBRT.

AB - Purpose Stereotactic body radiation therapy (SBRT) is a promising treatment modality for locally advanced pancreatic cancer (LAPC). We evaluated the clinical outcomes of SBRT in patients with LAPC. Patients and methods We retrospectively analyzed the medical records of patients with LAPC who underwent SBRT at our institution between April 2011 and July 2016. Fiducial markers were implanted using endoscopic ultrasound guidance one week prior to 4-dimensional computed tomography (CT) simulation and daily cone beam CT was used for image guidance. Patients received volumetric modulated arc therapy or intensity modulated radiotherapy using respiratory gating technique. A median dose of 28 Gy (range, 24–36 Gy) was given over four consecutive fractions delivered within one week. Survival outcomes including freedom from local disease progression (FFLP), progression-free survival (PFS), and overall survival (OS) were analyzed. Acute and late toxicities related to SBRT were assessed. Results A total of 95 patients with LAPC were analyzed, 52 of which (54.7%) had pancreatic head cancers. Most (94.7%) had received gemcitabine-based chemotherapy. The 1-year FFLP rate was 80.1%. Median OS and PFS were 16.7 months and 10.2 months, respectively; the 1-year OS and PFS rates were 67.4% and 42.9%, respectively. Among 79 patients who experienced failure, the sites of first failures were isolated local progressions in 12 patients (15.2%), distant metastasis in 55 patients (69.6%), and both in 12 patients (15.2%). Seven patients (7.4%) were able to undergo surgical resection after SBRT and four had margin-negative resections. Three patients (3.2%) had grade 3 nausea/vomiting during SBRT, and late grade 3 toxicity was observed in another three patients. Conclusions LAPC patients who received chemotherapy and SBRT had favorable FFLP and OS with minimal treatment-related toxicity. The most common pattern of failure was distant metastasis, which warrants further studies on the optimal scheme of chemotherapy and SBRT.

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U2 - 10.1371/journal.pone.0214970

DO - 10.1371/journal.pone.0214970

M3 - Article

C2 - 30978229

AN - SCOPUS:85064349091

SN - 1932-6203

VL - 14

JO - PLoS ONE

JF - PLoS ONE

IS - 4

M1 - e0214970

ER -

Stereotactic body radiation therapy for locally advanced pancreatic cancer

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