TY - JOUR
T1 - Single- versus multifraction stereotactic body radiation therapy for pancreatic adenocarcinoma
T2 - Outcomes and toxicity
AU - Pollom, Erqi L.
AU - Alagappan, Muthuraman
AU - Von Eyben, Rie
AU - Kunz, Pamela L.
AU - Fisher, George A.
AU - Ford, James A.
AU - Poultsides, George A.
AU - Visser, Brendan C.
AU - Norton, Jeffrey A.
AU - Kamaya, Aya
AU - Cox, Veronica L.
AU - Columbo, Laurie A.
AU - Koong, Albert C.
AU - Chang, Daniel T.
N1 - Funding Information:
This study was supported by Stanford Med Scholars (to M.A.) and My Blue Dots Foundation (to A.C.K.).
Funding Information:
Conflicts of interest: Dr Koong has received speaker honoraria and grant support from Varian.
Publisher Copyright:
© 2014 Elsevier Inc.
PY - 2014/11/15
Y1 - 2014/11/15
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=84908193587&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84908193587&partnerID=8YFLogxK
U2 - 10.1016/j.ijrobp.2014.06.066
DO - 10.1016/j.ijrobp.2014.06.066
M3 - Article
C2 - 25585785
AN - SCOPUS:84908193587
SN - 0360-3016
VL - 90
SP - 918
EP - 925
JO - International Journal of Radiation Oncology Biology Physics
JF - International Journal of Radiation Oncology Biology Physics
IS - 4
ER -