Current Oncology (Jul 2023)

Can STEreotactic Body Radiation Therapy (SBRT) Improve the Prognosis of Unresectable Locally Advanced Pancreatic Cancer? Long-Term Clinical Outcomes, Toxicity and Prognostic Factors on 142 Patients (STEP Study)

  • Tiziana Comito,
  • Maria Massaro,
  • Maria Ausilia Teriaca,
  • Ciro Franzese,
  • Davide Franceschini,
  • Pierina Navarria,
  • Elena Clerici,
  • Luciana Di Cristina,
  • Anna Bertolini,
  • Stefano Tomatis,
  • Giacomo Reggiori,
  • Andrea Bresolin,
  • Silvia Bozzarelli,
  • Lorenza Rimassa,
  • Cristiana Bonifacio,
  • Silvia Carrara,
  • Armando Santoro,
  • Alessandro Zerbi,
  • Marta Scorsetti

DOI
https://doi.org/10.3390/curroncol30070513
Journal volume & issue
Vol. 30, no. 7
pp. 7073 – 7088

Abstract

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Aim: The gold standard of care for pancreatic adenocarcinoma is the integrated treatment of surgery and chemotherapy (ChT), but about 50% of patients present with unresectable disease. Our study evaluated the efficacy in terms of local control, survival and safety of stereotactic body radiation therapy (SBRT) in locally advanced pancreatic cancer (LAPC). Methods: A retrospective study (STEP study) analyzed patients with LAPC treated with a dose of 45 Gy in 6 fractions. Local control (LC), distant progression free survival (DPFS), overall survival (OS) and toxicity were analyzed according to the Kaplan-Meier method. Results: A total of 142 patients were evaluated. Seventy-six patients (53.5%) received induction ChT before SBRT. The median follow-up was 11 months. One-, 2- and 3-year LC rate was 81.9%, 69.1% and 58.5%. Median DPFS was 6.03 months; 1- and 2-year DPFS rate was 19.9% and 4.5%. Median OS was 11.6 months and 1-, 2- and 3-year OS rates were 45.4%, 16.1%, and 9.8%. At univariate analysis, performed by the log-rank test, age p = 0.037), pre-SBRT ChT (p = 0.004) and post-SBRT ChT (p = 0.019) were associated with better OS. No patients experienced G3 toxicity. Conclusion: SBRT represents an effective and safe therapeutic option in the multimodal treatment of patients with LAPC in terms of increased LC. When SBRT was sequentially integrated with ChT, the treatment proved to be promising in terms of OS as well.

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