Proton Therapy for Unresectable and Medically Inoperable Locally Advanced Pancreatic Cancer: Results From a Multi-Institutional Prospective Registry

Jacob Eckstein, MD; J. Isabelle Choi, MD; Alicia Lozano, MS; Nitin Ohri, MD; Robert Press, MD; Shaakir Hasan, DO; Rafi Kabarriti, MD; John Chang, MD; James Urbanic, MD; Michael Durci, MD; Nasiruddin Mohammed, MD; Craig Stevens, MD, PhD; Henry Tsai, MD; Smith Apisarnthanarax, MD; William Regine, MD; Carlos Vargas, MD; Romaine Nichols, Jr, MD; Joseph Herman, MD; Charles B. Simone, II, MD; Arpit Chhabra, MD

Advances in Radiation Oncology (Sep 2023)

Proton Therapy for Unresectable and Medically Inoperable Locally Advanced Pancreatic Cancer: Results From a Multi-Institutional Prospective Registry

Jacob Eckstein, MD,
J. Isabelle Choi, MD,
Alicia Lozano, MS,
Nitin Ohri, MD,
Robert Press, MD,
Shaakir Hasan, DO,
Rafi Kabarriti, MD,
John Chang, MD,
James Urbanic, MD,
Michael Durci, MD,
Nasiruddin Mohammed, MD,
Craig Stevens, MD, PhD,
Henry Tsai, MD,
Smith Apisarnthanarax, MD,
William Regine, MD,
Carlos Vargas, MD,
Romaine Nichols, Jr, MD,
Joseph Herman, MD,
Charles B. Simone, II, MD,
Arpit Chhabra, MD

Affiliations

Jacob Eckstein, MD: Northwell Health, Department of Radiation Medicine, New Hyde Park, New York; Corresponding author: Jacob Eckstein, MD
J. Isabelle Choi, MD: New York Proton Center, New York, New York
Alicia Lozano, MS: New York Proton Center, New York, New York
Nitin Ohri, MD: Montefiore Einstein Cancer Center, Department of Radiation Oncology, Bronx, New York
Robert Press, MD: New York Proton Center, New York, New York
Shaakir Hasan, DO: New York Proton Center, New York, New York
Rafi Kabarriti, MD: Montefiore Einstein Cancer Center, Department of Radiation Oncology, Bronx, New York
John Chang, MD: Oklahoma Proton Center, Oklahoma City, Oklahoma
James Urbanic, MD: University of California, Department of Radiation Medicine and Applied Sciences, San Diego, California
Michael Durci, MD: Willis Knighton Cancer Center, Shreveport, Louisiana
Nasiruddin Mohammed, MD: Northwestern Medicine, Department of Radiation Oncology, Chicago, Illinois
Craig Stevens, MD, PhD: Oakland University William Beaumont School of Medicine, Department of Radiation Oncology, Royal Oak, Michigan
Henry Tsai, MD: Princeton Radiation Oncology, Somerset, New Jersey
Smith Apisarnthanarax, MD: University of Washington Medicine, Department of Radiation Oncology, Seattle, Washington
William Regine, MD: University of Maryland School of Medicine, Department of Radiation Oncology, Baltimore, Maryland
Carlos Vargas, MD: Mayo Clinic, Department of Radiation Oncology, Rochester, Minnesota
Romaine Nichols, Jr, MD: University of Florida Protons, Department of Radiation Oncology, Gainesville, Florida
Joseph Herman, MD: Northwell Health, Department of Radiation Medicine, New Hyde Park, New York
Charles B. Simone, II, MD: New York Proton Center, New York, New York
Arpit Chhabra, MD: New York Proton Center, New York, New York

Journal volume & issue: Vol. 8, no. 5
p. 101250

Abstract

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Purpose: Compared with photon-based techniques, proton beam radiation therapy (PBT) may improve the therapeutic ratio of radiation therapy (RT) for locally advanced pancreatic cancer (LAPC), but available data have been limited to single-institutional experiences. This study examined the toxicity, survival, and disease control rates among patients enrolled in a multi-institutional prospective registry study and treated with PBT for LAPC. Methods and Materials: Between March 2013 and November 2019, 19 patients with inoperable disease across 7 institutions underwent PBT with definitive intent for LAPC. Patients received a median radiation dose/fractionation of 54 Gy/30 fractions (range, 50.4-60.0 Gy/19-33 fractions). Most received prior (68.4%) or concurrent (78.9%) chemotherapy. Patients were assessed prospectively for toxicities using National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0. Kaplan-Meier analysis was used to analyze overall survival, locoregional recurrence-free survival, time to locoregional recurrence, distant metastasis-free survival, and time to new progression or metastasis for the adenocarcinoma cohort (17 patients). Results: No patients experienced grade ≥3 acute or chronic treatment-related adverse events. Grade 1 and 2 adverse events occurred in 78.7% and 21.3% of patients, respectively. Median overall survival, locoregional recurrence-free survival, distant metastasis-free survival, and time to new progression or metastasis were 14.6, 11.0, 11.0, and 13.9 months, respectively. Freedom from locoregional recurrence at 2 years was 81.7%. All patients completed treatment with one requiring a RT break for stent placement. Conclusions: Proton beam RT for LAPC offered excellent tolerability while still maintaining disease control and survival rates comparable with dose-escalated photon-based RT. These findings are consistent with the known physical and dosimetric advantages offered by proton therapy, but the conclusions are limited owing to the patient sample size. Further clinical studies incorporating dose-escalated PBT are warranted to evaluate whether these dosimetric advantages translate into clinically meaningful benefits.

Published in Advances in Radiation Oncology

ISSN: 2452-1094 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine; Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: http://www.journals.elsevier.com/advances-in-radiation-oncology/

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