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Maximizing Tumor Control and Limiting Complications With Stereotactic Body Radiation Therapy for Pancreatic Cancer.

Publication ,  Journal Article
Mahadevan, A; Moningi, S; Grimm, J; Li, XA; Forster, KM; Palta, M; Prior, P; Goodman, KA; Narang, A; Heron, DE; Lo, SS; Urbanic, J; Herman, JM
Published in: Int J Radiat Oncol Biol Phys
May 1, 2021

PURPOSE: Stereotactic body radiation therapy (SBRT) and stereotactic ablative body radiation therapy is being increasingly used for pancreatic cancer (PCa), particularly in patients with locally advanced and borderline resectable disease. A wide variety of dose fractionation schemes have been reported in the literature. This HyTEC review uses tumor control probability models to evaluate the comparative effectiveness of the various SBRT treatment regimens used in the treatment of patients with localized PCa. METHODS AND MATERIALS: A PubMed search was performed to review the published literature on the use of hypofractionated SBRT (usually in 1-5 fractions) for PCa in various clinical scenarios (eg, preoperative [neoadjuvant], borderline resectable, and locally advanced PCa). The linear quadratic model with α/β= 10 Gy was used to address differences in fractionation. Logistic tumor control probability models were generated using maximum likelihood parameter fitting. RESULTS: After converting to 3-fraction equivalent doses, the pooled reported data and associated models suggests that 1-year local control (LC) without surgery is ≈79% to 86% after the equivalent of 30 to 36 Gy in 3 fractions, showing a dose response in the range of 25 to 36 Gy, and decreasing to less than 70% 1-year LC at doses below 24 Gy in 3 fractions. The 33 Gy in 5 fraction regimen (Alliance A021501) corresponds to 28.2 Gy in 3 fractions, for which the HyTEC pooled model had 77% 1-year LC without surgery. Above an equivalent dose of 28 Gy in 3 fractions, with margin-negative resection the 1-year LC exceeded 90%. CONCLUSIONS: Pooled analyses of reported tumor control probabilities for commonly used SBRT dose-fractionation schedules for PCa suggests a dose response. These findings should be viewed with caution given the challenges and limitations of this review. Additional data are needed to better understand the dose or fractionation-response of SBRT for PCa.

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Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

May 1, 2021

Volume

110

Issue

1

Start / End Page

206 / 216

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Radiotherapy, Adjuvant
  • Radiosurgery
  • Radiation Dose Hypofractionation
  • Probability
  • Pancreaticoduodenectomy
  • Pancreatic Neoplasms
  • Oncology & Carcinogenesis
  • Neoadjuvant Therapy
  • Models, Theoretical
 

Citation

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MLA
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Mahadevan, A., Moningi, S., Grimm, J., Li, X. A., Forster, K. M., Palta, M., … Herman, J. M. (2021). Maximizing Tumor Control and Limiting Complications With Stereotactic Body Radiation Therapy for Pancreatic Cancer. Int J Radiat Oncol Biol Phys, 110(1), 206–216. https://doi.org/10.1016/j.ijrobp.2020.11.017
Mahadevan, Anand, Shalini Moningi, Jimm Grimm, X Allen Li, Kenneth M. Forster, Manisha Palta, Phillip Prior, et al. “Maximizing Tumor Control and Limiting Complications With Stereotactic Body Radiation Therapy for Pancreatic Cancer.Int J Radiat Oncol Biol Phys 110, no. 1 (May 1, 2021): 206–16. https://doi.org/10.1016/j.ijrobp.2020.11.017.
Mahadevan A, Moningi S, Grimm J, Li XA, Forster KM, Palta M, et al. Maximizing Tumor Control and Limiting Complications With Stereotactic Body Radiation Therapy for Pancreatic Cancer. Int J Radiat Oncol Biol Phys. 2021 May 1;110(1):206–16.
Mahadevan, Anand, et al. “Maximizing Tumor Control and Limiting Complications With Stereotactic Body Radiation Therapy for Pancreatic Cancer.Int J Radiat Oncol Biol Phys, vol. 110, no. 1, May 2021, pp. 206–16. Pubmed, doi:10.1016/j.ijrobp.2020.11.017.
Mahadevan A, Moningi S, Grimm J, Li XA, Forster KM, Palta M, Prior P, Goodman KA, Narang A, Heron DE, Lo SS, Urbanic J, Herman JM. Maximizing Tumor Control and Limiting Complications With Stereotactic Body Radiation Therapy for Pancreatic Cancer. Int J Radiat Oncol Biol Phys. 2021 May 1;110(1):206–216.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

EISSN

1879-355X

Publication Date

May 1, 2021

Volume

110

Issue

1

Start / End Page

206 / 216

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Radiotherapy, Adjuvant
  • Radiosurgery
  • Radiation Dose Hypofractionation
  • Probability
  • Pancreaticoduodenectomy
  • Pancreatic Neoplasms
  • Oncology & Carcinogenesis
  • Neoadjuvant Therapy
  • Models, Theoretical