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. 2023 Jul 24;30(7):7073-7088.
doi: 10.3390/curroncol30070513.

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  1 , Maria Massaro  1 , Maria Ausilia Teriaca  1 , Ciro Franzese  1   2 , Davide Franceschini  1 , Pierina Navarria  1 , Elena Clerici  1 , Luciana Di Cristina  1 , Anna Bertolini  1 , Stefano Tomatis  1 , Giacomo Reggiori  1 , Andrea Bresolin  1 , Silvia Bozzarelli  3 , Lorenza Rimassa  2   3 , Cristiana Bonifacio  4 , Silvia Carrara  5 , Armando Santoro  2   3 , Alessandro Zerbi  2   6 , Marta Scorsetti  1   2
Affiliations

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 et al. Curr Oncol. .

Abstract

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 < 70 years (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.

Keywords: locally advanced pancreatic cancer; radiotherapy; stereotactic body radiation therapy; unresectable pancreatic cancer.

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Conflict of interest statement

LR reports consulting fees from AstraZeneca, Basilea, Bayer, BMS, Eisai, Exelixis, Genenta, Hengrui, Incyte, Ipsen, IQVIA, Lilly, MSD, Nerviano Medical Sciences, Roche, Servier, Taiho Oncology, Zymeworks; lecture fees from AstraZeneca, Bayer, Eisai, Gilead, Incyte, Ipsen, Merck Serono, Roche, Sanofi, Servier; travel expenses from AstraZeneca; research grants (to Institution) from Agios, AstraZeneca, BeiGene, Eisai, Exelixis, Fibrogen, Incyte, Ipsen, Lilly, MSD, Nerviano Medical Sciences, Roche, Zymeworks.

Figures

Figure 1
Figure 1
A prescription dose of 45 Gy in 6 fractions was delivered with a maximum acceptable dose heterogeneity to the PTV of D98% > 95% and D2% < 107%. In the area of overlap between PTV and OaR, we delivered the maximum tolerated dose by OaR. PRV: Planning Organs at Risk Volume; OAR: Organ at Risk; PTV = Planning Target Volume; ITV: Internal Target Volume; CTV = Clinical Target Volume.
Figure 2
Figure 2
Example of dose distribution and radiological response after SBRT.
Figure 3
Figure 3
(a) Local control; (b) distant progression free survival; and (c) overall survival.
Figure 3
Figure 3
(a) Local control; (b) distant progression free survival; and (c) overall survival.
Figure 4
Figure 4
Overall survival in patients treated with chemotherapy and SBRT (n = 76) and in patients treated with SBRT alone (n = 66). Specifically, pre-SBRT ChT (HR 0.59, 95% CI 0.41–0.84, p = 0.004) and post-SBRT ChT (HR 0.63, 95% CI 0.43–0.92, p = 0.019) were significantly associated with OS.
See this image and copyright information in PMC

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