ASTRO: Stereotactic radiotherapy slows pancreatic cancer progression

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Depicted are the mass in the pancreatic head (blue), biliary stent (red), arteries (aorta and superior mesenteric artery in orange), extrahepatic portal vein system (green), and liver outline (which is not used for alignments in pancreatic cancer) in yellow. Image source: Gastrointest Cancer Res 2007 Jan–Feb; 1(1): 2–11.

Stereotactic body radiotherapy may slow progression and ease symptoms of pancreatic cancer in medically inoperable patients, providing patients with no curative treatment options extended survival, according to a study presented November 2 at the annual meeting for the American Society for Radiation Oncology (ASTRO) in San Diego.

Approximately 43,000 Americans are expected to be diagnosed with pancreatic cancer in 2010. More than 36,000 of these patients will die from the disease, for which surgery is the only known cure but remains an option for only 23 percent of patients, according to the National Cancer Institute and the study's lead author, Michael Haley, DO, and colleagues of the department of radiation oncology at Henry Ford Hospital in Detroit.

The study included 11 medically inoperable patients with stage I or II pancreatic adenocarcinoma with a median age of 82 years (ranging from 80 to 90 years). The patients were administered three to six fractions of 6, 7 or 12 Gy doses, for cumulative stereotactic doses of 30, 35 or 36 Gy.

Local recurrence as first site of failure was 27.7 percent, with local recurrence plus distant metastasis as first site of failure occurring in 27.7 percent of patients as well. Distant metastasis alone were observed in 9 percent of patients, while 36.3 percent of patients experienced no recurrence within a median followup of 3.7 months.

The median time to progression was 4.3 months; median progression-free survival was recorded at 4.7 months. The median survival for all patients, from diagnosis to death, was 7.4 months.

"While it's not a curative therapy, it does seem to allow some progression-free survival benefit with minimal side effects for patients," commented study co-author, Munther Ajlouni, MD, senior staff physician in Henry Ford Hospital's department of radiation oncology. "Ultimately, we're able to provide a treatment to patients who don't have any other options other than a traditionally prolonged course of radiation, which may not be as effective, and possibly has more side effects."

Two patients experienced grade 3 toxicity with gastric ulcers and one patient was exposed to acute toxicity with loss of appetite, fatigue and weakness, but all three patients recovered.

"Our research establishes stereotactic body radiotherapy as a reasonable treatment option for patients who can't have surgery or aren't candidates for chemotherapy," Haley concluded.