Stereotactic body radiotherapy in the treatment of pancreatic adenocarcinoma in elderly patients
Treatment of pancreatic adenocarcinoma in the elderly is often complicated by comorbidities that preclude surgery, chemotherapy and/or conventional external beam radiation therapy (EBRT). Stereotactic body radiotherapy (SBRT) has thus garnered interest in this setting. A retrospective review of 26 p...
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| Veröffentlicht in: | Radiation oncology (London, England) England), 2013-10, Vol.8 (1), p.240-240, Article 240 |
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| creator | Kim, Carolyn H Ling, Diane C Wegner, Rodney E Flickinger, John C Heron, Dwight E Zeh, Herbert Moser, Arthur J Burton, Steven A |
| description | Treatment of pancreatic adenocarcinoma in the elderly is often complicated by comorbidities that preclude surgery, chemotherapy and/or conventional external beam radiation therapy (EBRT). Stereotactic body radiotherapy (SBRT) has thus garnered interest in this setting.
A retrospective review of 26 patients of age ≥ 80 with pancreatic adenocarcinoma treated with definitive SBRT+/-chemotherapy from 2007-2011 was performed. Twenty-seven percent of patients were stage I, 38% were stage II, 27% were stage III and 8% were stage IV. Patients most commonly received 24 Gy/1 fraction or 30-36 Gy/3 fractions. Kaplan-Meier was used to estimate overall survival (OS), local control (LC), cause specific survival (CSS) and freedom-from-metastatic disease (FFMD).
The median age was 86 (range 80-91), and median follow-up was 11.6 months (3.5-24.6). The median planning target volume was 21.48 cm3 (6.1-85.09). Median OS was 7.6 months with 6/12 month OS rates of 65.4%/34.6%, respectively. Median LC was 11.5 months, 6-month and 12-month actuarial LC rates were 60.1% and 41.2%, respectively. There were no independent predictors for LC, but there was a trend for improved LC with prescription dose greater than 20 Gy (p = 0.063). Median CSS was 6.3 months, and 6-month and 12-month actuarial CSS were 53.8% and 23.1%, respectively. Median FFMD was 8.4 months, and 6-month and 12-month actuarial rates were 62.0% and 41.4%, respectively. Nine patients (47%) had local failures, 11 (58%) had distant metastasis, and 7 (37%) had both. There were no acute or late grade 3+ toxicities.
Definitive SBRT is feasible, safe and effective in elderly patients who have unresectable disease, have comorbidities precluding surgery or decline surgery. |
| doi_str_mv | 10.1186/1748-717X-8-240 |
| format | Article |
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A retrospective review of 26 patients of age ≥ 80 with pancreatic adenocarcinoma treated with definitive SBRT+/-chemotherapy from 2007-2011 was performed. Twenty-seven percent of patients were stage I, 38% were stage II, 27% were stage III and 8% were stage IV. Patients most commonly received 24 Gy/1 fraction or 30-36 Gy/3 fractions. Kaplan-Meier was used to estimate overall survival (OS), local control (LC), cause specific survival (CSS) and freedom-from-metastatic disease (FFMD).
The median age was 86 (range 80-91), and median follow-up was 11.6 months (3.5-24.6). The median planning target volume was 21.48 cm3 (6.1-85.09). Median OS was 7.6 months with 6/12 month OS rates of 65.4%/34.6%, respectively. Median LC was 11.5 months, 6-month and 12-month actuarial LC rates were 60.1% and 41.2%, respectively. There were no independent predictors for LC, but there was a trend for improved LC with prescription dose greater than 20 Gy (p = 0.063). Median CSS was 6.3 months, and 6-month and 12-month actuarial CSS were 53.8% and 23.1%, respectively. Median FFMD was 8.4 months, and 6-month and 12-month actuarial rates were 62.0% and 41.4%, respectively. Nine patients (47%) had local failures, 11 (58%) had distant metastasis, and 7 (37%) had both. There were no acute or late grade 3+ toxicities.
Definitive SBRT is feasible, safe and effective in elderly patients who have unresectable disease, have comorbidities precluding surgery or decline surgery.</description><identifier>ISSN: 1748-717X</identifier><identifier>EISSN: 1748-717X</identifier><identifier>DOI: 10.1186/1748-717X-8-240</identifier><identifier>PMID: 24131503</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Abdomen ; Adenocarcinoma - mortality ; Adenocarcinoma - surgery ; Aged patients ; Aged, 80 and over ; Anorexia ; Back pain ; Cancer therapies ; Chemotherapy ; Comorbidity ; Disease ; Disease-Free Survival ; Female ; Health aspects ; Humans ; Kaplan-Meier Estimate ; Male ; Medical equipment and supplies industry ; Medical test kit industry ; Medical treatment ; Metastasis ; Mortality ; Older people ; Oncology ; Pancreas ; Pancreatic cancer ; Pancreatic Neoplasms - mortality ; Pancreatic Neoplasms - surgery ; Patient safety ; Radiation therapy ; Radiosurgery - methods ; Radiotherapy ; Retrospective Studies ; Spinal cord ; Statistical analysis ; Studies ; Surgery ; Tumors</subject><ispartof>Radiation oncology (London, England), 2013-10, Vol.8 (1), p.240-240, Article 240</ispartof><rights>COPYRIGHT 2013 BioMed Central Ltd.</rights><rights>2013 Kim et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</rights><rights>Copyright © 2013 Kim et al.; licensee BioMed Central Ltd. 2013 Kim et al.; licensee BioMed Central Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b613t-8f5cf745fbef3adcf726abf644b564539427e345a409b17ef6689a9980115c6a3</citedby><cites>FETCH-LOGICAL-b613t-8f5cf745fbef3adcf726abf644b564539427e345a409b17ef6689a9980115c6a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4015447/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4015447/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27903,27904,53770,53772</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24131503$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kim, Carolyn H</creatorcontrib><creatorcontrib>Ling, Diane C</creatorcontrib><creatorcontrib>Wegner, Rodney E</creatorcontrib><creatorcontrib>Flickinger, John C</creatorcontrib><creatorcontrib>Heron, Dwight E</creatorcontrib><creatorcontrib>Zeh, Herbert</creatorcontrib><creatorcontrib>Moser, Arthur J</creatorcontrib><creatorcontrib>Burton, Steven A</creatorcontrib><title>Stereotactic body radiotherapy in the treatment of pancreatic adenocarcinoma in elderly patients</title><title>Radiation oncology (London, England)</title><addtitle>Radiat Oncol</addtitle><description>Treatment of pancreatic adenocarcinoma in the elderly is often complicated by comorbidities that preclude surgery, chemotherapy and/or conventional external beam radiation therapy (EBRT). Stereotactic body radiotherapy (SBRT) has thus garnered interest in this setting.
A retrospective review of 26 patients of age ≥ 80 with pancreatic adenocarcinoma treated with definitive SBRT+/-chemotherapy from 2007-2011 was performed. Twenty-seven percent of patients were stage I, 38% were stage II, 27% were stage III and 8% were stage IV. Patients most commonly received 24 Gy/1 fraction or 30-36 Gy/3 fractions. Kaplan-Meier was used to estimate overall survival (OS), local control (LC), cause specific survival (CSS) and freedom-from-metastatic disease (FFMD).
The median age was 86 (range 80-91), and median follow-up was 11.6 months (3.5-24.6). The median planning target volume was 21.48 cm3 (6.1-85.09). Median OS was 7.6 months with 6/12 month OS rates of 65.4%/34.6%, respectively. Median LC was 11.5 months, 6-month and 12-month actuarial LC rates were 60.1% and 41.2%, respectively. There were no independent predictors for LC, but there was a trend for improved LC with prescription dose greater than 20 Gy (p = 0.063). Median CSS was 6.3 months, and 6-month and 12-month actuarial CSS were 53.8% and 23.1%, respectively. Median FFMD was 8.4 months, and 6-month and 12-month actuarial rates were 62.0% and 41.4%, respectively. Nine patients (47%) had local failures, 11 (58%) had distant metastasis, and 7 (37%) had both. There were no acute or late grade 3+ toxicities.
Definitive SBRT is feasible, safe and effective in elderly patients who have unresectable disease, have comorbidities precluding surgery or decline surgery.</description><subject>Abdomen</subject><subject>Adenocarcinoma - mortality</subject><subject>Adenocarcinoma - surgery</subject><subject>Aged patients</subject><subject>Aged, 80 and over</subject><subject>Anorexia</subject><subject>Back pain</subject><subject>Cancer therapies</subject><subject>Chemotherapy</subject><subject>Comorbidity</subject><subject>Disease</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Medical equipment and supplies industry</subject><subject>Medical test kit industry</subject><subject>Medical treatment</subject><subject>Metastasis</subject><subject>Mortality</subject><subject>Older people</subject><subject>Oncology</subject><subject>Pancreas</subject><subject>Pancreatic cancer</subject><subject>Pancreatic Neoplasms - mortality</subject><subject>Pancreatic Neoplasms - surgery</subject><subject>Patient safety</subject><subject>Radiation therapy</subject><subject>Radiosurgery - methods</subject><subject>Radiotherapy</subject><subject>Retrospective Studies</subject><subject>Spinal cord</subject><subject>Statistical analysis</subject><subject>Studies</subject><subject>Surgery</subject><subject>Tumors</subject><issn>1748-717X</issn><issn>1748-717X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNp1Uk1P3DAQtRCofLRnblUkzgE7_khyqQSIlkpIHGil3tyJMwajxF4cL9L-exwt3bISyAfPx5vn56ch5JjRU8YadcZq0ZQ1q_-UTVkJukMONpXdN_E-OZymR0qF5LT9RPYrwTiTlB-Qv3cJI4YEJjlTdKFfFRF6F9IDRlisCueLHBYpIqQRfSqCLRbgzZznAejRBwPROB9GmNE49BiHVQYll_HTZ7JnYZjwy-t9RH5_v_p1eV3e3P74eXl-U3aK8VQ2VhpbC2k7tBz6HFcKOquE6KTKsltR1ciFBEHbjtVolWpaaNuGMiaNAn5Evq15F8tuxN7ktyMMehHdCHGlAzi93fHuQd-HZy0ok0LUmeBiTdC58AHBdseEUc8O69lh3ejsfyY5eVURw9MSp6QfwzL6_HHNhJAVo03L_qPuYUDtvA2Z0IxuMvpcclEzyVWbUafvoPLpcXQmeLQu17cGztYDJoZpimg34hnV87q8I_frW9M2-H_7wV8Aibu8oA</recordid><startdate>20131016</startdate><enddate>20131016</enddate><creator>Kim, Carolyn H</creator><creator>Ling, Diane C</creator><creator>Wegner, Rodney E</creator><creator>Flickinger, John C</creator><creator>Heron, Dwight E</creator><creator>Zeh, Herbert</creator><creator>Moser, Arthur J</creator><creator>Burton, Steven A</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>P64</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>5PM</scope></search><sort><creationdate>20131016</creationdate><title>Stereotactic body radiotherapy in the treatment of pancreatic adenocarcinoma in elderly patients</title><author>Kim, Carolyn H ; Ling, Diane C ; Wegner, Rodney E ; Flickinger, John C ; Heron, Dwight E ; Zeh, Herbert ; Moser, Arthur J ; Burton, Steven A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b613t-8f5cf745fbef3adcf726abf644b564539427e345a409b17ef6689a9980115c6a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Abdomen</topic><topic>Adenocarcinoma - mortality</topic><topic>Adenocarcinoma - surgery</topic><topic>Aged patients</topic><topic>Aged, 80 and over</topic><topic>Anorexia</topic><topic>Back pain</topic><topic>Cancer therapies</topic><topic>Chemotherapy</topic><topic>Comorbidity</topic><topic>Disease</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Health aspects</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Medical equipment and supplies industry</topic><topic>Medical test kit industry</topic><topic>Medical treatment</topic><topic>Metastasis</topic><topic>Mortality</topic><topic>Older people</topic><topic>Oncology</topic><topic>Pancreas</topic><topic>Pancreatic cancer</topic><topic>Pancreatic Neoplasms - mortality</topic><topic>Pancreatic Neoplasms - surgery</topic><topic>Patient safety</topic><topic>Radiation therapy</topic><topic>Radiosurgery - methods</topic><topic>Radiotherapy</topic><topic>Retrospective Studies</topic><topic>Spinal cord</topic><topic>Statistical analysis</topic><topic>Studies</topic><topic>Surgery</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kim, Carolyn H</creatorcontrib><creatorcontrib>Ling, Diane C</creatorcontrib><creatorcontrib>Wegner, Rodney E</creatorcontrib><creatorcontrib>Flickinger, John C</creatorcontrib><creatorcontrib>Heron, Dwight E</creatorcontrib><creatorcontrib>Zeh, Herbert</creatorcontrib><creatorcontrib>Moser, Arthur J</creatorcontrib><creatorcontrib>Burton, Steven A</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Radiation oncology (London, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kim, Carolyn H</au><au>Ling, Diane C</au><au>Wegner, Rodney E</au><au>Flickinger, John C</au><au>Heron, Dwight E</au><au>Zeh, Herbert</au><au>Moser, Arthur J</au><au>Burton, Steven A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Stereotactic body radiotherapy in the treatment of pancreatic adenocarcinoma in elderly patients</atitle><jtitle>Radiation oncology (London, England)</jtitle><addtitle>Radiat Oncol</addtitle><date>2013-10-16</date><risdate>2013</risdate><volume>8</volume><issue>1</issue><spage>240</spage><epage>240</epage><pages>240-240</pages><artnum>240</artnum><issn>1748-717X</issn><eissn>1748-717X</eissn><abstract>Treatment of pancreatic adenocarcinoma in the elderly is often complicated by comorbidities that preclude surgery, chemotherapy and/or conventional external beam radiation therapy (EBRT). Stereotactic body radiotherapy (SBRT) has thus garnered interest in this setting.
A retrospective review of 26 patients of age ≥ 80 with pancreatic adenocarcinoma treated with definitive SBRT+/-chemotherapy from 2007-2011 was performed. Twenty-seven percent of patients were stage I, 38% were stage II, 27% were stage III and 8% were stage IV. Patients most commonly received 24 Gy/1 fraction or 30-36 Gy/3 fractions. Kaplan-Meier was used to estimate overall survival (OS), local control (LC), cause specific survival (CSS) and freedom-from-metastatic disease (FFMD).
The median age was 86 (range 80-91), and median follow-up was 11.6 months (3.5-24.6). The median planning target volume was 21.48 cm3 (6.1-85.09). Median OS was 7.6 months with 6/12 month OS rates of 65.4%/34.6%, respectively. Median LC was 11.5 months, 6-month and 12-month actuarial LC rates were 60.1% and 41.2%, respectively. There were no independent predictors for LC, but there was a trend for improved LC with prescription dose greater than 20 Gy (p = 0.063). Median CSS was 6.3 months, and 6-month and 12-month actuarial CSS were 53.8% and 23.1%, respectively. Median FFMD was 8.4 months, and 6-month and 12-month actuarial rates were 62.0% and 41.4%, respectively. Nine patients (47%) had local failures, 11 (58%) had distant metastasis, and 7 (37%) had both. There were no acute or late grade 3+ toxicities.
Definitive SBRT is feasible, safe and effective in elderly patients who have unresectable disease, have comorbidities precluding surgery or decline surgery.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>24131503</pmid><doi>10.1186/1748-717X-8-240</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; PubMed Central Open Access; Springer Nature OA Free Journals; Springer Nature - Complete Springer Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Abdomen Adenocarcinoma - mortality Adenocarcinoma - surgery Aged patients Aged, 80 and over Anorexia Back pain Cancer therapies Chemotherapy Comorbidity Disease Disease-Free Survival Female Health aspects Humans Kaplan-Meier Estimate Male Medical equipment and supplies industry Medical test kit industry Medical treatment Metastasis Mortality Older people Oncology Pancreas Pancreatic cancer Pancreatic Neoplasms - mortality Pancreatic Neoplasms - surgery Patient safety Radiation therapy Radiosurgery - methods Radiotherapy Retrospective Studies Spinal cord Statistical analysis Studies Surgery Tumors |
| title | Stereotactic body radiotherapy in the treatment of pancreatic adenocarcinoma in elderly patients |
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