Radiation as a Single-Modality Treatment in Localized Pancreatic Cancer

• Authors: Walid Shaib, Emory University; Katerina Zakka, Emory University; Asser A Shahin, Emory University; Fares Yared, Lebanese University; Jeffrey Switchenko, Emory University; Christina Wu, Emory University; Mehmet Akce, Emory University; Olatunji Alese, Emory University; Pretesh Patel, Emory University; Mark McDonald, Emory University; Bassel El-Rayes, Emory University
• Journal Title: PANCREAS
• Volume: Volume 49, Number 6
• Publisher: LIPPINCOTT WILLIAMS & WILKINS | 2020-07-01, Pages 822-829
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1097/MPA.0000000000001584
• Subjects: Health Sciences, Oncology; Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Gastroenterology & Hepatology; localized stage; radiation; pancreatic cancer; external beam; IMRT; SBRT; STEREOTACTIC BODY RADIOTHERAPY; COOPERATIVE-ONCOLOGY-GROUP; AMERICAN SOCIETY; PHASE-III; THERAPY; ADENOCARCINOMA; GEMCITABINE; 5-FLUOROURACIL; RESECTION; STATISTICS

Abstract

Objectives Locally advanced pancreatic cancer (LAPC) is managed with multimodality therapy. We aim to evaluate the outcome of single-modality radiation therapy for LAPC. Methods Locally advanced pancreatic cancer patients were identified between 2004 and 2013 using the National Cancer Database excluding patients who received chemotherapy or surgery. Results A total of 6590 patients were included. The mean age was 73.5 (range, 28-90) years, 83.2% were white, and 54.4% were female. Tumors of 4 cm or greater (>T3 stage) accounted for 52.7%. The median radiation dose was 39.6 Gy. Stereotactic body radiation (SBRT) delivered to 64 patients and external-beam/intensity modulated radiotherapy in 416 patients. Radiation therapy was associated with improved overall survival (OS) compared with no treatment in univariate and multivariable analyses. The medians OS for patients who received SBRT, external-beam/intensity modulated radiotherapy, or no radiation were 8.6, 6.7, and 3.4 months, respectively (P < 0.001). There is a significant difference in 12-month OS for the SBRT cohort (31.9%; 95% confidence interval [CI], 20.9%-43.5%) compared with patients who received no radiation (15.1%; 95% CI, 14.2%-16.0%), and on multivariable analysis (hazard ratio, 0.50; 95% CI, 0.38-0.65; P < 0.001). Conclusions The current study suggests potential benefit for radiation therapy alone in comparison with no treatment in LAPC. © 2020 Wolters Kluwer Health, Inc. All rights reserved.