Skip to main content

Advertisement

SpringerLink
Log in

Stereotactic body radiation for pancreatic cancer: results of an international survey of practice patterns

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Objective

Stereotactic body radiotherapy (SBRT) is an emerging treatment option for borderline resectable and locally advanced, unresectable pancreatic cancer (PCA). However, no standardized guidelines for treatment exist and patterns of SBRT use for PCA are unclear.

Methods

Radiation oncologists known to use SBRT in the setting of PCA were invited to complete a 26-item Web-based survey on practice patterns.

Results

Thirty of the 36 (83 %) invited radiation oncologists completed the survey. Of the responders, 86 % treat with 6–8 Gy ×5 fractions. The majority (93 %) of responders use four-dimensional computed tomography (4D-CT) for simulation, with 50 % using gating for breathing motion. Two thirds of radiation oncologists use fiducials for tumor localization. Most (79 %) responders noted an improvement in patient-reported pain after SBRT. Approximately, 59 % report difficulty obtaining insurance clearance for pancreas SBRT in the absence of a clinical trial. The largest variations in practice were related to gross tumor volume (GTV) to planning target volume (PTV) expansions and management of respiratory motion.

Conclusions

SBRT is increasingly used for PCA. The data presented here indicate that the majority of radiation oncologists treat with 6–8 Gy ×5 fractions and use fiducials with 4D-CT simulation for localization and planning. Although the majority of the surveyed physicians prefer SBRT to standard radiation, it may be underutilized due to the difficulty of obtaining insurance approval outside of a clinical trial. Our investigation documents current pancreas SBRT practice patterns and highlights the need for prospective clinical trials as a means to develop consensus guidelines for this emerging treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Wolfgang CL, Herman JM, Laheru DA, et al. (2013) Recent progress in pancreatic cancer. CA Cancer J Clin 63(5):318–348

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ryan DP, Hong TS, Bardeesy N (2014) Pancreatic adenocarcinoma. N Engl J Med 371(11):1039–1049

    Article  CAS  PubMed  Google Scholar 

  3. Iacobuzio-Donahue CA, Fu B, Yachida S, et al. (2009) DPC4 gene status of the primary carcinoma correlates with patterns of failure in patients with pancreatic cancer. J Clin Oncol 27(11):1806–1813

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Loehrer PJS, Feng Y, Cardenes H, et al. (2011) Gemcitabine alone versus gemcitabine plus radiotherapy in patients with locally advanced pancreatic cancer: an eastern cooperative oncology group trial. J Clin Oncol 29(31):4105–4112

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Treatment of locally unresectable carcinoma of the pancreas: comparison of combined-modality therapy (chemotherapy plus radiotherapy) to chemotherapy alone. gastrointestinal tumor study group. J Natl Cancer Inst. 1988;80(10):751–755.

  6. Vincent A, Herman J, Schulick R, Hruban RH, Goggins M (2011) Pancreatic cancer. Lancet 378(9791):607–620

    Article  PubMed  PubMed Central  Google Scholar 

  7. Rwigema JC, Parikh SD, Heron DE, et al. (2011) Stereotactic body radiotherapy in the treatment of advanced adenocarcinoma of the pancreas. Am J Clin Oncol 34(1):63–69

    Article  CAS  PubMed  Google Scholar 

  8. Chuong MD, Springett GM, Freilich JM, et al. (2013) Stereotactic body radiation therapy for locally advanced and borderline resectable pancreatic cancer is effective and well tolerated. Int J Radiat Oncol Biol Phys 86(3):516–522

    Article  PubMed  Google Scholar 

  9. Mahadevan A, Miksad R, Goldstein M, et al. (2011) Induction gemcitabine and stereotactic body radiotherapy for locally advanced nonmetastatic pancreas cancer. Int J Radiat Oncol Biol Phys 81(4):e615–e622

    Article  CAS  PubMed  Google Scholar 

  10. Chang DT, Schellenberg D, Shen J, et al. (2009) Stereotactic radiotherapy for unresectable adenocarcinoma of the pancreas. Cancer 115(3):665–672

    Article  PubMed  Google Scholar 

  11. Herman JM, Koong AC (2014) Stereotactic body radiation therapy: a new standard option for pancreatic cancer? J Natl Compr Cancer Netw 12(10):1489–1493

    Article  Google Scholar 

  12. Herman JM, Chang DT, Goodman KA, et al. (2015) Phase 2 multi-institutional trial evaluating gemcitabine and stereotactic body radiotherapy for patients with locally advanced unresectable pancreatic adenocarcinoma. Cancer 121(7):1128–1137

    Article  CAS  PubMed  Google Scholar 

  13. Pollom EL, Alagappan M, von Eyben R, et al. (2014) Single- versus multifraction stereotactic body radiation therapy for pancreatic adenocarcinoma: outcomes and toxicity. Int J Radiat Oncol Biol Phys 90(4):918–925

    Article  PubMed  Google Scholar 

  14. Brunner TB, Nestle U, Grosu AL, Partridge M (2015) SBRT in pancreatic cancer: what is the therapeutic window? Radiother Oncol 114(1):109–116

    Article  PubMed  Google Scholar 

  15. Koong AC, Le QT, Ho A, et al. (2004) Phase I study of stereotactic radiosurgery in patients with locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 58(4):1017--21

  16. Mahadevan A, Jain S, Goldstein M, et al. (2010) Stereotactic body radiotherapy and gemcitabine for locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 78(3):735--42

  17. Polistina F, Costantin G, Casamassima F, et al. (2010) Unresectable locally advanced pancreatic cancer: a multimodal treatment using neoadjuvant chemoradiotherapy (gemcitabine plus stereotactic radiosurgery) and subsequent surgical exploration. Ann Surg Oncol 17(8):2092--101

  18. Schellenberg D, Kim J, Christman-Skieller C et al. (2011) Single-fraction stereotactic body radiation therapy and sequential gemcitabine for the treatment of locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 81(1):181--8

  19. Tozzi A, Alongi F, Navarria P et al. (2013) SBRT in unresectable advanced pancreatic cancer: preliminary results of a mono-institutional experience. Radiat Oncol 21;8:148

  20. Gurka MK, Kim C, He AR et al. (2014) Stereotactic Body Radiation Therapy (SBRT) Combined With Chemotherapy for Unresected Pancreatic Adenocarcinoma. Am J Clin Oncol. doi:10.1097/COC.0000000000000118

  21. Lominska CE, Unger K, Nasr NM, Haddad N, Gagnon G (2012) Stereotactic body radiation therapy for reirradiation of localized adenocarcinoma of the pancreas. Radiat Oncol 7:74-717X-7-74

  22. Wild AT, Hiniker SM, Chang DT, et al. (2013) Re-irradiation with stereotactic body radiation therapy as a novel treatment option for isolated local recurrence of pancreatic cancer after multimodality therapy: experience from two institutions. J Gastrointest Oncol 4(4):343–351

  23. Dagoglu N, Callery M, Moser J, et al. (2016) Stereotactic body radiotherapy (SBRT) reirradiation for recurrent pancreas cancer. J Cancer 7(3):283–288

    Article  PubMed  PubMed Central  Google Scholar 

  24. Wo JY, Mamon HJ, Ferrone CR, et al. (2014) Phase I study of neoadjuvant accelerated short course radiation therapy with photons and capecitabine for resectable pancreatic cancer. Radiother Oncol 110(1):160–164

    Article  CAS  PubMed  Google Scholar 

  25. Hong TS, Ryan DP, Borger DR, et al. (2014) A phase 1/2 and biomarker study of preoperative short course chemoradiation with proton beam therapy and capecitabine followed by early surgery for resectable pancreatic ductal adenocarcinoma. Int J Radiat Oncol Biol Phys 89(4):830–838

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Lin C, Sasson, AR, Ly, QP: Survival outcome of a phase I trial: hypofractionated stereotactic body radiation therapy concurrent with nelfinavir following gemcitabine and 5FU in patients with locally advanced pancreatic adenocarcinoma. J Clin Oncol 32, 2014 (suppl 3; abstr 284).

  27. Tempero MA, Malafa MP, Al-Hawary M, et al. (2016) Pancreatic adenocarcinoma, version 1.2016. J Natl Compr Canc Netw. 2016 Mar 22.

  28. Balaban EP, Mangu PB, Khorana AA, et al. (2016)Locally Advanced, Unresectable Pancreatic Cancer: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol ;34(22):2654–68

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Johns Hopkins Hospital, Baltimore, MD, USA

    A. Parekh, L. M. Rosati & J. M. Herman

  2. Department of Radiation Oncology, Stanford Cancer Institute, Stanford, CA, USA

    D. T. Chang & A. C. Koong

  3. Department of Radiation Oncology, University of Colorado, Denver, CO, USA

    K. A. Goodman

  4. Department of Surgical Oncology, Johns Hopkins Hospital, Baltimore, MD, USA

    T.M. Pawlik

Authors
  1. A. Parekh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. M. Rosati
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. T. Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K. A. Goodman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T.M. Pawlik
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. C. Koong
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. M. Herman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. M. Herman.

Ethics declarations

Funding

The work was supported by the Department of Radiation Oncology, Johns Hopkins Hospital.

Conflict of interest

A. Parekh declares that she has no conflict of interest. L. M. Rosati declares that she has no conflict of interest. D. T. Chang declares that he has no conflict of interest. K. A. Goodman, MD declares that she has no conflict of interest. T.M. Pawlik declares that he has no conflict of interest. A. C. Koong declares that he has no conflict of interest. J. M. Herman declares that he has no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, formal consent is not required.

Electronic supplementary material

ESM 1

(DOCX 69 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Parekh, A., Rosati, L.M., Chang, D.T. et al. Stereotactic body radiation for pancreatic cancer: results of an international survey of practice patterns. J Radiat Oncol 6, 273–278 (2017). https://doi.org/10.1007/s13566-016-0267-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13566-016-0267-2

Keywords

Search

Navigation