Local control in resectable and borderline resectable pancreatic cancer (PCa) treated with preoperative chemoradiation using IMRT or chemotherapy alone.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 282-282
Author(s):  
Jordan Kharofa ◽  
Tracy R. Kelly ◽  
Ben George ◽  
Paul S. Ritch ◽  
Susan Tsai ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Local Control ◽  
Primary Objective ◽  
Preoperative Chemoradiation ◽  
Local Failure ◽  
Resectable Pancreatic Cancer ◽  
Borderline Resectable ◽  
Failure Patterns ◽  
Free Interval ◽  
Target Volumes

282 Background: The primary objective is to review local control and failure patterns in PCa patients treated with preoperative chemoradiation (chemoXRT) using IMRT compared to patients treated with chemotherapy alone. Methods: All patients with resectable and borderline resectable PCa treated between 1/1/2009 -11/1/2011 were reviewed. During the study period, 68 patients (40 borderline resectable, 28 resectable) were treated with preoperative chemoXRT (50.4 Gy [1.8 Gy/fx] with concurrent gemcitabine [n=59] or capecitabine [n=7]). 12 patients with resectable tumors received gemcitabine based chemotherapy alone and did not receive radiation therapy due to enrollment on chemotherapy only protocols (n=10) or to patient preference (n=2). Radiation was delivered to a CTV that includes the primary mass, the SMA and SMV, +/- the celiac axis. A 4D-CT and daily image guidance were used in all patients. The local failure free interval was defined as the time from surgical resection to local failure or last documented CT scan of the abdomen with no evidence of local disease progression. Results: Following preoperative chemoXRT, 48/68 patients underwent resection with 47(98%) R0 resections. 11/12 patients in the No XRT group undwerent resection with 10 (91%) R0 resections. In the No XRT group, 8/11 (73%) patients failed locally at the SMA/SMV or resection bed as a component of first failure compared to 1/48 (2%) patients who received preoperative chemoXRT (p<0.001). Local failure was the sole site of first failure in 5/11 patients in the No XRT group and 0/48 patients who received preoperative chemoXRT. The actuarial rate of local failure 1 year from surgery was 5% in the preoperative chemoXRT group vs 27% in the No XRT group (p<0.001). All local failures in the No XRT group would have been encompassed using the CTV target volumes used in patients treated with preoperative chemoXRT. Conclusions: IMRT-based, conformal, preoperative chemoXRT for resectable and borderline resectable PCa may facilitate margin negative resection and increase local control. Omission of radiation therapy may result in high rates of local failures at the SMA/SMV vasculature or in the pancreatic bed.

scholarly journals Preoperative Chemoradiation for Borderline Resectable Pancreatic Cancer

2018 ◽  
Vol 268 (2) ◽  
pp. 223-224 ◽  
Author(s):  
Matthew HG Katz ◽  
Michael P. Kim ◽  
Ching-Wei Tzeng ◽  
Jeffrey E. Lee
Keyword(s):  
Pancreatic Cancer ◽  
Preoperative Chemoradiation ◽  
Resectable Pancreatic Cancer ◽  
Borderline Resectable ◽  
Borderline Resectable Pancreatic Cancer

Alliance for clinical trials in oncology trial A021501: Preoperative extended chemotherapy vs. chemotherapy plus hypofractionated radiation therapy for borderline resectable adenocarcinoma of the head of the pancreas.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. TPS4151-TPS4151 ◽  
Author(s):  
Matthew H. G. Katz ◽  
Fang-Shu Ou ◽  
Joseph Herman ◽  
Syed A. Ahmad ◽  
Brian M. Wolpin ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Radiation Therapy ◽  
De Novo ◽  
Phase Iii ◽  
Ductal Adenocarcinoma ◽  
R0 Resection ◽  
Preoperative Treatment ◽  
Resectable Pancreatic Cancer ◽  
Borderline Resectable ◽  
Oncology Trial

TPS4151 Background: Borderline resectable pancreatic cancers infiltrate into adjacent vascular structures to an extent that makes an R0 resection unlikely when pancreatectomy is performed de novo. In a pilot study, Alliance for Clinical Trials in Oncology Trial A021101, the median survival of patients who received chemotherapy and radiation prior to anticipated pancreatectomy was 22 months, and an R0 resection was achieved in 64% of operations. However, the individual contributions of preoperative chemotherapy and radiation therapy are poorly defined.This study, Alliance for Clinical Oncology Trial A021501, will help define a standard preoperative treatment regimen for borderline resectable pancreatic cancer and position the superior arm for further evaluation in future phase III trials. Methods: In this recently activated randomized phase II trial, 134 patients with a biopsy-confirmed pancreatic ductal adenocarcinoma that meets centrally-reviewed radiographic criteria for borderline resectable disease are randomized to receive either 8 cycles of modified FOLFIRINOX (oxaliplatin 85 mg/m2, irinotecan 180 mg/m2, leucovorin 400 mg/m2 and infusional 5-fluorouracil 2400 mg/m2 for 4 cycles) or to 7 cycles of modified FOLFIRINOX followed by stereotactic body radiation therapy (33-40 Gy in 5 fractions). Patients without evidence of disease progression following preoperative therapy undergo pancreatectomy and subsequently receive 4 cycles of postoperative modified FOLFOX6 (oxaliplatin 85 mg/m2, leucovorin 400 mg/m2 and infusional 5-fluorouracil 2400 mg/m2 for 4 cycles). The primary endpoint is the 18-month overall survival rate of patients enrolled into each of the two treatment arms. An interim analysis of the R0 resection rate within each arm will be conducted to assess treatment futility after accrual of 30 patients. Secondary endpoints include rates of margin-negative resection and event-free survival. The trial is activated nationwide and eligible to be opened for accrual at any National Clinical Trials Network cooperative group member site. Clinical trial information: NCT02839343.

Hypofractionated radiation therapy for unresectable/locally recurrent intrahepatic cholangiocarcinoma.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 412-412 ◽  
Author(s):  
Alicia Smart ◽  
Theodore S. Hong ◽  
Natasa Petkovska ◽  
Bridget N. Noe ◽  
Andrew X. Zhu ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Local Control ◽  
Intrahepatic Cholangiocarcinoma ◽  
Multivariate Analyses ◽  
Female Gender ◽  
Local Failure ◽  
Photon Radiation ◽  
Prior Chemotherapy ◽  
Younger Age ◽  
Locally Recurrent

412 Background: Our objective was to evaluate outcomes for patients with unresectable/locally recurrent intrahepatic cholangiocarcinoma (ICC) treated with hypofractionated proton or photon radiation therapy (HF-RT). Methods: We retrospectively identified 66 patients with ICC who were treated with HF-RT from 2008-18. 51 patients had intrahepatic disease only, and 15 patients had extrahepatic disease at time of RT but received RT for biliary control. Median age at RT was 76 years (range: 30-92), including 27 patients (41%) ≥ 80 years. Median RT dose was 58.05 Gy (range: 37.5-67.5), delivered in 15 daily fractions. 32 patients received proton RT, and 34 patients received photon RT. Rates of local control (LC), progression-free survival (PFS), and overall survival (OS) were calculated by the Kaplan-Meier method. Univariate and multivariate analyses were conducted using the Cox proportional hazards method. For multivariate analyses, variables with p < 0.5 on univariate analysis were evaluated by backwards selection. Results: Median follow-up times from diagnosis and RT start were 21 and 14 months, respectively. In total, 5 patients (7.6%) developed local failure. Only 1 patient developed isolated local failure. The 2-yr outcomes were 93% LC, 37% PFS, and 55% OS. Among the 51 patients treated with definitive intent, the 2-yr LC was 96%, PFS 35%, OS 60%. Receipt of protons was significantly associated with younger age (p = 0.02), but not gender, race, ECOG status, metastatic disease at presentation, mean liver dose, cumulative GTV, or number of lesions. There were no significant predictors of LC or PFS, including RT dose. On UVA for OS, younger age, female gender, prior chemotherapy, prior surgery, and proton RT were associated with improved OS (p < 0.05). On MVA, female gender (HR: 0.33, p = 0.001), prior chemotherapy (HR: 0.38, p = 0.002), and proton vs. photon RT (HR: 0.50, p = 0.05) remained significantly associated with OS. Conclusions: HF-RT yields high rates of local control and is an effective modality to optimize biliary control for unresectable/locally recurrent IC. HF-RT should be considered for elderly patients who are considered medically inoperable. Proton RT and chemotherapy may further improve outcomes.

Comparison of radiation treatment volumes for borderline resectable pancreatic cancer.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 440-440
Author(s):  
Trevor Scott Bluemel ◽  
Jordan Kharofa
Keyword(s):  
Pancreatic Cancer ◽  
High Risk ◽  
Local Recurrence ◽  
Radiation Treatment ◽  
Prospective Trial ◽  
Resectable Pancreatic Cancer ◽  
Borderline Resectable ◽  
Borderline Resectable Pancreatic Cancer ◽  
Target Volumes ◽  
Prospective Trials

440 Background: Optimal radiation target volumes for downstaging and local control in patients with borderline resectable pancreatic cancer (BRPCa) are undefined. Most local recurrences are near the celiac axis (CA) and superior mesenteric artery (SMA), as demonstrated by pattern of failure mapping (Dholakia et al IJROBP 2013). Methods for generating target volumes include symmetric margins around the tumor or a customized approach. We investigated three current prospective trials’ coverage of vascular regions at risk of recurrence. Methods: CT simulation scans of 14 patients with BRPCa from an institutional prospective trial were used to create treatment volumes for comparison. Treatment volumes from three current prospective trials (PREOPANC, Alliance A021101, and Alliance A021501) were generated for each patient based upon their respective protocols. The trials’ volumes were compared to two reference volumes created for coverage evaluation. A customized vasculature (CustVasc) CTV was based on the CA, SMA, and vessels abutting the tumor. The Hopkins PTV reference volume was based upon the proximal 1 cm of the CA and 3 cm of the SMA, and expanded according to the study’s protocol. Boolean operators located regions the three prospective trials would not provide treatment when compared to reference volumes. Results: Table outlines the target volumes and the proportion of the CustVascPTV and Hopkins PTV covered by each trial definition. Conclusions: Symmetric expansion from the primary tumor to generate target volumes may not adequately cover the mesenteric vasculature which is at high risk of local recurrence and varies based on patient/tumor anatomy. An approach utilizing a customized target volume that specifically includes the SMA and CA will improve coverage to this region at high risk of local recurrence.[Table: see text]

Carcinoma of the ampulla of Vater: Patterns of failure after resection and benefit of adjuvant radiotherapy.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 254-254
Author(s):  
M. Palta ◽  
C. G. Willett ◽  
P. Patel ◽  
D. S. Tyler ◽  
H. E. Uronis ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Local Control ◽  
Survival Rates ◽  
Radical Resection ◽  
Ampulla Of Vater ◽  
Ampullary Carcinoma ◽  
Local Failure ◽  
Term Survival ◽  
Free Survival ◽  
Significant Difference

254 Background: Ampullary carcinoma is a rare malignancy. Despite radical resection, survival rates remain low with high rates of local failure. To define the role of radiation therapy and chemotherapy with surgery, we performed a single institution analysis of treatment- related outcomes. Methods: A retrospective analysis was performed of all patients undergoing potentially curative therapy for adenocarcinoma of the ampulla of Vater at Duke University Hospitals between 1975 and 2009. Local control (LC), overall survival (OS), disease-free survival (DFS), and metastases-free survival (MFS) were estimated using the Kaplan-Meier Method. Results: One hundred thirty-seven patients with ampullary carcinoma underwent potentially curative pancreaticoduodenectomy. Sixty-one patients undergoing resection received adjuvant (n= 43) or neoadjuvant (n=18) radiation therapy with concurrent chemotherapy (CRT). Patients receiving radiotherapy were more likely to have poorly differentiated tumors. Median radiation dose was 50 Gy. Median follow up was 8.8 years. Of patients receiving neoadjuvant therapy, 67% were downstaged on final pathology with 28% achieving pathologic complete response. Three-year local control was significantly improved in patients receiving CRT (88% vs. 55% p= 0.001) with trend toward a 3-year OS benefit in patients receiving CRT (62% vs. 46% p=0.074). Despite this, there was no significant difference in 3-year DFS (66% CRT vs 48% surgery alone p=0.09) or MFS (69% CRT vs 63% surgery alone p=0.337). Conclusions: Long term survival rates are low. Local failure rates are high following radical resection alone and improved with CRT. Despite more adverse pathologic features in patients receiving CRT, survival outcomes were at least equivalent with a trend toward statistical significance. Given the patterns of relapse with surgery alone and local control benefit in patients receiving CRT, the use of chemoradiotherapy in selected patients should be considered. No significant financial relationships to disclose.

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