Safety and efficacy of neoadjuvant stereotactic ablative radiotherapy (SABR) in pancreatic cancer
Hyun-Cheol Kang,
Korea Republic of
PO-1309
Abstract
Safety and efficacy of neoadjuvant stereotactic ablative radiotherapy (SABR) in pancreatic cancer
Authors: Jun Yeong Song1, Eui Kyu Chie1,2, Yong-Tae Kim3, Ji Kon Ryu3, Sang Hyub Lee3, Woo Hyun Paik3, In Rae Cho4, Hongbeom Kim4, Jin-Young Jang4, Hyeon-Cheol Kang5
1Seoul National University Hospital, Department of Radiation Oncology, Seoul, Korea Republic of; 2Seoul National University, Cancer Research Institute, Seoul, Korea Republic of; 3Seoul National University Hospital, Department of Internal Medicine, Seoul, Korea Republic of; 4Seoul National University Hospital, Department of Surgery, Seoul, Korea Republic of; 5Seoul National University Hosptial, Department of Radiation Oncology, Seoul, Korea Republic of
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Purpose or Objective
To evaluate the safety
and clinical outcome of neoadjuvant stereotactic ablative radiotherapy (SABR) using
magnetic resonance image guided respiratory-gated adaptive radiotherapy (MRgRg-ART)
in pancreatic cancer.
Material and Methods
We performed a single institution retrospective
review for patients with non-metastatic pancreatic cancer who underwent neoadjuvant
SABR followed by surgical resection. Patients who were considered unresectable
by our multidisciplinary conference received neoadjuvant chemotherapy. After
neoadjuvant chemotherapy, those who were converted resectable received neoadjuvant
SABR. SABR was delivered over 5 consecutive days using MRgRg-ART. Predictive
factors for severe postoperative complications (Clavien-Dindo grade ≥ III) and prognostic factors for overall
survival (OS) were analyzed.
Results
A total of 77
patients were included with a median follow up duration of 10.8 months. The median
value of the prescribed dose to the planning target volume (PTV) was 50 Gy. Sixty-seven
(88.2%) patients had negative resection margin and 12 (15.8%) patients
experienced severe postoperative complications. No clinical or
treatment-related factors were associated with severe postoperative
complication including OAR D1cc (P=.951) and PTV volume (P=.114).
There were four cases of locoregional recurrence and among those, one recurred
within the radiation field resulting in a 12-month local control (LC) rate of
94.3%. Patients who had positive resection margin showed trend towards poorer
OS than those who had negative resection margin (1 year OS, 91,4% vs 75.0%; P = .066).
Conclusion
Neoadjuvant SABR
using MRgRg-ART for pancreatic cancer appears to offer high rates of LC while
maintaining postoperative complications at a tolerable level.