Table 1.
Summary of current literature for SBRT in locally advanced pancreatic cancer
| Study | Nature of study and number of patients | Dose/fractionation | Outcomes | Acute toxicity (≥ Grade 3) | Toxicity (≥ Grade 3) |
|---|---|---|---|---|---|
| Chang et al., 2009 (7) | Retrospective, 77 (LAPC) | 25 Gy/1 fraction | 1-year FFLP: 84%; 1-year PFS: 9%; 1-year OS: 21% | Gastric ulcer [1] | Gastric ulcer [3], duodenal stricture [1], biliary stricture [2] |
| Chuong et al., 2013 (8) | Retrospective, 73 (LAPC and borderline) | 25 Gy/5 fractions | 1-year PFS: 42.8% (borderline), 41% (LAPC); 1-year OS: 72.2% (borderline), 68.1% (LAPC) | GI bleeding [3], anorexia [1] | |
| Comito et al., 2017 (9) | Phase II, 45 (LAPC) | 45 Gy/6 fractions | 2-year FFLP: 90%; median OS: 23.5 months | None | |
| Gurka et al., 2017 (10) | Retrospective 38 (LAPC and borderline) | 25–30 Gy/5 fractions | 6-month FFLP: 82%; median PFS: 6.8 months; median OS: 12.3 months | Gastric outlet obstruction [1], biliary obstruction [1], GI bleeding (1-Grade 5) | |
| Herman et al., 2015 (11) | Phase II 49 (LAPC) | 33 Gy/5 fractions | 1-year FFLP: 78%; 1-year PFS: 32%; 2-year PFS: 10%; 1-year OS: 59%; 2-year OS: 18% | Duodenal ulcer [1], elevated liver function tests [5] | Fistula [1], ulcer [3] |
| Mahadevan et al., 2011 (12) | Retrospective 39 (LAPC) | 24–36 Gy/3 fractions | Local control 85% (median follow-up: 21 months); median DFS: 15 months median OS: 20 months | GI bleeding [2], gastric outlet obstruction [1] | |
| Mellon et al., 2015 (13) | Retrospective 159 (LAPC and borderline) | 28–30 Gy/5 fractions | Median OS: 19.2 months (borderline), 15 months (LAPC) | GI bleeding [6] | |
| Pollom et al., 2014 (14) | Retrospective 167 (LAPC) | 25 Gy/1 fraction [76]; 25–45 Gy/5 fraction [91] | 1-year OS: 33.1% | GI bleed [1], gastric ulcer [1] | Duodenal perforation [3], biliary stricture [1], gastric ulcer [4], GI bleed [1], duodenal ulcer [2], duodenal stricture [2] |
| Schellenberg et al., 2008 (6) | Phase II 16 (LAPC) | 25 Gy/1 fraction | 1-year OS: 50%; median OS: 11.4 months | Gastric outlet obstruction [1] | Acute: gastric outlet obstruction [1] |
| Late: duodenal perforation [1], duodenal stenosis [1] | |||||
| Tozzi et al., 2013 (15) | Prospective, 30, (21 LAPC +9 recurrence post-surgery) | 45 Gy/6 fractions | 1-year FFLP: 77%; 2-year FFLP: 77%; median PFS: 8 months; 1-year OS: 47% | None | |
| Rwigema et al., 2011 (16) | Retrospective 71 (40 LAPC, 11 recurrence post surgery, 8 with metastatic disease, 12 adjuvant treatment) |
18–25 Gy/1–4 fractions | 1-year FFLP: 48.5% (73% in those who received ≥24 Gy vs. 45% in those who had lower doses); 1-year OS: 41%; median OS: 10.3 months | Nausea [1], enteritis [1], gastroparesis [1] | None |
IMRT, intensity modulated radiation therapy; SBRT, stereotactic body radiotherapy; LAPC, locally advanced pancreatic cancer; OS, overall survival; PFS, progression-free survival; FFLP, freedom from local progression; GI, gastrointestinal.