Table 5.
Selected Studies of Stereotactic Body Radiation Therapy for Elderly Patients with Pancreas Adenocarcinoma.
| Study | Median Age at Dx (range) | RT Modality | Image Guidance | Gating | Stage | N | Median BED10 (range) Fx range | Median FU, m | Treatment | Overall survival | Local control | Acute toxicity Grading Scale | Late toxicity |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Yechieli et al. 20171 | 83.2 y (77-90 y) | SBRT | Orthogonal portal films | NR | IA-IIIB | 20 | 59.5 Gy (48-79.2 Gy) | 5.3 | RT: 90% Surg+RT: 10% |
Median: 6.4 m 2-year: 7.7% |
LC:NR | G3+: 0% CTCAE v4.0 |
G2+: 15% |
| 3-5 Fx | |||||||||||||
| Zhu et al. 20172 |
73 y (65-90 y) | SBRT | CBCT | Respiratory tracking system | II-IV | 417 | NR (48-74.2 Gy) | 11 | CTX+RT: 24.3% CTX+Surg+RT: 3.4% Surg+RT: 9.4% RT: 58.4% Other+RT: 7.9% |
Median: 10 m 1-year: 35.5% |
Median: 10 m 1-year: 26.6% |
G3+: .5% RTOG |
G3+: 0% |
| 5-8 Fx | |||||||||||||
| Kim et al. 20133 | 86 y (80-91 y) | SBRT | CBCT | Respiratory tracking system | I-IV | 26 | 81.6 Gy (70.4-87.5 Gy) | 11.6 | CTX+RT: 15% RT+CTX: 23% RT: 62% |
Median: 7.6 m 2-year: 6.6% |
Median LC: 11.5 m | G3+: .0% NR |
G2+: .0% |
| 1-3 Fx | |||||||||||||
| Sutera et al. 20184 | 79 y (70-90 y) | SBRT | CBCT | NR | I-III | 145 | Single Fx (37%) 81.6 Gy (50.4 – 87.5 Gy) 68 Gy (42-72.9 Gy) |
12.3 | CTX+RT: 42.1% CRT: 3.4% RT+CTX: 37% RT: 17.5% Surg: 33.8%* |
Median: 14 m 1-year: 60% 2-year: 27% |
1-year LC: 72% 2-year LC: 63% |
G3+: .7% CTCAE v4.0 |
G2+: 2% |
| Multiple Fx (63%) 79.2 Gy (5m1.3-79.2 Gy) 66 Gy (42.8-66 Gy) | |||||||||||||
| Ryan et al. 20185 | 74 y (IQR, 68-79) | SBRT | Orthogonal portal films | Active breathing control | NR | 29 | 43.7 Gy (IQR, 37.5-54.8 Gy) | 15 | CTX+RT: 52% RT+CTX: 7% CTX+RT+CTX: 24% RT: 17% |
Median: 8 m 1-year: 28% |
Median: Not reached 1-year LC: 78% |
G2+: 41 CTCAE |
G2and3: 0% G4: 4% |
| 5 Fx | |||||||||||||
| Reddy et al. 20226 | 74 y (70-84 y) | SBRT | Pretreatment and intrafractional CBCT | Respiratory tracking system | II-III | 57 | 54.8 Gy (48 – 61.9 Gy) | 13.5 | CTX+RT: 33% CTX+RT+Surg: 67% |
Median: 19.6 m 1-year: 66.5% 2-year: 42.4% |
Median: 18.7 m 1-year: 73.3% 2-year: 44.6% |
G3+: 0% CTCAE |
G3+: 5% |
| 5 Fx | |||||||||||||
| Current study | 81 y (75-91 y) | A-SMART | MRI | Real time MR gating | I-III | 49 | 100 Gy (72-100 Gy) | 14 | RT: 6% CTX RT: 76% CTX+RT+Surg: 8% RT+Surg: 10% |
Median: 18 m 1-year: 59.9% |
Median: 24 m 1-year: 81.9% |
G3+: 8.2% CTCAE v5.0 |
G3+: 4.1% |
| 5 Fx |
BED10: biologically effect dose with alpha/beta ratio of 10; CBCT: cone-beam computerized tomography; CCRT: chemoradiotherapy; CTX: chemotherapy; CTCAE: Common Terminology Criteria for adverse Events; 3D-CRT: three dimensional conformal radiotherapy; Dx: Diagnosis; FU: follow-up; Fx: Fraction(s); IMRT: intensity modulated radiotherapy; IQR: interquartile range; LC: local control; LRC: locoregional control; m: month(s); NR: not reported; OS: overall survival; RT: radiotherapy; RTOG: Radiation Therapy Oncology Group; SBRT: stereotactic body radiotherapy; A-SMART: ablative stereotactic magnetic resonance image-guided adaptive radiation therapy; Surg: surgery; y: year(s)
aCombination of surgery with either SBRT or CTX is not reported.