Pancreatic Reirradiation: A Multi-Institutional Retrospective Analysis of Feasibility, Tolerability, and Clinical Outcomes.

IF 1.8 4区医学 Q4 ONCOLOGY

American Journal of Clinical Oncology-Cancer Clinical Trials Pub Date : 2026-10-05 DOI:10.1097/COC.0000000000001381

Helen X Hou, Hannah J Roberts, Priyadarshini S Pathak, Harvey J Mamon, Joseph D Mancias, Harshabad Singh, Motaz Qadan, Carlos Fernandez-Del Castillo, Julie L Koenig, Theodore S Hong, Celia R Blaszkowsky, Lawrence S Blaszkowsky, Aparna R Parikh, Jill N Allen, Jeffrey W Clark, Colin D Weekes, Ritchell van Dams, Jennifer Y Wo

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引用次数: 0

Abstract

Objectives: With improvements in systemic therapy for pancreatic cancer (PC), the role of radiation therapy (RT) to optimize local control has increased. While the tolerability and outcomes for RT for PC are well described, limited data exist on the feasibility and clinical impact after pancreatic reirradiation (re-RT). This study retrospectively reviews a multi-institutional experience of pancreatic re-RT.

Methods: A retrospective analysis of 44 patients treated with pancreatic reirradiation at 2 academic centers between 2012 and 2025 was conducted. The primary study endpoint was local control (LC) from the completion of re-RT. Secondary endpoints included progression-free survival (PFS), distant metastasis-free survival (DMFS), overall survival (OS), and chemotherapy-free (CT-free) interval. Median BED for pancreatic re-RT was 59.5 Gy (range: 8.5 to 97.9) delivered in a median of 20 fractions (range: 3 to 28), with 77.3% (n=34) receiving concurrent chemotherapy. Re-RT techniques included: 3D-CRT (n=5), IMRT/VMAT (n=27), SBRT (n=12), and proton RT (n=3).

Results: Median follow-up after re-RT was 8.0 months (range: 1.0 to 81.1). Among patients alive, the median follow-up was 7.5 months (range: 3.6 to 32.8). 95.5% (42/44) completed re-RT. Following re-RT, 22 patients received further systemic therapy; the median CT-free interval was 5.4 months (range: 0.0 to 35.4). The 6- and 12-month LC from the time of re-RT were 69.6% and 58.5%. The 6-month PFS, DMFS, and OS were 47.7%, 61.0%, and 71.6%, respectively. Acute grade ≥3 toxicities occurred in 2 patients, including anorexia, dysphagia, and GI bleed.

Conclusions: Pancreatic re-RT is feasible and may offer promising local control and time off chemotherapy for selected patients. Future studies should refine patient selection criteria for pancreatic re-RT, and improvements in RT delivery with online adaptive therapy may further minimize toxicity.

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胰腺再照射：可行性、耐受性和临床结果的多机构回顾性分析。

目的：随着胰腺癌（PC）全身治疗的改善，放射治疗（RT）在优化局部控制方面的作用越来越大。虽然对PC的放射治疗的耐受性和结果有很好的描述，但关于胰腺再照射（re-RT）的可行性和临床影响的数据有限。本研究回顾性回顾了多机构胰腺再放射治疗的经验。方法：回顾性分析2012年至2025年在2个学术中心接受胰腺再照射治疗的44例患者。主要研究终点为re-RT完成后的局部对照（LC）。次要终点包括无进展生存期（PFS）、无远处转移生存期（DMFS）、总生存期（OS）和无化疗期（CT-free）。胰腺re-RT的中位BED为59.5 Gy（范围：8.5至97.9），中位分为20个部分（范围：3至28），77.3% （n=34）接受同期化疗。Re-RT技术包括：3D-CRT （n=5）、IMRT/VMAT （n=27）、SBRT （n=12）和质子RT （n=3）。结果：re-RT后中位随访时间为8.0个月（范围：1.0 ~ 81.1个月）。在存活的患者中，中位随访时间为7.5个月（范围：3.6 - 32.8）。95.5%（42/44）完成再放射治疗。再放射治疗后，22例患者接受了进一步的全身治疗；无ct间隔中位数为5.4个月（范围：0.0 ~ 35.4）。术后6个月和12个月的LC分别为69.6%和58.5%。6个月PFS、DMFS和OS分别为47.7%、61.0%和71.6%。2例患者出现急性≥3级毒性反应，包括厌食、吞咽困难和胃肠道出血。结论：胰腺re-RT治疗是可行的，可为选定的患者提供有希望的局部控制和间歇化疗。未来的研究应该完善胰腺再放射治疗的患者选择标准，通过在线适应性治疗改善放射治疗的递送可能会进一步减少毒性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Clinical Oncology-Cancer Clinical Trials 医学-肿瘤学

CiteScore

4.90

自引率

0.00%

发文量

130

审稿时长

4-8 weeks

期刊介绍： American Journal of Clinical Oncology is a multidisciplinary journal for cancer surgeons, radiation oncologists, medical oncologists, GYN oncologists, and pediatric oncologists. The emphasis of AJCO is on combined modality multidisciplinary loco-regional management of cancer. The journal also gives emphasis to translational research, outcome studies, and cost utility analyses, and includes opinion pieces and review articles. The editorial board includes a large number of distinguished surgeons, radiation oncologists, medical oncologists, GYN oncologists, pediatric oncologists, and others who are internationally recognized for expertise in their fields.