可切除和边缘性可切除胰腺癌的新辅助化疗和立体定向放射治疗II期试验中边缘局部失败的模式。

Jordan Kharofa, Michelle Mierzwa, Olugbenga Olowokure, Jeffrey Sussman, Tahir Latif, Anumeha Gupta, Changchun Xie, Sameer Patel, Hope Esslinger, Brian Mcgill, Eric Wolf, Syed A Ahmad
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引用次数: 47

摘要

目的:本研究的主要目的是前瞻性评估立体定向全身放射治疗(SBRT)在可切除或边缘性可切除胰腺癌新辅助治疗中的安全性和有效性。材料与方法:2014年11月至2017年6月入组18例患者。在3个周期的化疗后,SBRT被输送到肿瘤和邻近血管,3mm规划靶体积(PTV)范围为33 Gy (6.6 Gy×5),可根据淋巴结间隙和肠系膜血管定制PTV至25 Gy (5 Gy×5)。主要终点为≥3级急性和晚期胃肠道毒性。结果:15例患者因动脉基台(n=7)或肠系膜上静脉阻塞(n=8)发生可切除肿瘤;3例患者肿瘤可切除。没有≥3级急性或晚期胃肠道事件。在SBRT后,12例患者(67%)进行了手术,11例(92%)R0切除。中位总生存期和无进展生存期分别为21个月(95% CI: 18-29)和11个月(95% CI: 8.4-16)。83%(10/12)的切除患者出现进展(远处[n= 4,40%],局部仅[n= 4,40%],局部和远处[n= 2,20%])。术后12个月局部衰竭(LF)的累积发生率为50% (95% CI: 20-80)。所有的LF都在PTV33外面。结论:新辅助SBRT耐受性良好,然而LFs主要出现在PTV33体积之外,而传统的RT体积会覆盖PTV33体积。在纳入常规治疗前,与放化疗相比,SBRT在新辅助治疗后局部控制的持久性值得进行检查。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Pattern of Marginal Local Failure in a Phase II Trial of Neoadjuvant Chemotherapy and Stereotactic Body Radiation Therapy for Resectable and Borderline Resectable Pancreas Cancer.

Objectives: The main objectives of this study were to prospectively evaluate the safety and efficacy of stereotactic body radiation therapy (SBRT) in the neoadjuvant setting for resectable or borderline resectable pancreatic cancer.

Materials and methods: Eighteen patients were enrolled from November 2014 to June 2017. Following 3 cycles of chemotherapy, SBRT was delivered to the tumor and abutting vessel and a 3 mm planning target volume (PTV) margin to 33 Gy (6.6 Gy×5) with an optional elective PTV to 25 Gy (5 Gy×5) customized to the nodal space and mesenteric vessels. The primary endpoint is ≥grade 3 acute and late gastrointestinal toxicity.

Results: Fifteen patients had borderline resectable tumors due to arterial abutment (n=7) or superior mesenteric vein encasement (n=8); 3 patients had resectable tumors. There were no ≥grade 3 acute or late gastrointestinal events. Following SBRT, surgery was performed in 12 patients (67%) with 11 (92%) R0 resections. The median overall survival and progression-free survival was 21 months (95% CI: 18-29) and 11 months (95% CI: 8.4-16). Progression occurred in 83% (10/12) of resected patients (distant [n=4, 40%], local-only [n=4, 40%], and local and distant [n=2, 20%]). The cumulative incidence of local failure (LF) at 12 months from resection was 50% (95% CI: 20-80). All LF were outside to the PTV33.

Conclusions: Neoadjuvant SBRT was well tolerated, however LFs were predominantly observed outside the PTV33 volume that would have been covered with conventional RT volumes. The durability of local control after SBRT in the neoadjuvant setting merits examination relative to chemoradiation before incorporation into routine practice.

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