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Stereotactic Body Radiotherapy (SBRT) of Pancreatic Cancer-A Critical Review and Practical Consideration.

ABSTRACT: Pancreatic cancer is the third leading cause of cancer death in the developed world and is predicted to become the second by 2030. A cure may be achieved only with surgical resection of an early diagnosed disease. Surgery for more advanced disease is challenging and can be contraindicated for many reasons. Neoadjuvant therapy may improve the probability of achieving R0 resection. It consists of systemic treatment followed by radiation therapy applied concurrently or sequentially with cytostatics. A novel approach to irradiation, stereotactic body radiotherapy (SBRT), has the potential to improve treatment results. SBRT can deliver higher doses of radiation to the tumor in only a few treatment fractions. It has attracted significant interest for pancreatic cancer patients, as it is completed quickly, requires less time away from full-dose chemotherapy, and is well-tolerated than conventional radiotherapy. In this review, we aim to provide the reader with a basic overview of current evidence for SBRT indications in the treatment of pancreatic tumors. In the second part of the review, we focus on practical information with respect to SBRT treatment plan preparation the performance of such therapy. Finally, we discuss future directions related to the use of magnetic resonance linear accelerators.

SUBMITTER: Burkon P

PROVIDER: S-EPMC9599229 | biostudies-literature | 2022 Oct

REPOSITORIES: biostudies-literature

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Stereotactic Body Radiotherapy (SBRT) of Pancreatic Cancer-A Critical Review and Practical Consideration.

Burkoň Petr P Trna Jan J Slávik Marek M Němeček Radim R Kazda Tomáš T Pospíšil Petr P Dastych Milan M Eid Michal M Novotný Ivo I Procházka Tomáš T Vrzal Miroslav M

Biomedicines 20221004 10

Pancreatic cancer is the third leading cause of cancer death in the developed world and is predicted to become the second by 2030. A cure may be achieved only with surgical resection of an early diagnosed disease. Surgery for more advanced disease is challenging and can be contraindicated for many reasons. Neoadjuvant therapy may improve the probability of achieving R0 resection. It consists of systemic treatment followed by radiation therapy applied concurrently or sequentially with cytostatics ...[more]

PMID: 36289742

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Project description:Stereotactic body radiotherapy (SBRT) is a novel noninvasive treatment for hepatocellular carcinoma. SBRT can achieve effective local control, but it requires a relatively high input of resources; this systematic review was performed to assess the cost effectiveness of SBRT in the treatment of hepatocellular carcinoma to provide a basis for government pricing and medical insurance decision-making. The PubMed, EMBASE, Cochrane Library, CNKI, Wanfang and SinoMed databases were searched to collect economic evaluations of SBRT for the treatment of hepatocellular carcinoma from the date of database inception through December 31, 2018. Two reviewers independently screened the studies, extracted the data and performed a descriptive analysis of the basic characteristics, methods of economic evaluation and main results, as well as the quality and heterogeneity of the reports. A total of 5 studies were included. Among them, the level of heterogeneity was relatively acceptable, with a median score of 90%. Four studies were cost-utility analyses (CUAs), and 1 was a cost-effectiveness analysis (CEA). The incremental cost effectiveness ratio (ICER) for sorafenib compared to SBRT was US $114,795 per quality-adjusted life year gained (cost/QALY) in patients with advanced hepatocellular carcinoma. The ICER for proton beam therapy compared to SBRT was US $6465 in patients with inoperable advanced hepatocellular carcinoma. The ICER for SBRT compared to RFA was US $164,660 for patients with unresectable colorectal cancer (CRC) with liver metastases and US $56,301 for patients with early-stage hepatocellular carcinoma. For patients with inoperable localized hepatocellular carcinoma, compared with RFA-SBRT therapy, the ICERs for SBRT-SBRT and SBRT-RFA were US $558,679 and US $2197,000, respectively; RFA-RFA was dominated. In conclusion, there is limited evidence suggesting that SBRT could be cost-effective for highly specific subpopulations of HCC patients, and further economic evaluations based on randomized controlled trials (RCTs) or cohort studies are needed.

Project description:BackgroundExternal beam radiotherapy (EBRT) is a standard treatment for localized prostate cancer, with recent advancements favoring a reduced number of treatment sessions. Stereotactic body radiotherapy (SBRT) is a form of radiotherapy that delivers higher doses per fraction, typically in five or fewer sessions. This retrospective study aims to evaluate the implementation of the PACE-SBRT protocol for localized prostate cancer at our center by assessing the incidence and severity of toxicity, as well as biochemical relapse-free survival.MethodsWe conducted a retrospective analysis of patients with localized prostate cancer treated with SBRT at the Iridium Network in Antwerp, Belgium, who were treated between January 1, 2020, and December 31, 2022. Data were extracted from electronic medical records and included descriptive information on patient outcomes. Acute and late genitourinary (GU) and gastrointestinal (GI) toxicities were graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Acute toxicity was defined as events occurring within 90 days post-SBRT, whereas late toxicity was evaluated at 6 months, 1 year, 2 years, and 3 years post treatment. Biochemical recurrence was defined via the Phoenix criteria, as a rise in PSA levels of 2 ng/mL or more above the post treatment nadir.ResultsA total of 267 patients met the eligibility criteria for this study. In total, 9% of patients were low risk, 51% were intermediate risk, and 40% were high risk. The cumulative incidence of Grade 2 or higher GU toxicity was 27%, and for GI toxicity, it was 2%. At 24 months, 11.5% (20/175) of patients experienced CTCAE grade 2 or higher GU toxicity, and 1.7% (3/175) experienced grade 2 or higher GI toxicity. Biochemical relapse occurred in 1.5% (4/267) of patients, leading to a 2-year biochemical relapse-free survival rate of 98.5%.ConclusionSBRT for localized prostate cancer has favorable oncological outcomes with a low incidence of Grade 2 or higher toxicity. The results of this study are consistent with findings from prospective trials, suggesting that SBRT is an effective treatment modality. Trial registration Retrospectively registered.

Project description:ObjectiveIn contrast to traditional views of incurability, patients with oligometastatic disease present with an opportunity for disease eradication with aggressive treatment. There is mounting evidence in support of the role of stereotactic body radiotherapy (SBRT) in oligometastatic prostate cancer (OMPC).MethodsMEDLINE and EMBASE were queried for prospective cohort studies reporting the outcomes of metachronous OMPC treated with SBRT. The primary outcome was overall local control. Secondary outcomes included androgen deprivation therapy-free survival (ADTFS), biochemical recurrence free survival (BCFS), and progression-free survival (PFS). When appropriate, these endpoints were combined in a meta-analysis.ResultsWe screened 356 abstracts and identified 10 studies to include in our analysis, with a total of 653 patients and 1,111 lesions. The maximum number of lesions included in any single study ranged from 3 to 5. PET-CT staging occurred in 92.4% of all patients. SBRT dose varied, with BED1.5 ranging from 152 to 408. Only one Grade 3 bone toxicity was observed. Meta-analysis reported an overall local control rate of 97% (95% CI, 94-100). Median ADTFS was 24.7 months (95% CI, 20.1-29.2 months). Two-year BCFS, PFS, and ADTFS were 33% (95% CI, 11-55), 39% (95% CI, 24-54), and 52% (95%CI, 41-62), respectively. Patients treated with SBRT were half as likely to experience PSA progression than those on observation when looking at randomized control trial data alone.ConclusionSBRT appears to be effective in controlling overall disease burden in metachronous OMPC patients and is associated with minimal significant toxicity. The current prospective literature is scarce, and further prospective data are needed to guide treatment recommendations.Advances in knowledgeThis study provides a comprehensive summary of the prospective evidence reporting the outcomes of SBRT in the management of OMPC patients. We quantify the rates of local control, biochemical-free recurrence, progression-free survival, and ADT-free survival through meta-analysis.

Dataset Information

Stereotactic Body Radiotherapy (SBRT) of Pancreatic Cancer-A Critical Review and Practical Consideration.

Publications

Stereotactic Body Radiotherapy (SBRT) of Pancreatic Cancer-A Critical Review and Practical Consideration.

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