Isotoxic High-Dose Stereotactic Body Radiotherapy (iHD-SBRT) Versus Conventional Chemoradiotherapy for Localized Pancreatic Cancer: A Single Cancer Center Evaluation

Martin Manderlier, Julie Navez, Matthieu Hein, Jean-Luc Engelholm, Jean Closset, Maria Antonietta Bali, Dirk Van Gestel, Luigi Moretti, Jean-Luc Van Laethem, Christelle Bouchart, Martin Manderlier, Julie Navez, Matthieu Hein, Jean-Luc Engelholm, Jean Closset, Maria Antonietta Bali, Dirk Van Gestel, Luigi Moretti, Jean-Luc Van Laethem, Christelle Bouchart

Abstract

Given the lack of direct comparative evidence, we aimed to compare the oncological outcomes of localized pancreatic ductal adenocarcinoma (PDAC) treated in the same tertiary cancer center with isotoxic high-dose stereotactic body radiotherapy (iHD-SBRT) or conventional chemoradiotherapy (CRT). Biopsy-proven borderline/locally advanced patients treated with iHD-SBRT (35 Gy in 5 fractions with a simultaneous integrated boost up to 53 Gy) or CRT (45−60 Gy in 25−30 fractions) were retrospectively included from January 2006 to January 2021. The median overall survival (mOS) was evaluated trough uni- and multivariate analyses. The progression free survival (PFS) and the 1-year local control (1-yLC) were also reported. Eighty-two patients were included. The median follow-up was 19.7 months. The mOS was in favour of the iHD-SBRT group (22.5 vs. 15.9 months, p < 0.001), including after multivariate analysis (HR 0.39 [CI95% 0.18−0.83], p = 0.014). The median PFS and the 1-yLC were also significantly better for iHD-SBRT (median PFS: 16.7 vs. 11.5 months, p = 0.011; 1-yLC: 75.8 vs. 39.3%, p = 0.004). In conclusion, iHD-SBRT is a promising RT option and may offer an improvement in OS in comparison to CRT for localized PDAC. Further validation is required to confirm the exact role of iHD-SBRT and the optimal therapeutic sequence for the treatment of localized PDAC.

Keywords: chemoradiotherapy; neoadjuvant therapy; pancreatic cancer; radiotherapy; stereotactic radiotherapy.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier plot of overall survival of the iHD-SBRT and CRT cohort (n = 82).
Figure 2
Figure 2
Kaplan–Meier plot of overall survival of the iHD-SBRT and CRT cohort for patients without oncological resection only (n = 59).

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Source: PubMed

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