Multi-Institutional Outcomes of Patients Aged 75 years and Older With Pancreatic Ductal Adenocarcinoma Treated With 5-Fraction Ablative Stereotactic Magnetic Resonance Image-Guided Adaptive Radiation Therapy (A-SMART).
Multi-Institutional Outcomes of Patients Aged 75 years and Older With Pancreatic Ductal Adenocarcinoma Treated With 5-Fraction Ablative Stereotactic Magnetic Resonance Image-Guided Adaptive Radiation Therapy (A-SMART).
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DOI：
10.1177/10732748221150228
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发表时间：
2023-01
期刊：
影响因子：
2.6
通讯作者：
Chuong, Michael D.
中科院分区：
文献类型：
--
作者：
Bryant, J. M.;Palm, Russell F.;Herrera, Roberto;Rubens, Muni;Hoffe, Sarah E.;Kim, Dae Won;Kaiser, Adeel;Ucar, Antonio;Fleming, Jason;De Zarraga, Fernando;Hodul, Pamela;Aparo, Santiago;Asbun, Horacio;Malafa, Mokenge;Jimenez, Ramon;Denbo, Jason;Frakes, Jessica M.;Chuong, Michael D.
胰腺导管腺癌(PDAC)的治疗选择对于高龄患者来说通常是有限的，因为医学上的合并症和/或糟糕的表现状态。这些患者可能不适合更积极的化疗方案和/或手术切除，几乎没有其他有效的治疗方法。消融性立体定向MRI引导的自适应放射治疗(A-SMART)对PDAC既有效又安全，并能实现良好的长期局部控制，但A-SMART是否适用于不能手术的老年PDAC患者尚不清楚。对在2个机构接受MRIdian直线加速器治疗的75岁或75岁以上不能手术的非转移性PDAC患者进行了回顾性分析。临床结果包括总生存期(OS)、无进展生存期(PFS)、无远处转移生存期(DMFS)和局部区域生存期(LRC)。根据不良事件通用术语标准(CTCAE，v5)对毒性进行分级。共有49名患者接受了评估，中位年龄为81岁(范围为75-91岁)，从确诊起平均随访14个月。PDAC分为局部晚期(46.9%)、交界性切除(36.7%)或内科无法手术(16.3%)。84%的患者接受了新辅助化疗，所有患者都接受了A-SMART至中位数50Gy5次照射(范围为40-50Gy5次)。1年LRC、PFS和OS分别为88.9%、53.8%和78.9%。9名患者(18%)在A-SMART后接受了切除，并受益于PFS的改善(26个月对6个月，P=.01)。在多变量分析中，ECOG PS<；2是改善OS的唯一预测因子。急性和晚期3级毒性发生率分别为8.2%和4.1%。A-SMART与鼓励老年PDAC患者的LRC和OS有关。这种新的非侵入性治疗策略似乎在高龄患者中耐受性良好，应该考虑在治疗选择有限的人群中使用。
Treatment options for pancreatic ductal adenocarcinoma (PDAC) are commonly limited for patients with advanced age due to medical comorbidities and/or poor performance status. These patients may not be candidates for more aggressive chemotherapy regimens and/or surgical resection leaving few, if any, other effective treatments. Ablative stereotactic MRI-guided adaptive radiation therapy (A-SMART) is both efficacious and safe for PDAC and can achieve excellent long-term local control, however, the appropriateness of A-SMART for elderly patients with inoperable PDAC is not well understood. A retrospective analysis was performed of inoperable non-metastatic PDAC patients aged 75 years or older treated on the MRIdian Linac at 2 institutions. Clinical outcomes of interest included overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and locoregional (LRC). Toxicity was graded according to Common Terminology Criteria for Adverse Events (CTCAE, v5). A total of 49 patients were evaluated with a median age of 81 years (range, 75-91) and a median follow-up of 14 months from diagnosis. PDAC was classified as locally advanced (46.9%), borderline resectable (36.7%), or medically inoperable (16.3%). Neoadjuvant chemotherapy was delivered to 84% of patients and all received A-SMART to a median 50 Gy (range, 40-50 Gy) in 5 fractions. 1 Year LRC, PFS, and OS were 88.9%, 53.8%, and 78.9%, respectively. Nine patients (18%) had resection after A-SMART and benefited from PFS improvement (26 vs 6 months, P = .01). ECOG PS <2 was the only predictor of improved OS on multivariate analysis. Acute and late grade 3 + toxicity rates were 8.2% and 4.1%, respectively. A-SMART is associated with encouraging LRC and OS in elderly patients with initially inoperable PDAC. This novel non-invasive treatment strategy appears to be well-tolerated in patients with advanced age and should be considered in this population that has limited treatment options.
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影响因子：
4.7
作者：
Boldrini L;Corradini S;Gani C;Henke L;Hosni A;Romano A;Dawson L
通讯作者：
Dawson L
DOI：
10.1016/j.ijrobp.2015.12.003
发表时间：
2016-03-15
期刊：
International journal of radiation oncology, biology, physics
影响因子：
--
作者：
Krishnan S;Chadha AS;Suh Y;Chen HC;Rao A;Das P;Minsky BD;Mahmood U;Delclos ME;Sawakuchi GO;Beddar S;Katz MH;Fleming JB;Javle MM;Varadhachary GR;Wolff RA;Crane CH
通讯作者：
Crane CH
影响因子：
2.3
作者：
Hassanzadeh C;Rudra S;Bommireddy A;Hawkins WG;Wang-Gillam A;Fields RC;Cai B;Park J;Green O;Roach M;Henke L;Kim H
通讯作者：
Kim H
影响因子：
5.7
作者：
Henke, Lauren;Kashani, Rojano;Olsen, Jeffrey
通讯作者：
Olsen, Jeffrey
DOI：
10.1186/1748-717x-8-240
发表时间：
2013-10-16
期刊：
Radiation oncology (London, England)
影响因子：
--
作者：
Kim CH;Ling DC;Wegner RE;Flickinger JC;Heron DE;Zeh H;Moser AJ;Burton SA
通讯作者：
Burton SA