High local failure rates despite high margin-negative resection rates in a cohort of borderline resectable and locally advanced pancreatic cancer patients treated with stereotactic body radiation therapy following multi-agent chemotherapy.
High local failure rates despite high margin-negative resection rates in a cohort of borderline resectable and locally advanced pancreatic cancer patients treated with stereotactic body radiation therapy following multi-agent chemotherapy.
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DOI：
10.1002/cam4.4527
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发表时间：
2022-04
期刊：
影响因子：
4
通讯作者：
Narang A
中科院分区：
文献类型：
--
作者：
Hill C;Sehgal S;Fu W;Hu C;Reddy A;Thompson E;Hacker-Prietz A;Le D;De Jesus-Acosta A;Lee V;Zheng L;Laheru DA;Burns W;Weiss M;Wolfgang C;He J;Herman JM;Meyer J;Narang A
立体定向体部放射治疗（SBRT）用于边缘可切除和局部晚期胰腺癌（BRPC/LAPC）患者仍存在争议。在本文中，我们报告了在高容量机构接受诱导化疗（CTX）后接受5次SBRT治疗的BRPC/LAPC患者的手术、病理和生存结局。对2016年至2019年期间接受治疗的BRPC/LAPC患者进行了回顾性分析。手术和病理结果进行了定性分析。使用考克斯比例风险回归分析总生存期（OS）和无进展生存期（PFS）。采用Fine-Gray竞争风险模型分析了局部失效和远距离失效。在155例患者中，91例（59%）患有LAPC，64例（41%）患有BRPC。几乎所有患者均接受了多药CTX联合FOLFIRINOX（75%）或吉西他滨和白蛋白结合紫杉醇（24%）诱导治疗，中位持续时间为4.0个月（1-18个月）。所有患者均接受SBRT，中位剂量为33戈伊。在64例BRPC患者中，50例（78%）接受了切除术，其中48例（96%）实现了切缘阴性（R 0）切除。在91例LAPC患者中，57例（63%）接受了切除术，其中50例（88%）实现了R 0切除。尽管R 0率较高，但33%的患者发生了局部失败，占所有失败的44%。SBRT后，中位OS和PFS分别为18.7和7.7个月。SBRT后，1年和2年OS概率分别为70%和45%，而从诊断开始，它们分别为93%和51%。尽管接受诱导多药CTX治疗后接受SBRT治疗的BRPC/LAPC患者中有很高比例成功实现了R 0切除，但局部失败仍然很常见，这突出表明在这种情况下需要继续优化放射治疗。在接受多药CTX随后SBRT治疗的BRPC/LAPC患者的现代队列中，高比例的患者有资格接受手术探查和切除，92%的患者实现了切缘阴性切除。尽管R 0切除率很高，但33%的患者发生了局部失败，44%的失败包括局部失败作为一个组成部分，突出了在这种情况下需要继续优化放射治疗。
Stereotactic body radiation therapy (SBRT) for patients with borderline resectable and locally advanced pancreatic adenocarcinoma (BRPC/LAPC) remains controversial. Herein, we report on surgical, pathologic, and survival outcomes in BRPC/LAPC patients treated at a high‐volume institution with induction chemotherapy (CTX) followed by 5‐fraction SBRT. BRPC/LAPC patients treated between 2016 and 2019 were retrospectively reviewed. Surgical and pathological outcomes were descriptively characterized. Overall survival (OS) and progression‐free survival (PFS) were analyzed using Cox proportional hazard regression. Locoregional failure and distant failure were analyzed with Fine–Gray competing risk model. Of 155 patients, 91 (59%) had LAPC and 64 (41%) had BRPC. Almost all were treated with induction multi‐agent CTX with either FOLFIRINOX (75%) or gemcitabine and nab‐paclitaxel (24%) for a median duration of 4.0 months (1–18 months). All received SBRT to a median dose of 33 Gy. Among 64 BRPC patients, 50 (78%) underwent resection, of whom 48 (96%) achieved margin‐negative (R0) resection. Among 91 LAPC patients, 57 (63%) underwent resection, of whom 50 (88%) achieved R0 resection. Despite the high R0 rate, 33% of patients experienced locoregional failure, which was a component of 44% of all failures. After SBRT, median OS and PFS were 18.7 and 7.7 months, respectively. After SBRT, 1‐ and 2‐year OS probabilities were 70% and 45%, whereas, from diagnosis, they were 93% and 51%. Although a high proportion of BRPC/LAPC patients treated with induction multi‐agent CTX followed by SBRT successfully achieved R0 resection, locoregional failure remained common, highlighting the need to continue to optimize radiation delivery in this context. A high proportion of patients in a modern cohort of BRPC/LAPC patients treated with multi‐agent CTX followed by SBRT became eligible for surgical exploration and resection with 92% achieving a margin‐negative resection. Despite the high rate of R0 resection, 33% of patients experienced locoregional failure, and 44% of all failures included locoregional failure as a component, highlighting the need to continue to optimize radiation delivery in this context.
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通过放射疗法诱导ADAM10胰腺癌的纤维化，抗性和上皮转变。
影响因子：
11.2
作者：
Mueller AC;Piper M;Goodspeed A;Bhuvane S;Williams JS;Bhatia S;Phan AV;Van Court B;Zolman KL;Peña B;Oweida AJ;Zakem S;Meguid C;Knitz MW;Darragh L;Bickett TE;Gadwa J;Mestroni L;Taylor MRG;Jordan KR;Dempsey P;Lucia MS;McCarter MD;Del Chiaro M;Messersmith WA;Schulick RD;Goodman KA;Gough MJ;Greene CS;Costello JC;Neto AG;Lagares D;Hansen KC;Van Bokhoven A;Karam SD
通讯作者：
Karam SD
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：
9
作者：
Ferrone, Cristina R.;Marchegiani, Giovanni;Fernandez-del Castillo, Carlos
通讯作者：
Fernandez-del Castillo, Carlos
影响因子：
45.3
作者：
Loehrer, Patrick J., Sr.;Feng, Yang;Benson, Al B., III
通讯作者：
Benson, Al B., III
影响因子：
3.3
作者：
Chuong, Michael D.;Bryant, John;Gutierrez, Alonso N.
通讯作者：
Gutierrez, Alonso N.