Surgical and Pathologic Outcomes of Pancreatic Adenocarcinoma (PA) After Preoperative Ablative Stereotactic Magnetic Resonance Image Guided Adaptive Radiation Therapy (A-SMART).
Surgical and Pathologic Outcomes of Pancreatic Adenocarcinoma (PA) After Preoperative Ablative Stereotactic Magnetic Resonance Image Guided Adaptive Radiation Therapy (A-SMART).
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DOI：
10.1016/j.adro.2022.101045
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发表时间：
2022-11
影响因子：
2.3
通讯作者：
Frakes, Jessica
中科院分区：
文献类型：
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作者：
Bryant, J M;Palm, Russell F;Liveringhouse, Casey;Boyer, Emanuel;Hodul, Pam;Malafa, Mokenge;Denbo, Jason;Kim, Dae;Carballido, Estrella;Fleming, Jason B;Hoffe, Sarah;Frakes, Jessica
胰腺癌的术前放射治疗（RT）可降低手术切缘阳性率，并且当输送至消融剂量范围时，可改善不可切除疾病患者的局部控制和总生存率。使用立体定向体部RT以达到更高的生物有效剂量受到邻近放射敏感结构的毒性的限制，但这可以通过立体定向磁共振图像引导的自适应放射治疗（SMART）来缓解。我们描述了我们的单一机构的经验，高生物有效剂量SMART切除局限性胰腺癌。根据不良事件通用术语标准（V 5.0）进行毒性评价。根据美国病理学家学会肿瘤消退分级标准评价肿瘤缓解。我们分析了26例边缘可切除（80.8%）、局部晚期（11.5%）和可切除（7.7%）肿瘤患者，这些患者接受了消融剂量SMART（A-SMART），然后进行了手术切除。诊断时的中位年龄为68岁（范围，34-86岁）。大多数患者在RT前接受化疗（80.8%）。所有患者均接受A-SMART，中位剂量为50（范围，40-50）戈伊，分5次治疗。前瞻性收集毒性数据，没有与RT相关的急性2+级毒性。切除的中位时间为50天（范围，37-115），手术类型包括维普莱切除术（69%）、远端（23%）或全胰腺切除术（8%）。R 0切除率为96%，90天内无围手术期死亡。在88%的病例中观察到病理反应。从RT到手术的时间与肿瘤消退等级相关（P = 0.0003）。RT后的中位随访时间为16.5个月（范围：3.9-26.2）。RT的中位无进展生存期为13.2个月。A-SMART后的初始手术和病理结果令人鼓舞。术前A-SMART与低毒性率相关，无手术或RT相关死亡率。手术发病率与前期切除术后的历史发病率相当。这些数据还表明，从立体定向体RT到手术切除的时间与病理反应相关。
Preoperative radiation therapy (RT) for pancreatic adenocarcinoma reduces positive surgical margin rates, and when delivered to an ablative dose range it may improve local control and overall survival for patients with unresectable disease. Use of stereotactic body RT to achieve a higher biologically effective dose has been limited by toxicity to adjacent radiosensitive structures, but this can be mitigated by stereotactic magnetic resonance image guided adaptive radiation therapy (SMART). We describe our single-institution experience of high biologically effective dose SMART before resection of localized pancreatic adenocarcinoma. Toxicity was evaluated according to Common Terminology Criteria for Adverse Events (V 5.0). Tumor response was evaluated according to the College of American Pathologists tumor regression grading criteria. We analyzed 26 patients with borderline resectable (80.8%), locally advanced (11.5%), and resectable (7.7%) tumors who received ablative dose SMART (A-SMART) followed by surgical resection. Median age at diagnosis was 68 years (range, 34-86). Most patients received chemotherapy (80.8%) before RT. All patients received A-SMART to a median dose of 50 (range, 40-50) Gy in 5 fractions. Toxicity data were collected prospectively and there were no acute grade 2+ toxicities associated with RT. The median time to resection was 50 days (range, 37-115), and the procedure types included Whipple (69%), distal (23%), or total pancreatectomy (8%). The R0 resection rate was 96% and no perioperative deaths occurred within 90 days. Pathologic response was observed in 88% of cases. The time from RT to surgery was associated with tumor regression grade (P = .0003). The median follow-up after RT was 16.5 months (range, 3.9-26.2). The derived median progression-free survival from RT was 13.2 months. The initial surgical and pathologic outcomes after A-SMART are encouraging. Preoperative A-SMART was associated with low toxicity rates and no surgical or RT-associated mortality. The surgical morbidity was comparable to historic rates after upfront resection. These data also suggest that the time from stereotactic body RT to surgical resection is associated with pathologic response.