Abstract
Objective: To determine whether increasing biologically effective dose (BED) with stereotactic body radiation therapy (SBRT) is associated with improved local control (LC) or toxicities in patients with locally advanced pancreatic cancer. Methods: A PICOS/PRISMA/MOOSE selection protocol was used to identify 15 studies across 12 institutions in 5 countries where patients received definitive SBRT for nonmetastatic disease. Biologically equivalent doses were calculated with an α/β of 10 (ie, BED 10) for LC and acute toxicity and 3 (ie, BED 3) for late toxicity. Fixed and random effects models were used to characterize LC and grade 3/4 toxicities by BED. Results: There were 508 patients included with a median follow-up time of 9.1 months. The median dose was 30 Gy, and the most common regimen was 30 Gy/5 fractions. There was no significant difference in LC rates at 1 year between the BED 10 <70 Gy versus ≥70 Gy groups, with an estimate of 0.60 (95% confidence interval [CI], 0.36-0.81) versus 0.83 (95% CI, 0.63-0.97), respectively. There was no significant difference in acute toxicity rates between the BED 10 <70 Gy versus ≥70 Gy groups, with an estimate of 0.02 (95% CI, 0.00-0.08) versus 0.05 (95% CI, 0.00-0.22), respectively. Given the dose distribution across studies, 3 intervals were used to characterize BED 3. There were no significant differences in late toxicity among those receiving BED 3 <100, 100 to 200, or >200 Gy. Conclusions: SBRT for pancreatic cancer results in LC rates of 60% to 83% and clinically significant toxicity of <7%. Increasing BED 10 beyond 70 Gy was not associated with increased rates of 1-year LC or acute toxicity. Increasing BED 3 beyond 100 Gy was not associated with increased rates of late toxicity.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 46-55 |
| Number of pages | 10 |
| Journal | American Journal of Clinical Oncology: Cancer Clinical Trials |
| Volume | 42 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 1 2019 |
Fingerprint
All Science Journal Classification (ASJC) codes
- Oncology
- Cancer Research
Cite this
}
Dose escalation in stereotactic body radiation therapy for pancreatic cancer. / Zaorsky, Nicholas; Lehrer, Eric J.; Handorf, Elizabeth; Meyer, Joshua E.
In: American Journal of Clinical Oncology: Cancer Clinical Trials, Vol. 42, No. 1, 01.01.2019, p. 46-55.Research output: Contribution to journal › Article
TY - JOUR
T1 - Dose escalation in stereotactic body radiation therapy for pancreatic cancer
AU - Zaorsky, Nicholas
AU - Lehrer, Eric J.
AU - Handorf, Elizabeth
AU - Meyer, Joshua E.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Objective: To determine whether increasing biologically effective dose (BED) with stereotactic body radiation therapy (SBRT) is associated with improved local control (LC) or toxicities in patients with locally advanced pancreatic cancer. Methods: A PICOS/PRISMA/MOOSE selection protocol was used to identify 15 studies across 12 institutions in 5 countries where patients received definitive SBRT for nonmetastatic disease. Biologically equivalent doses were calculated with an α/β of 10 (ie, BED 10) for LC and acute toxicity and 3 (ie, BED 3) for late toxicity. Fixed and random effects models were used to characterize LC and grade 3/4 toxicities by BED. Results: There were 508 patients included with a median follow-up time of 9.1 months. The median dose was 30 Gy, and the most common regimen was 30 Gy/5 fractions. There was no significant difference in LC rates at 1 year between the BED 10 <70 Gy versus ≥70 Gy groups, with an estimate of 0.60 (95% confidence interval [CI], 0.36-0.81) versus 0.83 (95% CI, 0.63-0.97), respectively. There was no significant difference in acute toxicity rates between the BED 10 <70 Gy versus ≥70 Gy groups, with an estimate of 0.02 (95% CI, 0.00-0.08) versus 0.05 (95% CI, 0.00-0.22), respectively. Given the dose distribution across studies, 3 intervals were used to characterize BED 3. There were no significant differences in late toxicity among those receiving BED 3 <100, 100 to 200, or >200 Gy. Conclusions: SBRT for pancreatic cancer results in LC rates of 60% to 83% and clinically significant toxicity of <7%. Increasing BED 10 beyond 70 Gy was not associated with increased rates of 1-year LC or acute toxicity. Increasing BED 3 beyond 100 Gy was not associated with increased rates of late toxicity.
AB - Objective: To determine whether increasing biologically effective dose (BED) with stereotactic body radiation therapy (SBRT) is associated with improved local control (LC) or toxicities in patients with locally advanced pancreatic cancer. Methods: A PICOS/PRISMA/MOOSE selection protocol was used to identify 15 studies across 12 institutions in 5 countries where patients received definitive SBRT for nonmetastatic disease. Biologically equivalent doses were calculated with an α/β of 10 (ie, BED 10) for LC and acute toxicity and 3 (ie, BED 3) for late toxicity. Fixed and random effects models were used to characterize LC and grade 3/4 toxicities by BED. Results: There were 508 patients included with a median follow-up time of 9.1 months. The median dose was 30 Gy, and the most common regimen was 30 Gy/5 fractions. There was no significant difference in LC rates at 1 year between the BED 10 <70 Gy versus ≥70 Gy groups, with an estimate of 0.60 (95% confidence interval [CI], 0.36-0.81) versus 0.83 (95% CI, 0.63-0.97), respectively. There was no significant difference in acute toxicity rates between the BED 10 <70 Gy versus ≥70 Gy groups, with an estimate of 0.02 (95% CI, 0.00-0.08) versus 0.05 (95% CI, 0.00-0.22), respectively. Given the dose distribution across studies, 3 intervals were used to characterize BED 3. There were no significant differences in late toxicity among those receiving BED 3 <100, 100 to 200, or >200 Gy. Conclusions: SBRT for pancreatic cancer results in LC rates of 60% to 83% and clinically significant toxicity of <7%. Increasing BED 10 beyond 70 Gy was not associated with increased rates of 1-year LC or acute toxicity. Increasing BED 3 beyond 100 Gy was not associated with increased rates of late toxicity.
UR - http://www.scopus.com/inward/record.url?scp=85049220478&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85049220478&partnerID=8YFLogxK
U2 - 10.1097/COC.0000000000000472
DO - 10.1097/COC.0000000000000472
M3 - Article
VL - 42
SP - 46
EP - 55
JO - American Journal of Clinical Oncology
JF - American Journal of Clinical Oncology
SN - 0277-3732
IS - 1
ER -