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S352
ESTRO 36 2017
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Purpose or Objective
Pancreatic carcinoma is projected to become the 2^
leading cause of cancer mortality by 2030. At diagnosis,
30% of patients (pts) present with LAPC involving adjacent
structures such as blood vessels, not usually removed
because of risk of postoperative complications. Patients
with LAPC have an intermediate prognosis between
resectable and metastatic pts (median OS ranging from 5
to 11 months). LAPC cause significant pain, obstruction,
and other morbidity due to direct extension of the primary
tumor. Currently, a treatment option for LAPC is radio-
chemotherapy (RCT). SBRT is one emerging technique for
treatment of LAPC, used by specialized centers to deliver
a higher biologically effective dose of precisely targeted
radiation in a short course of therapy. Conformity and
rapid dose fall-off associated with SBRT offer the potential
for dose escalation. We retrospectively review the
experience of 5 different centers treating LAPC with SBRT.
Material and Methods
We included 41 pts with LAPC, undergoing SBRT +/-
chemotherapy (CT) with multiagent CT regimens.
Exclusion criteria were metastatic disease and radical
surgical treatment. Only palliative surgery was admitted.
Median dose and median fractionation dose for SBRT were
25 Gy (range: 4-45) and 6 Gy (range: 4-22), respectively.
Toxicity was evaluated by CTCAE.4 scale. Overall survival
(OS) was estimated and compared by Kaplan-Meier and
log-rank methods, respectively.
Results
We analyzed 41 pts (M/F: 21/20; median age: 71, range:
36-89). Median, 6 months, 1-year, and 2-year OS were: 15
months (range 13.5-16.4), 87.6%, 73.9%, 20.1%,
respectively. At univariate analysis a better prognosis was
recorded for pts with tumor located at the tail (p= 0.046),
with a histologic grade 2 tumor (p<0.001), treated with
adjuvant CT (p=0.036). There was a trend for improved OS
in pts with cT3 tumor stage (p=0.085), and in pts treated
with biliary stent (p=0.066). Nodal stage was not
significantly related to OS. Incidence of gastrointestinal
(GI) G1-G2 acute toxicity was 40%. Only one case of G3 GI
acute toxicity (4%) and only one of G3 GI late toxicity
(4.5%) were registered.
Conclusion
Fractionated SBRT +/- CT results in tolerable acute and
minimal late GI toxicity and warrants OS comparable to
current standard treatment (RCT). Future studies should
incorporate SBRT with more aggressive multiagent CT to
optimize pts outcomes.
PO-0681 SBRT VS standard chemoradiation in locally
advanced pancreatic cancer (LAPC): a case-control
study
A. Arcelli
1
, F. Bertini
1
, A.G. Morganti
1
, A. Guido
1
, L.
Fuccio
2
, F. Deodato
3
, S. Cilla
4
, F. Dalla Torre
3
, V. Scotti
5
,
E.M. Rosetto
6
, I. Djan
7
, S. Parisi
8
, G.C. Mattiucci
9
, V.
Valentini
9
, M. Fiore
10
, P. Bonomo
11
, A. Bacigalupo
12
, R.M.
Niespolo
13
, P. Gabriele
14
, G. Macchia
3
1
University of Bologna, Radiation Oncology Center-
Department of Experimental- Diagnostic and Specialty
Medicine - DIMES, Bologna, Italy
2
University of Bologna, Department of Medical and
Surgical Sciences - DIMEC, Bologna, Italy
3
Fondazione di Ricerca e Cura “Giovanni Paolo II”,
Radiotherapy Unit, Campobasso, Italy
4
Fondazione di Ricerca e Cura “Giovanni Paolo II”,
Medical Physic Unit, Campobasso, Italy
5
Radiosurgery Center Malzoni, Radiosurgery Center,
Agropoli, Italy
6
Ospedale Belcolle, Radiotherapy Unit, Viterbo, Italy
7
Medical Faculty- University of Novi Sad, Institute of
Oncology Vojvodina- Sremska Kamenica, Serbia, Serbia
8
Ospedale Casa Sollievo della Sofferenza San Giovanni
Rotondo, Radiotherapy Unit, Foggia, Italy
9
Policlinico Universitario “A. Gemelli”- Università
Cattolica del Sacro Cuore, Department of Radiotherapy,
Rome, Italy
10
Università Campus Biomedico, Department of
Radiotherapy, Rome, Italy
11
Azienda Ospedaliero Universitaria Careggi AOUC,
Department of Radiotherapy, Firenze, Italy
12
IRCCS AOU San Martino– IST, Department of
Radiotherapy, Genova, Italy
13
Azienda Ospedaliera San Gerardo, Radiotherapy Unit,
Monza, Italy
14
Fondazione del Piemonte per l'Oncologia FPO- IRCCS
Candiolo, Department of Radiotherapy, Torino, Italy
Purpose or Objective
In the last decades a treatment option for LAPC has been
represented by chemoradiation (CRT), however SBRT is
considered an emerging option for these patients (pts).
Unfortunately, comparison between these two treatment
techniques, in terms of toxicity and pts outcome, are
lacking. Therefore, aim of this multicentric study is to
compare toxicity and outcome between two cohorts of pts
treated with SBRT or CRT.
Material and Methods
A case-control study was performed. Forty-two patients
were enrolled (M/F: 25/17; median age: 68.5; range: 36-
89). Pts in the two groups were matched according to: age
</≥ 65years, tumor diameter </≥ 3 cm, cT, cN,
neoadjuvant chemotherapy, adjuvant chemotherapy.
Median dose in pts treated with SBRT was 25 Gy (range:
12-30) and median dose in pts treated with CRT was 54 Gy
(range: 30-63). Toxicity was evaluated by CTCAE v4.0
scale and survival curves were assessed by Kaplan-Meier
method.
Results
The incidence of GI ≥ G2 acute toxicity was 31% in the
SBRT-arm and 37.5% in the CRT-arm, while the incidence
of hematological ≥ G2 acute toxicity was 6.3% in both
groups. Late GI bleeding was recorded in 6.3% and 8.3%
pts treated with SBRT or CRT, respectively. One-year, 2-
year and median survival were 50.3%, 30.2% and 13 months
(range: 7.3-18.7) in pts treated with SBRT, respectively.
One-year, 2-year and median survival were 51.8%, 33.8%
and 16 months (range: 7.5-24.5) in pts treated with CRT,
respectively.
Conclusion
This analysis showed that SBRT compared to CRT, is
correlated with a similar incidence of adverse effects and
with a comparable survival.