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Open Access Research

Stereotactic body radiation therapy with concurrent full-dose gemcitabine for locally advanced pancreatic cancer: a pilot trial demonstrating safety

Marie K Gurka1, Sean P Collins1, Rebecca Slack23, Gary Tse1, Aline Charabaty4, Lisa Ley2, Liam Berzcel2, Siyuan Lei1, Simeng Suy1, Nadim Haddad4, Reena Jha5, Colin D Johnson6, Patrick Jackson7, John L Marshall2 and Michael J Pishvaian2*

Author Affiliations

1 Department of Radiation Oncology, Georgetown University Hospital, 20007, Washington, DC, USA

2 Lombardi Comprehensive Cancer Center, Georgetown University, Podium B 3800 Reservoir Road, NW, 20007, Washington, DC, USA

3 Department of Biostatistics, University of Texas MD Anderson Cancer Center, 77230, Houston, TX, USA

4 Division of Gastroenterology, Department of Medicine, Georgetown University Hospital, 20007, Washington, DC, USA

5 Department of Radiology, Georgetown University Hospital, 20007, Washington, DC, USA

6 University Surgical Unit, Southampton University Hospitals, Southampton, United Kingdom

7 Department of Surgery, Georgetown University Hospital, 20007, Washington, DC, USA

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Radiation Oncology 2013, 8:44  doi:10.1186/1748-717X-8-44

Published: 1 March 2013

Abstract

Background

Concurrent chemoradiation is a standard option for locally advanced pancreatic cancer (LAPC). Concurrent conventional radiation with full-dose gemcitabine has significant toxicity. Stereotactic body radiation therapy (SBRT) may provide the opportunity to administer radiation in a shorter time frame with similar efficacy and reduced toxicity. This Pilot study assessed the safety of concurrent full-dose gemcitabine with SBRT for LAPC.

Methods

Patients received gemcitabine, 1000 mg/m2 for 6 cycles. During week 4 of cycle 1, patients received SBRT (25 Gy delivered in five consecutive daily fractions of 5 Gy prescribed to the 75-83% isodose line). Acute and late toxicities were assessed using NIH CTCAE v3. Tumor response was assessed by RECIST. Patients underwent an esophagogastroduodenoscopy at baseline, 2, and 6 months to assess the duodenal mucosa. Quality of life (QoL) data was collected before and after treatment using the QLQ-C30 and QLQ-PAN26 questionnaires.

Results

Between September 2009 and February 2011, 11 patients enrolled with one withdrawal during radiation therapy. Patients had grade 1 to 2 gastrointestinal toxicity from the start of SBRT to 2 weeks after treatment. There were no grade 3 or greater radiation-related toxicities or delays for cycle 2 of gemcitabine. On endoscopy, there were no grade 2 or higher mucosal toxicities. Two patients had a partial response. The median progression free and overall survival were 6.8 and 12.2 months, respectively. Global QoL did not change between baseline and immediately after radiation treatment.

Conclusions

SBRT with concurrent full dose gemcitabine is safe when administered to patients with LAPC. There is no delay in administration of radiation or chemotherapy, and radiation is completed with minimal toxicity.

Keywords:
Pancreatic cancer; Gemcitabine; Radiation; Stereotactic body radiation therapy; SBRT; CyberKnife; Quality of life; QLQ-C30; QLQ-PAN26; Upper endoscopy