Stereotactic Body Radiotherapy Proves Effective for Older Pancreatic Cancer Patients

An extremely targeted cancer radiotherapy may provide a safe and effective treatment alternative for older pancreatic cancer patients unable to undergo surgery or combined chemotherapy and radiation therapy.

Using the technology, stereotactic body radiotherapy (SBRT), the study’s findings revealed that patients lived an average if six to seven months longer following treatment with minimal side-effects even when they had other severe comorbidities such as chronic obstructive pulmonary disease (COPD), heart disease and diabetes.

Two of the patients in the study lived nearly two years. “Elderly individuals, those ages 75 and older, account for approximately 40% of patients diagnosed with pancreatic cancer,” stated study lead author Raphael Yechieli, MD, with the department of radiation oncology at Henry Ford Hospital (Detroit, MI, USA). “These patients are too ill to receive any other treatment, but with stereotactic body radiotherapy we’re able to deliver a safe and effective treatment in two weeks that can provide them with a substantial quality of life with minimal side effects.”

The study was presented at the 55nd annual American Society for Radiation Oncology (ASTRO) meeting, held September 2013 in Atlanta (GA, USA). In 2013, there will be an estimated 45,220 new cases of pancreatic cancer, and approximately 38,460 will die from the disease, according to the US National Cancer Institute (Bethesda, MD, USA). Risk factors for pancreatic cancer include smoking, diabetes, obesity, family history of the disease and pancreatitis. Most people diagnosed with the disease are older than 65.

Surgery is the only known cure for resectable pancreatic cancer, where the cancer is localized to the pancreas and it has not spread. It is estimated that only 20% of pancreatic cancer patients have their tumors present with localized disease amendable to surgical removal. A select number of those patients, however, are not candidates for surgery due to having other comorbidities such as COPD, heart disease, and diabetes. Only chemotherapy and radiation, or a combination of the two, therefore, remains available for treatment. However, for a large portion of elderly patients with localized pancreatic cancer even chemotherapy and radiation therapy are not options.

The Henry Ford study looked to determine if SBR—a method of giving radiation that can be highly targeted to the tumor, sparing the neighboring healthy tissue—was a workable alternative for this group of patients. SBRT provides a higher dose of radiation, meaning patients have fewer treatments. In this case, treatment averaged two weeks. The study included 20 patients with a median age of 83, all of whom were medically unable to tolerate surgery and/or combined chemo-radiation therapy. The majority of patients in the study (90%) received SBRT treatment at the time of diagnosis.

Seven patients reported side effects from treatment: nausea, vomiting, and fatigue. Among the patients, 13 had a recurrence of cancer and nine had cancer spread from the original tumor to distant organs or distant lymph nodes. Median overall survival was 6.7 months, and the average recurrence-free survival was 8.1 months. At six months post-treatment, 61 % of patients were alive; two patients in the study survived for nearly two years.

“National trends tell us that very few patients over the age of 75 are getting any treatment at all for pancreatic cancer due to comorbidity risks,” noted Dr. Yechieli. “So we want to push the envelope to give them a treatment option that, while not a cure, is short, effective, and safe, and has the potential to give them a good quality of life.”

The next step in this research, according to Dr. Yechieli, is to carefully follow patients after SBRT and get their direct feedback to measure post-treatment quality of life.

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Henry Ford Hospital