SBRT Found Effective for Older Pancreatic Cancer Patients

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SBRT Found Effective for Older Pancreatic Cancer Patient

A highly targeted cancer radiotherapy may provide a safe and effective treatment option for older pancreatic cancer patients unable to have surgery or combined chemotherapy and radiation therapy.

Using the technology, stereotactic body radiotherapy (SBRT), the study’s findings showed that patients lived a median of six to seven months longer after treatment with minimal side-effects even when they had other harsh complications such as chronic obstructive pulmonary disease (COPD), heart disease, and diabetes. 

Two of the patients involved 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 around 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 who are diagnosed with the disease are older than 65. 

As of today, surgery is the only known form of treatment for resectable pancreatic cancer, where the cancer is designated to the pancreas and not spread. It is assumed that only 20% of pancreatic cancer patients have their tumors present with localized disease adaptable to surgical removal. A select number of those patients, however, are not suitable contenders for surgery due to having other complications such as COPD, heart disease, and diabetes. Only chemotherapy and radiation, or a joint combination of the two, remains the only available option for treatment. However, for a large section of elderly patients with localized pancreatic cancer even chemotherapy and radiation therapy are not viable options.

The Henry Ford study sought to identify whether SBR, a technique of administering radiation that can be extremely targeted to the tumor, steering clear of adjacent healthy tissue, was a viable substitute for this specific group of patients.

SBRT gives off a higher dose of radiation, meaning patients have fewer treatment sessions. In this case, treatment averaged two weeks. The study included 20 patients with an average age of 83, all of whom were medically unable to undergo surgery and/or combined chemo-radiation therapy. The majority of patients in the study (90%) were given 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 the cancer spread from the original tumor to distant organs or distant lymph nodes. Average 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. 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," said Yechieli.

For the next phase of this research, Yechieli is to cautiously follow patients after SBRT and obtain their direct feedback to determine post-treatment quality of life.

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