A highly targeted cancer radiation therapy called stereotactic body radiotherapy or SBRT may offer a safe and effective treatment option for elderly pancreatic cancer patients unable to undergo surgery or combined chemotherapy and radiation therapy, according to researchers at Henry Ford Hospitalin Detroit.
A stereotactic radiation treatment is a method of giving radiation that can be highly targeted to the tumor, sparing the normal tissue around it. The treatment focuses on the exact location of a tumor or tumors in order to treat these with limited but highly precise radiation fields. Depending on the need, SBRT involves the delivery of a single high dose radiation treatment or a few fractionated radiation treatments.
Survival benefit
As a results of this therapy patients lived, on average, 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.
Safe and effective
“Elderly individuals, ages 75 and older, account for approximately 40% of patients diagnosed with pancreatic cancer,” noted study lead author Raphael Yechieli, M.D., with the Department of Radiation Oncology at Henry Ford Hospital. “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.”
We want to …. give them a treatment option that, while not [offering] a cure, is short, effective and safe, and has the potential to give them a good quality of life…
The study was presented at the 55nd annual American Society for Radiation Oncology(ASTRO) meeting being held from September 22 – 25, 2013 in Atlanta, Ga.
Risk factors
According to the National Cancer Institute, there will be an estimated 45,220 new cases of pancreatic cancer in 2013. Approximately 38,460 patients will die from the disease. 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 years of age.
Resectable pancreatic cancer
Surgery is the only known cure for resectable pancreatic cancer, where the cancer is localized to the pancreas and hasn’t spread. It is estimated that only 20 percent of pancreatic cancer patients have their tumors present with localized disease amendable to surgical removal.
A select number of patients, however, are not appropriate candidates for surgery due to having other co-morbidities such as COPD, heart disease and diabetes. This leaves only chemotherapy and radiation, or a combination of the two, available for treatment. However, for a large portion of elderly patients with localized pancreatic cancer even chemotherapy and radiation therapy may not be appropriate treatment options.
Surgery or chemo-radiation therapy
The Henry Fordstudy looked to determine if SBRT was a viable option 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 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. Thirteen patients had a recurrence of cancer. Nine had cancer spread from the original tumor to distant organs or distant lymph nodes. The median overall survival was 6.7 months, and median recurrence-free survival was 8.1 months. At six months post-treatment, 61% of patients were alive and two patients in the study survived 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,” Yechieli noted. “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, Yechieli explained, “Is to closely follow patients after SBRT and get their direct feedback to measure post-treatment quality of life (QoL).”
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