title: Gemcitabine chemotherapy and single-fraction stereotactic body radiotherapy for locally advanced pancreatic cancer.
abstract: OBJECTIVE
  Fractionated radiotherapy and chemotherapy for locally advanced pancreatic cancer achieves only modest local control. This prospective trial evaluated the efficacy of a single fraction of 25 Gy stereotactic body radiotherapy (SBRT) delivered between Cycle 1 and 2 of gemcitabine chemotherapy.
  
  
  METHODS
  A total of 16 patients with locally advanced, nonmetastatic, pancreatic adenocarcinoma received gemcitabine with SBRT delivered 2 weeks after completion of the first cycle. Gemcitabine was resumed 2 weeks after SBRT and was continued until progression or dose-limiting toxicity. The gross tumor volume, with a 2-3-mm margin, was treated in a single 25-Gy fraction by Cyberknife. Patients were evaluated at 4-6 weeks, 10-12 weeks, and every 3 months after SBRT.
  
  
  RESULTS
  All 16 patients completed SBRT. A median of four cycles (range one to nine) of chemotherapy was delivered. Three patients (19%) developed local disease progression at 14, 16, and 21 months after SBRT. The median survival was 11.4 months, with 50% of patients alive at 1 year. Patients with normal carbohydrate antigen (CA)19-9 levels either at diagnosis or after Cyberknife SBRT had longer survival (p <0.01). Acute gastrointestinal toxicity was mild, with 2 cases of Grade 2 (13%) and 1 of Grade 3 (6%) toxicity. Late gastrointestinal toxicity was more common, with five ulcers (Grade 2), one duodenal stenosis (Grade 3), and one duodenal perforation (Grade 4). A trend toward increased duodenal volumes radiated was observed in those experiencing late effects (p = 0.13).
  
  
  CONCLUSIONS
  SBRT with gemcitabine resulted in comparable survival to conventional chemoradiotherapy and good local control. However, the rate of duodenal ulcer development was significant.
authors.affiliation: Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Devin
authors.initials: D
authors.lastname: Schellenberg
authors.forename: Karyn A
authors.initials: KA
authors.lastname: Goodman
authors.forename: Florence
authors.initials: F
authors.lastname: Lee
authors.forename: Stephanie
authors.initials: S
authors.lastname: Chang
authors.forename: Timothy
authors.initials: T
authors.lastname: Kuo
authors.forename: James M
authors.initials: JM
authors.lastname: Ford
authors.forename: George A
authors.initials: GA
authors.lastname: Fisher
authors.forename: Andrew
authors.initials: A
authors.lastname: Quon
authors.forename: Terry S
authors.initials: TS
authors.lastname: Desser
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Norton
authors.forename: Ralph
authors.initials: R
authors.lastname: Greco
authors.forename: George P
authors.initials: GP
authors.lastname: Yang
authors.forename: Albert C
authors.initials: AC
authors.lastname: Koong
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use* / Q000633:toxicity; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use / Q000633:toxicity; D018450:Disease Progression; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery; D011859:Radiography; D016634:Radiosurgery; D011879:Radiotherapy Dosage; D016019:Survival Analysis; D017741:Survivors; D000093542:Gemcitabine
chemical_list: D000970:Antineoplastic Agents; D003841:Deoxycytidine; D000093542:Gemcitabine