title: Induction gemcitabine and stereotactic body radiotherapy for locally advanced nonmetastatic pancreas cancer.
abstract: OBJECTIVE
  Stereotactic body radiotherapy (SBRT) has been used successfully to treat patients with locally advanced pancreas cancer. However, many patients develop metastatic disease soon after diagnosis and may receive little benefit from such therapy. We therefore retrospectively analyzed a planned strategy of initial chemotherapy with restaging and then treatment for those patients with no evidence of metastatic progression with SBRT.
  
  
  METHODS
  Forty-seven patients received gemcitabine (1,000 mg/m(2) per week for 3 weeks then 1 week off) until tolerance, at least six cycles, or progression. Patients without metastases after two cycles were treated with SBRT (tolerance-based dose of 24-36 Gy in 3 fractions) between the third and fourth cycles without interrupting the chemotherapy cycles.
  
  
  RESULTS
  Eight of the 47 patients (17%) were found to have metastatic disease after two cycles of gemcitabine; the remaining 39 patients received SBRT. The median follow-up for survivors was 21 months (range, 6-36 months). The median overall survival for all patients who received SBRT was 20 months, and the median progression-free survival was 15 months. The local control rate was 85% (33 of 39 patients); and 54% of patients (21 of 39) developed metastases. Late Grade III toxicities such as GI bleeding and obstruction were observed in 9% (3/39) of patients.
  
  
  CONCLUSIONS
  For patients with locally advanced pancreas cancer, this strategy uses local therapy for those who are most likely to benefit from it and spares those patients with early metastatic progression from treatment. SBRT delivers such local therapy safely with minimal interruption to systemic chemotherapy, thereby potentially improving the outcome in these patients.
authors.affiliation: Department of Radiation Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA. amahadev@bidmc.harvard.edu
authors.forename: Anand
authors.initials: A
authors.lastname: Mahadevan
authors.forename: Rebecca
authors.initials: R
authors.lastname: Miksad
authors.forename: Michael
authors.initials: M
authors.lastname: Goldstein
authors.forename: Ryan
authors.initials: R
authors.lastname: Sullivan
authors.forename: Andrea
authors.initials: A
authors.lastname: Bullock
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Buchbinder
authors.forename: Douglas
authors.initials: D
authors.lastname: Pleskow
authors.forename: Mandeep
authors.initials: M
authors.lastname: Sawhney
authors.forename: Tara
authors.initials: T
authors.lastname: Kent
authors.forename: Charles
authors.initials: C
authors.lastname: Vollmer
authors.forename: Mark
authors.initials: M
authors.lastname: Callery
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018395:CA-19-9 Antigen / Q000097:blood; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D003841:Deoxycytidine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011838:Radiation-Sensitizing Agents / Q000627:therapeutic use*; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D012189:Retrospective Studies; D000093542:Gemcitabine
chemical_list: D018395:CA-19-9 Antigen; D011838:Radiation-Sensitizing Agents; D003841:Deoxycytidine; D000093542:Gemcitabine