title: Stereotactic body radiotherapy in the treatment of pancreatic adenocarcinoma in elderly patients.
abstract: BACKGROUND
  Treatment of pancreatic adenocarcinoma in the elderly is often complicated by comorbidities that preclude surgery, chemotherapy and/or conventional external beam radiation therapy (EBRT). Stereotactic body radiotherapy (SBRT) has thus garnered interest in this setting.
  
  
  METHODS
  A retrospective review of 26 patients of age ≥ 80 with pancreatic adenocarcinoma treated with definitive SBRT+/-chemotherapy from 2007-2011 was performed. Twenty-seven percent of patients were stage I, 38% were stage II, 27% were stage III and 8% were stage IV. Patients most commonly received 24 Gy/1 fraction or 30-36 Gy/3 fractions. Kaplan-Meier was used to estimate overall survival (OS), local control (LC), cause specific survival (CSS) and freedom-from-metastatic disease (FFMD).
  
  
  RESULTS
  The median age was 86 (range 80-91), and median follow-up was 11.6 months (3.5-24.6). The median planning target volume was 21.48 cm3 (6.1-85.09). Median OS was 7.6 months with 6/12 month OS rates of 65.4%/34.6%, respectively. Median LC was 11.5 months, 6-month and 12-month actuarial LC rates were 60.1% and 41.2%, respectively. There were no independent predictors for LC, but there was a trend for improved LC with prescription dose greater than 20 Gy (p = 0.063). Median CSS was 6.3 months, and 6-month and 12-month actuarial CSS were 53.8% and 23.1%, respectively. Median FFMD was 8.4 months, and 6-month and 12-month actuarial rates were 62.0% and 41.4%, respectively. Nine patients (47%) had local failures, 11 (58%) had distant metastasis, and 7 (37%) had both. There were no acute or late grade 3+ toxicities.
  
  
  CONCLUSIONS
  Definitive SBRT is feasible, safe and effective in elderly patients who have unresectable disease, have comorbidities precluding surgery or decline surgery.
authors.forename: Carolyn H
authors.initials: CH
authors.lastname: Kim
authors.forename: Diane C
authors.initials: DC
authors.lastname: Ling
authors.forename: Rodney E
authors.initials: RE
authors.lastname: Wegner
authors.forename: John C
authors.initials: JC
authors.lastname: Flickinger
authors.affiliation: Department of Radiation Oncology, University of Pittsburgh Cancer Institute, 5150 Centre Avenue, #545, Pittsburgh, PA 15232, USA. herond2@upmc.edu.
authors.forename: Dwight E
authors.initials: DE
authors.lastname: Heron
authors.forename: Herbert
authors.initials: H
authors.lastname: Zeh
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Moser
authors.forename: Steven A
authors.initials: SA
authors.lastname: Burton
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies