title: Stereotactic Body Radiation Therapy (SBRT) Combined With Chemotherapy for Unresected Pancreatic Adenocarcinoma.
abstract: OBJECTIVE
  The role of radiation therapy in the management of unresectable pancreatic cancer is controversial. One concern about concurrent chemoradiation relates to the timing of chemotherapy. In contrast to conventional radiation therapy, stereotactic body radiation therapy (SBRT) delivers high doses in a shorter duration resulting in minimal disruption in chemotherapy. Here, we report our results of patients treated with SBRT and chemotherapy for inoperable pancreatic cancer.
  
  
  METHODS
  Thirty-eight patients treated with SBRT and chemotherapy for locally advanced, borderline resectable, and medically inoperable pancreatic cancer at our institution from January 2008 to December 2012 were included in this retrospective analysis. Treatment was delivered in 5 fractions of 5 or 6 Gy per fraction over 5 days. Toxicities were scored using the Common Terminology Criteria for Adverse Events version 3. Survival was calculated using the Kaplan-Meier method.
  
  
  RESULTS
  The median age was 70 years (range, 45 to 90 y). Eastern Cooperative Oncology Group performance status ranged from 0 to 3. Thirty-four patients received concurrent chemotherapy. Four patients received sequential chemotherapy. Median overall survival was 14.3 months and median progression-free survival was 9.2 months from diagnosis. From radiation, overall survival and progression-free survival were 12.3 and 6.8 months, respectively. The overall local control rate was 79%. Acute toxicity was minimal. Severe late SBRT-related toxicities included 1 grade 3 gastric outlet obstruction, 1 grade 4 biliary stricture, and 1 grade 5 gastric hemorrhage.
  
  
  CONCLUSIONS
  SBRT combined with chemotherapy for unresectable pancreatic cancer is convenient, feasible, and generally well tolerated. Outcomes of SBRT combined with chemotherapy compare favorably to results obtained with chemotherapy and conventional radiation therapy.
authors.affiliation: *Department of Radiation Oncology §Division of Gastroenterology, Department of Medicine ∥Department of Surgery, Georgetown University Hospital †Georgetown University School of Medicine ‡Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC.
authors.forename: Marie K
authors.initials: MK
authors.lastname: Gurka
authors.forename: Christine
authors.initials: C
authors.lastname: Kim
authors.forename: Aiwu Ruth
authors.initials: AR
authors.lastname: He
authors.forename: Aline
authors.initials: A
authors.lastname: Charabaty
authors.forename: Nadim
authors.initials: N
authors.lastname: Haddad
authors.forename: Jenna
authors.initials: J
authors.lastname: Turocy
authors.forename: Lynt
authors.initials: L
authors.lastname: Johnson
authors.forename: Patrick
authors.initials: P
authors.lastname: Jackson
authors.forename: Louis M
authors.initials: LM
authors.lastname: Weiner
authors.forename: John L
authors.initials: JL
authors.lastname: Marshall
authors.forename: Sean P
authors.initials: SP
authors.lastname: Collins
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Pishvaian
authors.forename: Keith
authors.initials: K
authors.lastname: Unger
mesh_terms: D000230:Adenocarcinoma / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000628:therapy*; D016634:Radiosurgery; D012189:Retrospective Studies