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Proton Radiotherapy for Isolated Local Recurrence of Primary Resected Pancreatic Ductal Adenocarcinoma

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The optimal treatment for isolated local recurrence (ILR) of pancreatic adenocarcinoma (PDAC) after surgical resection remains unclear. This study aimed to evaluate the safety and efficacy of proton radiotherapy (PRT) for ILR of PDAC after surgery.

Methods

The medical records of patients with ILR of PDAC after surgery who underwent proton beam therapy between 2011 and 2015 at Hyogo Ion Beam Medical Center were retrospectively studied.

Results

The study analyzed 30 patients (14 women and 16 men) with a median age of 65 years (range 38–81 years) who had initially undergone pancreatoduodenectomy (n = 23) or distal pancreatectomy (n = 7) for their primary tumors. Upon ILR, PRT was administered with a median total cumulative dose of 67.5 gray equivalent (GyE) (range 50–67.5 GyE) using 19 to 25 fractions. For 25 patients, concurrent chemotherapy was administered using gemcitabine (n = 18) or S-1 (n = 7). Four patients (13.3%) experienced acute grade ≥ 3 gastrointestinal toxicities. After a median follow-up period of 17.6 months (range 2.1–50.4 months), 23 patients had experienced tumor progression and 10 had died. Nine patients (30%) experienced local tumor progression. The median overall, progression-free, and local progression-free survival rates were 26.1, 12.3, and 41.2 months, respectively. Pre-PRT serum levels of cancer antigen 19-9 higher than 100 U/mL and duke pancreatic monoclonal antigen type 2 higher than 150 U/mL were significantly associated with shorter progression-free survival rates.

Conclusions

Proton radiotherapy for ILR of PDAC after surgery is well tolerated and produces good locoregional control and should be considered for eligible patients.

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References

  1. Ryan DP, Hong TS, Bardeesy N. Pancreatic adenocarcinoma. N Engl J Med. 2014;371:1039–49.

    Article  CAS  PubMed  Google Scholar 

  2. Ferrone CR, Brennan MF, Gonen M, et al. Pancreatic adenocarcinoma: the actual 5-year survivors. J Gastrointest Surg. 2008;12:701–6.

    Article  PubMed  Google Scholar 

  3. Groot VP, Rezaee N, Wu W, et al. (2017) Patterns, timing, and predictors of recurrence following pancreatectomy for pancreatic ductal adenocarcinoma. Ann Surg. 2018;267:936–45.

    Article  PubMed  Google Scholar 

  4. Hishinuma S, Ogata Y, Tomikawa M, Ozawa I, Hirabayashi K, Igarashi S. Patterns of recurrence after curative resection of pancreatic cancer, based on autopsy findings. J Gastrointest Surg. 2006;10:511–8.

    Article  PubMed  Google Scholar 

  5. Iacobuzio-Donahue CA, Fu B, Yachida S, et al. DPC4 gene status of the primary carcinoma correlates with patterns of failure in patients with pancreatic cancer. J Clin Oncol. 2009;27:1806–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Nakayama Y, Sugimoto M, Gotohda N, Konishi M, Takahashi S. Efficacy of completion pancreatectomy for recurrence of adenocarcinoma in the remnant pancreas. J Surg Res. 2018;221:15–23.

    Article  PubMed  Google Scholar 

  7. Miyazaki M, Yoshitomi H, Shimizu H, et al. Repeat pancreatectomy for pancreatic ductal cancer recurrence in the remnant pancreas after initial pancreatectomy: is it worthwhile? Surgery. 2014;155:58–66.

    Article  PubMed  Google Scholar 

  8. Strobel O, Hartwig W, Hackert T, et al. Re-resection for isolated local recurrence of pancreatic cancer is feasible, safe, and associated with encouraging survival. Ann Surg Oncol. 2013;20:964–72.

    Article  PubMed  Google Scholar 

  9. Kleeff J, Reiser C, Hinz U, et al. Surgery for recurrent pancreatic ductal adenocarcinoma. Ann Surg. 2007;245:566–72.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Miura F, Takada T, Amano H, et al. Repeated pancreatectomy after pancreatoduodenectomy. J Gastrointest Surg. 2007;11:179–86.

    Article  PubMed  Google Scholar 

  11. Nakamura A, Itasaka S, Takaori K, et al. Radiotherapy for patients with isolated local recurrence of primary resected pancreatic cancer: prolonged disease-free interval associated with favorable prognosis. Strahlenther Onkol. 2014;190:485–90.

    Article  PubMed  Google Scholar 

  12. Habermehl D, Brecht IC, Bergmann F, et al. Chemoradiation in patients with isolated recurrent pancreatic cancer: therapeutical efficacy and probability of re-resection. Radiat Oncol. 2013;8:27.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Greco C, Wolden S. Current status of radiotherapy with proton and light ion beams. Cancer. 2007;109:1227–38.

    Article  PubMed  Google Scholar 

  14. Terashima K, Demizu Y, Hashimoto N, et al. A phase I/II study of gemcitabine-concurrent proton radiotherapy for locally advanced pancreatic cancer without distant metastasis. Radiother Oncol. 2012;103:25–31.

    Article  PubMed  Google Scholar 

  15. Nishioka K, Prayongrat A, Ono K, et al. Prospective study to evaluate the safety of the world-first spot-scanning dedicated, small 360-degree gantry, synchrotron-based proton beam therapy system. J Radiat Res. 2018;59(Supp 1):i63–i71.

    Google Scholar 

  16. Ishida J, Toyama H, Matsumoto I, et al. Second primary pancreatic ductal carcinoma in the remnant pancreas after pancreatectomy for pancreatic ductal carcinoma: high cumulative incidence rates at 5 years after pancreatectomy. Pancreatology. 2016;16:615–20.

    Article  PubMed  Google Scholar 

  17. Groot VP, van Santvoort HC, Rombouts SJ, et al. Systematic review on the treatment of isolated local recurrence of pancreatic cancer after surgery: re-resection, chemoradiotherapy, and SBRT. HPB Oxford. 2017;19:83–92.

    Article  PubMed  Google Scholar 

  18. Ryan JF, Groot VP, Rosati LM, et al. Stereotactic body radiation therapy for isolated local recurrence after surgical resection of pancreatic ductal adenocarcinoma appears to be safe and effective. Ann Surg Oncol. 2018;25:280–9.

    Article  PubMed  Google Scholar 

  19. Wild AT, Hiniker SM, Chang DT, et al. Re-irradiation with stereotactic body radiation therapy as a novel treatment option for isolated local recurrence of pancreatic cancer after multimodality therapy: experience from two institutions. J Gastrointest Oncol. 2013;4:343–51.

    PubMed  PubMed Central  Google Scholar 

  20. Gkika E, Adebahr S, Kirste S, et al. Stereotactic body radiotherapy (SBRT) in recurrent or oligometastatic pancreatic cancer: a toxicity review of simultaneous integrated protection (SIP) versus conventional SBRT. Strahlenther Onkol. 2017;193:433–43.

    Article  CAS  PubMed  Google Scholar 

  21. Toesca DA, Pollom EL, Poullos PD, et al. Assessing local progression after stereotactic body radiation therapy for unresectable pancreatic adenocarcinoma: CT versus PET. Pract Radiat Oncol. 2017;7:120–5.

    Article  PubMed  Google Scholar 

  22. Kurahara H, Maemura K, Mataki Y, et al. Clinical significance of serum carbohydrate antigen 19.9 and duke pancreatic monoclonal antigen type 2 for the prediction of hematogenous metastases in patients with pancreatic ducal adenocarcinoma. Pancreatology. 2016;16:1051–6.

    Article  CAS  PubMed  Google Scholar 

  23. Fujioka S, Misawa T, Okamoto T, Gocho T, Futagawa Y, Ishida Y, Yanaga K. Preoperative serum carcinoembryonic antigen and carbohydrate antigen 19-9 levels for the evaluation of curability and resectability in patients with pancreatic adenocarcinoma. J Hepatobiliary Pancreat Surg. 2007;14:539–44.

    Article  PubMed  Google Scholar 

  24. Fong ZV, Alvino DML, Fernández-Del Castillo C, et al. Reappraisal of staging laparoscopy for patients with pancreatic adenocarcinoma: a contemporary analysis of 1001 patients. Ann Surg Oncol. 2017;24:3203–11.

    Article  PubMed  Google Scholar 

  25. Conroy T, Desseigne F, Ychou M, et al. FOLFIRINOX versus gemcitabine for metastatic pancreatic cancer. N Engl J Med. 2011;364:1817–25.

    Article  CAS  PubMed  Google Scholar 

  26. Von Hoff DD, Ervin T, Arena FP, et al. Increased survival in pancreatic cancer with nab-paclitaxel plus gemcitabine. N Engl J Med. 2013;369:1691–703.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan

    Takuya Mizumoto MD, PhD, Hirochika Toyama MD, PhD & Takumi Fukumoto MD, PhD

  2. Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Hyogo, Japan

    Takuya Mizumoto MD, PhD, Kazuki Terashima MD, PhD, Yoshiro Matsuo MD, PhD, Fumiko Nagano MD, PhD, Yusuke Demizu MD, PhD, Masayuki Mima MD, PhD, Nor Shazrina Sulaiman MD, PhD, Sunao Tokumaru MD, PhD & Tomoaki Okimoto MD, PhD

Authors
  1. Takuya Mizumoto MD, PhD
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  2. Kazuki Terashima MD, PhD
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  3. Yoshiro Matsuo MD, PhD
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  4. Fumiko Nagano MD, PhD
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  5. Yusuke Demizu MD, PhD
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  6. Masayuki Mima MD, PhD
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  7. Nor Shazrina Sulaiman MD, PhD
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  8. Sunao Tokumaru MD, PhD
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  9. Tomoaki Okimoto MD, PhD
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  10. Hirochika Toyama MD, PhD
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  11. Takumi Fukumoto MD, PhD
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Correspondence to Hirochika Toyama MD, PhD.

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Mizumoto, T., Terashima, K., Matsuo, Y. et al. Proton Radiotherapy for Isolated Local Recurrence of Primary Resected Pancreatic Ductal Adenocarcinoma. Ann Surg Oncol 26, 2587–2594 (2019). https://doi.org/10.1245/s10434-019-07471-z

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  • DOI: https://doi.org/10.1245/s10434-019-07471-z

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