胰腺癌立体定向放射治疗上海专家共识

doi:10.3760/cma.j.cn113030-20221117-00387

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Abstract Pancreatic cancer is a life-threatening and lethal malignancy with a 5-year survival rate of only approximately 9%. Despite that immunotherapy or targeted therapy has been confirmed effective in other cancers, limited survival benefits have been achieved in pancreatic cancer. Therefore, surgery, chemotherapy and radiotherapy are still the main regimens of pancreatic cancer. Owing to that most of the patients have locally advanced or advanced pancreatic cancer at the initial diagnosis, radiotherapy is a pivotal local therapy for prolonging patients' survival and improving the quality of life. Given that stereotactic body radiation therapy has been gradually used in the treatment of pancreatic cancer, a consensus on stereotactic body radiation therapy for pancreatic cancer is required. Under the promotion of Radiation Oncology Society of Shanghai Medical Association, the consensus on stereotactic body radiation therapy for pancreatic cancer has been formulated based on the latest research and practice in stereotactic body radiation therapy for pancreatic cancer combined with national conditions in China, aiming to promote the standardization of stereotactic body radiation therapy for pancreatic cancer, and eventually provide favorable outcomes for pancreatic cancer patients.

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Key words： Pancreatic neoplasms Stereotactic body radiation therapy Consensus

Received: 17 November 2022

Corresponding Authors: Zhang Zhen, Fudan University Shanghai Cancer Center, Shanghai 200032,China, Email: zhen_zhang@fudan.edu.cn

Cite this article:

. Branch Association of Radiation Oncology of Shanghai Medical Association Consensus on stereotactic body radiation therapy for pancreatic cancer[J]. Chinese Journal of Radiation Oncology, 2023, 32(5): 389-399.

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http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.cn113030-20221117-00387 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2023/V32/I5/389

[1] Siegel RL, Miller KD, Fuchs HE, et al.Cancer statistics, 2021[J]. CA Cancer J Clin, 2021,71(1):7-33. DOI: 10.3322/caac.21654.
[2] Sung H, Ferlay J, Siegel RL, et al.Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021,71(3):209-249. DOI: 10.3322/caac.21660.
[3] Mizrahi JD, Surana R, Valle JW, et al.Pancreatic cancer[J]. Lancet, 2020,395(10242):2008-2020. DOI: 10.1016/S0140-6736(20)30974-0.
[4] Petrelli F, Comito T, Ghidini A, et al.Stereotactic body radiation therapy for locally advanced pancreatic cancer: a systematic review and pooled analysis of 19 trials[J]. Int J Radiat Oncol Biol Phys, 2017,97(2):313-322. DOI: 10.1016/j.ijrobp.2016.10.030.
[5] Krishnan S, Chadha AS, Suh Y, et al.Focal radiation therapy dose escalation improves overall survival in locally advanced pancreatic cancer patients receiving induction chemotherapy and consolidative chemoradiation[J]. Int J Radiat Oncol Biol Phys, 2016,94(4):755-765. DOI: 10.1016/j.ijrobp.2015.12.003.
[6] Rosati LM, Kumar R, Herman JM.Integration of stereotactic body radiation therapy into the multidisciplinary management of pancreatic cancer[J]. Semin Radiat Oncol, 2017,27(3):256-267. DOI: 10.1016/j.semradonc.2017.02.005.
[7] Pollom EL, Chin AL, Diehn M, et al.Normal tissue constraints for abdominal and thoracic stereotactic body radiotherapy[J]. Semin Radiat Oncol, 2017,27(3):197-208. DOI: 10.1016/j.semradonc.2017.02.001.
[8] Myrehaug S, Sahgal A, Russo SM, et al.Stereotactic body radiotherapy for pancreatic cancer: recent progress and future directions[J]. Expert Rev Anticancer Ther, 2016,16(5):523-530. DOI: 10.1586/14737140.2016.1168698.
[9] Mellon EA, Hoffe SE, Springett GM, et al.Long-term outcomes of induction chemotherapy and neoadjuvant stereotactic body radiotherapy for borderline resectable and locally advanced pancreatic adenocarcinoma[J]. Acta Oncol, 2015,54(7):979-985. DOI: 10.3109/0284186X.2015.1004367.
[10] Moningi S, Dholakia AS, Raman SP, et al.The role of stereotactic body radiation therapy for pancreatic cancer: a single-institution experience[J]. Ann Surg Oncol, 2015,22(7):2352-2358. DOI: 10.1245/s10434-014-4274-5.
[11] Herman JM, Chang DT, Goodman KA, et al.Phase 2 multi-institutional trial evaluating gemcitabine and stereotactic body radiotherapy for patients with locally advanced unresectable pancreatic adenocarcinoma[J]. Cancer, 2015,121(7):1128-1137. DOI: 10.1002/cncr.29161.
[12] Polistina F, Costantin G, Casamassima F, et al.Unresectable locally advanced pancreatic cancer: a multimodal treatment using neoadjuvant chemoradiotherapy (gemcitabine plus stereotactic radiosurgery) and subsequent surgical exploration[J]. Ann Surg Oncol, 2010,17(8):2092-2101. DOI: 10.1245/s10434-010-1019-y.
[13] Goyal K, Einstein D, Ibarra RA, et al.Stereotactic body radiation therapy for nonresectable tumors of the pancreas[J]. J Surg Res, 2012,174(2):319-325. DOI: 10.1016/j.jss.2011.07.044.
[14] Gurka MK, Collins SP, Slack R, et al.Stereotactic body radiation therapy with concurrent full-dose gemcitabine for locally advanced pancreatic cancer: a pilot trial demonstrating safety[J]. Radiat Oncol, 2013,8:44. DOI: 10.1186/1748-717X-8-44.
[15] Balaban EP, Mangu PB, Khorana AA, et al.Locally advanced, unresectable pancreatic cancer: american society of clinical oncology clinical practice guideline[J]. J Clin Oncol, 2016,34(22):2654-2668. DOI: 10.1200/JCO.2016.67.5561.
[16] Li J, Wang Z, Li AM, et al.Analysis of the efficacy, safety and survival factors of stereotactic body radiation therapy in patients with recurrence of pancreatic cancer[J]. Transl Oncol, 2020,13(10):100818. DOI: 10.1016/j.tranon.2020.100818.
[17] 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[J]. Ann Surg Oncol, 2018,25(1):280-289. DOI: 10.1245/s10434-017-6134-6.
[18] Zeng XL, Wang HH, Meng MB, et al.Stereotactic body radiation therapy for patients with recurrent pancreatic adenocarcinoma at the abdominal lymph nodes or postoperative stump including pancreatic stump and other stump[J]. Onco Targets Ther, 2016,9:3985-3992. DOI: 10.2147/OTT.S102784.
[19] Comito T, Cozzi L, Zerbi A, et al.Clinical results of stereotactic body radiotherapy (SBRT) in the treatment of isolated local recurrence of pancreatic cancer after R₀ surgery: a retrospective study[J]. Eur J Surg Oncol, 2017,43(4):735-742. DOI: 10.1016/j.ejso.2016.12.012.
[20] 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[J]. HPB (Oxford), 2017,19(2):83-92. DOI: 10.1016/j.hpb.2016.11.001.
[21] Zhu X, Cao Y, Liu W, et al.Stereotactic body radiotherapy plus pembrolizumab and trametinib versus stereotactic body radiotherapy plus gemcitabine for locally recurrent pancreatic cancer after surgical resection: an open-label, randomised, controlled, phase 2 trial[J]. Lancet Oncol, 2022,23(3): e105-e115. DOI: 10.1016/S1470-2045(22)00066-3.
[22] Sutera P, Bernard ME, Wang H, et al.Stereotactic body radiation therapy for locally progressive and recurrent pancreatic cancer after prior radiation[J]. Front Oncol, 2018,8:52. DOI: 10.3389/fonc.2018.00052.
[23] Dagoglu N, Callery M, Moser J, et al.Stereotactic body radiotherapy (SBRT) reirradiation for recurrent pancreas cancer[J]. J Cancer, 2016,7(3):283-288. DOI: 10.7150/jca.13295.
[24] Lominska CE, Unger K, Nasr NM, et al.Stereotactic body radiation therapy for reirradiation of localized adenocarcinoma of the pancreas[J]. Radiat Oncol, 2012,7:74. DOI: 10.1186/1748-717X-7-74.
[25] Koong AJ, Toesca D, von Eyben R, et al. Reirradiation with stereotactic body radiation therapy after prior conventional fractionation radiation for locally recurrent pancreatic adenocarcinoma[J]. Adv Radiat Oncol, 2017,2(1):27-36. DOI: 10.1016/j.adro.2017.01.003.
[26] 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]. J Gastrointest Oncol, 2013,4(4):343-351. DOI: 10.3978/j.issn.2078-6891.2013.044.
[27] Zhu X, Li F, Ju X, et al.Prediction of overall survival after re-irradiation with stereotactic body radiation therapy for pancreatic cancer with a novel prognostic model (the SCAD score)[J]. Radiother Oncol, 2018,129(2):313-318. DOI: 10.1016/j.radonc.2018.08.012.
[28] Zhu X, Li F, Ju X, et al.Prognostic role of stereotactic body radiation therapy for elderly patients with advanced and medically inoperable pancreatic cancer[J]. Cancer Med, 2017,6(10):2263-2270. DOI: 10.1002/cam4.1164.
[29] Zhu X, Cao Y, Lu M, et al.Stereotactic body radiation therapy with sequential S-1 for patients with locally advanced pancreatic cancer and poor performance status: an open-label, single-arm, phase 2 trial[J]. Radiother Oncol, 2021,162:178-184. DOI: 10.1016/j.radonc.2021.07.009.
[30] Ciabatti S, Cammelli S, Frakulli R, et al.Radiotherapy of pancreatic cancer in older patients: a systematic review[J]. J Geriatr Oncol, 2019,10(4):534-539. DOI: 10.1016/j.jgo.2018.09.007.
[31] Ji X, Zhao Y, He C, et al.Clinical effects of stereotactic body radiation therapy targeting the primary tumor of liver-only oligometastatic pancreatic cancer[J]. Front Oncol, 2021,11:659987. DOI: 10.3389/fonc.2021.659987.
[32] Mutic S, Palta JR, Butker EK, et al.Quality assurance for computed-tomography simulators and the computed-tomography-simulation process: report of the AAPM Radiation Therapy Committee Task Group No. 66[J]. Med Phys, 2003,30(10):2762-2792. DOI: 10.1118/1.1609271.
[33] Rasmussen B, Chu K, Tong S.SU-E-T-530: relative electron density phantom comparison[J]. Med Phys, 2012,39(6Part18):3827. DOI: 10.1118/1.4735619.
[34] Klein EE, Hanley J, Bayouth J, et al.Task group 142 report: quality assurance of medical accelerators[J]. Med Phys, 2009,36(9):4197-4212. DOI: 10.1118/1.3190392.
[35] Ezzell GA, Galvin JM, Low D, et al.Guidance document on delivery, treatment planning, and clinical implementation of IMRT: report of the IMRT Subcommittee of the AAPM Radiation Therapy Committee[J]. Med Phys, 2003,30(8):2089-2115. DOI: 10.1118/1.1591194.
[36] Benedict SH, Yenice KM, Followill D, et al.Stereotactic body radiation therapy: the report of AAPM Task Group 101[J]. Med Phys, 2010,37(8):4078-4101. DOI: 10.1118/1.3438081.
[37] Al-Hawary MM, Francis IR, Chari ST, et al.Pancreatic ductal adenocarcinoma radiology reporting template: consensus statement of the Society of Abdominal Radiology and the American Pancreatic Association[J]. Radiology, 2014,270(1):248-260. DOI: 10.1148/radiol.13131184.
[38] Oar A, Lee M, Le H, et al.Australasian Gastrointestinal Trials Group (AGITG) and Trans-Tasman Radiation Oncology Group (TROG) guidelines for pancreatic stereotactic body radiation therapy (SBRT)[J]. Pract Radiat Oncol, 2020,10(3): e136-e146. DOI: 10.1016/j.prro.2019.07.018.
[39] Shiinoki T, Shibuya K, Nakamura M, et al.Interfractional reproducibility in pancreatic position based on four-dimensional computed tomography[J]. Int J Radiat Oncol Biol Phys, 2011,80(5):1567-1572. DOI: 10.1016/j.ijrobp.2010.10.020.
[40] Heerkens HD, van Vulpen M, van den Berg CA, et al. MRI-based tumor motion characterization and gating schemes for radiation therapy of pancreatic cancer[J]. Radiother Oncol, 2014,111(2):252-257. DOI: 10.1016/j.radonc.2014.03.002.
[41] Lens E, Gurney-Champion OJ, Tekelenburg DR, et al.Abdominal organ motion during inhalation and exhalation breath-holds: pancreatic motion at different lung volumes compared[J]. Radiother Oncol, 2016,121(2):268-275. DOI: 10.1016/j.radonc.2016.09.012.
[42] Lens E, van der Horst A, Kroon PS, et al. Differences in respiratory-induced pancreatic tumor motion between 4D treatment planning CT and daily cone beam CT, measured using intratumoral fiducials[J]. Acta Oncol, 2014,53(9):1257-1264. DOI: 10.3109/0284186X.2014.905699.
[43] Whitfield G, Jain P, Green M, et al.Quantifying motion for pancreatic radiotherapy margin calculation[J]. Radiother Oncol, 2012,103(3):360-366. DOI: 10.1016/j.radonc.2012.02.012.
[44] Minn AY, Schellenberg D, Maxim P, et al.Pancreatic tumor motion on a single planning 4D-CT does not correlate with intrafraction tumor motion during treatment[J]. Am J Clin Oncol, 2009,32(4):364-368. DOI: 10.1097/COC.0b013e31818da9e0.
[45] Apte MV, Wilson JS, Lugea A, et al.A starring role for stellate cells in the pancreatic cancer microenvironment[J]. Gastroenterology, 2013,144(6):1210-1219. DOI: 10.1053/j.gastro.2012.11.037.
[46] Apte MV, Park S, Phillips PA, et al.Desmoplastic reaction in pancreatic cancer: role of pancreatic stellate cells[J]. Pancreas, 2004,29(3):179-187. DOI: 10.1097/00006676-200410000-00002.
[47] Katz M, Ou FS, Herman JM, et al.Alliance for clinical trials in oncology (ALLIANCE) trial A021501: preoperative extended chemotherapy vs. chemotherapy plus hypofractionated radiation therapy for borderline resectable adenocarcinoma of the head of the pancreas[J]. BMC Cancer, 2017,17(1):505. DOI: 10.1186/s12885-017-3441-z.
[48] Zhu X, Ju X, Cao Y, et al.Patterns of local failure after stereotactic body radiation therapy and sequential chemotherapy as initial treatment for pancreatic cancer: implications of target volume design[J]. Int J Radiat Oncol Biol Phys, 2019,104(1):101-110. DOI: 10.1016/j.ijrobp.2019.01.075.
[49] Chuong MD, Springett GM, Freilich JM, et al.Stereotactic body radiation therapy for locally advanced and borderline resectable pancreatic cancer is effective and well tolerated[J]. Int J Radiat Oncol Biol Phys, 2013,86(3):516-522. DOI: 10.1016/j.ijrobp.2013.02.022.
[50] Simoni N, Micera R, Paiella S, et al.Hypofractionated stereotactic body radiation therapy with simultaneous integrated boost and simultaneous integrated protection in pancreatic ductal adenocarcinoma[J]. Clin Oncol (R Coll Radiol), 2021,33(1): e31-e38. DOI: 10.1016/j.clon.2020.06.019.
[51] Witt JS, Kuczmarska-Haas A, Lubner M, et al.A phase 1 dose escalation study of neoadjuvant SBRT plus elective nodal radiation with concurrent capecitabine for resectable pancreatic cancer[J]. Int J Radiat Oncol Biol Phys, 2021,109(2):458-463. DOI: 10.1016/j.ijrobp.2020.09.010.
[52] Holyoake D, Robinson M, Silva M, et al.SPARC, a phase-I trial of pre-operative, margin intensified, stereotactic body radiation therapy for pancreatic cancer[J]. Radiother Oncol, 2021,155:278-284. DOI: 10.1016/j.radonc.2020.11.007.
[53] Tozzi A, Comito T, Alongi F, et al.SBRT in unresectable advanced pancreatic cancer: preliminary results of a mono-institutional experience[J]. Radiat Oncol, 2013,8:148. DOI: 10.1186/1748-717X-8-148.
[54] Mahadevan A, Miksad R, Goldstein M, et al.Induction gemcitabine and stereotactic body radiotherapy for locally advanced nonmetastatic pancreas cancer[J]. Int J Radiat Oncol Biol Phys, 2011,81(4):e615-622. DOI: 10.1016/j.ijrobp.2011.04.045.
[55] Zhu X, Cao Y, Su T, et al. Failure patterns and outcomes of dose escalation of stereotactic body radiotherapy for locally advanced pancreatic cancer: a multicenter cohort study[J]. Ther Adv Med Oncol, 2020,12:175883592097 7155. DOI: 10.1177/1758835920977155.
[56] Campbell WG, Jones BL, Schefter T, et al.An evaluation of motion mitigation techniques for pancreatic SBRT[J]. Radiother Oncol, 2017,124(1):168-173. DOI: 10.1016/j.radonc.2017.05.013.
[57] Huguet F, Yorke ED, Davidson M, et al.Modeling pancreatic tumor motion using 4-dimensional computed tomography and surrogate markers[J]. Int J Radiat Oncol Biol Phys, 2015,91(3):579-587. DOI: 10.1016/j.ijrobp.2014.10.058.
[58] Nakamura M, Shibuya K, Shiinoki T, et al.Positional reproducibility of pancreatic tumors under end-exhalation breath-hold conditions using a visual feedback technique[J]. Int J Radiat Oncol Biol Phys, 2011,79(5):1565-1571. DOI: 10.1016/j.ijrobp.2010.05.046.
[59] Nakamura M, Akimoto M, Ono T, et al.Interfraction positional variation in pancreatic tumors using daily breath-hold cone-beam computed tomography with visual feedback[J]. J Appl Clin Med Phys, 2015,16(2):5123. DOI: 10.1120/jacmp.v16i2.5123.
[60] Hanna GG, Murray L, Patel R, et al.UK consensus on normal tissue dose constraints for stereotactic radiotherapy[J]. Clin Oncol (R Coll Radiol), 2018,30(1):5-14. DOI: 10.1016/j.clon.2017.09.007.
[61] Kim L, Nguyen N, Singhal N, et al.Application of stereotactic body radiotherapy in advanced pancreatic cancers in Australia[J]. J Med Radiat Sci, 2019,66(1):54-61. DOI: 10.1002/jmrs.313.
[62] Gurka MK, Kim C, He AR, et al.Stereotactic body radiation therapy (SBRT) combined with chemotherapy for unresected pancreatic adenocarcinoma[J]. Am J Clin Oncol, 2017,40(2):152-157. DOI: 10.1097/COC.0000000000000118.
[63] Zhu X, Shi D, Li F, et al.Prospective analysis of different combined regimens of stereotactic body radiation therapy and chemotherapy for locally advanced pancreatic cancer[J]. Cancer Med, 2018,7(7):2913-2924. DOI: 10.1002/cam4.1553.