Liver Metastasis-Directed Ablative Radiotherapy in Pancreatic Cancer Offers Prolonged Time Off Systemic Therapy in Selected Patients: Data From a Multi-institutional Retrospective Study.

Autor:	Lee G, Kim DW; Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA., Oladeru OT; Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA., Niemierko A; Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA., Gergelis KR; Department of Radiation Oncology, Mayo Clinic, Rochester, MN., Haddock MG; Department of Radiation Oncology, Mayo Clinic, Rochester, MN., Toesca DAS; Department of Radiation Oncology, Stanford Cancer Institute, Stanford University, Stanford, CA., Koong AJ; Department of Radiation Oncology, Stanford Cancer Institute, Stanford University, Stanford, CA., Owen D; Department of Radiation Oncology, Mayo Clinic, Rochester, MN., Weekes C; Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA., Hong TS; Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA., Chang DT; Department of Radiation Oncology, Stanford Cancer Institute, Stanford University, Stanford, CA., Hallemeier CL; Department of Radiation Oncology, Mayo Clinic, Rochester, MN., Wo JY; Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA.
Jazyk:	angličtina
Zdroj:	Pancreas [Pancreas] 2021 May-Jun 01; Vol. 50 (5), pp. 736-743.
DOI:	10.1097/MPA.0000000000001822
Abstrakt:	Objectives: We evaluated the outcomes of metastatic pancreatic cancer (MPC) patients who underwent liver metastases (LMs)-directed ablative radiotherapy (RT) and sought to characterize patients with more favorable prognosis. Methods: A retrospective analysis of 76 MPC patients who underwent ablative RT (median dose, 50 Gy) to LM at 3 academic centers between 2008 and 2018 was performed. Endpoints were local control (LC), progression-free survival, and overall survival (OS) since RT. Results: Median follow-up was 10.9 months. Liver metastases were metachronous in 68%. Before RT, LM was responsive/stable on chemotherapy (CTX) in 36% whereas progressive in 43%. Median carbohydrate antigen 19-9 (CA 19-9) at RT was 334 U/mL. After RT, 32% had ≥6 months of CTX break. Twelve-month outcomes were: LC, 66%; progression-free survival, 7%; and OS, 38%. On multivariable analysis, Eastern Cooperative Oncology Group 2-3 (hazard ratio [HR], 13.49; P < 0.01), progressive LM on CTX (HR, 3.26; P < 0.01), and higher CA 19-9 (log10 scale; HR, 1.39; P < 0.01) at RT predicted worse OS. Conclusions: Ablative RT to LM in setting of MPC may offer LC of systemic disease and thus quality time off CTX. Selected patients with good performance status, stable/responsive LM on CTX, and lower CA 19-9 have more favorable prognosis. Competing Interests: The authors declare no conflict of interest. (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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