Gastrointestinal Cancer

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SU_17_2171 - SBRT with Simultaneous Integrated Boost results in high rate of R0 resection in borderline resectable pancreatic adenocarcinoma

Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3

SBRT with Simultaneous Integrated Boost results in high rate of R0 resection in borderline resectable pancreatic adenocarcinoma
W. H. Ennis, R. Chaudhari, E. C. Daugherty, S. Tanny, A. Jain, A. Jurdi, A. V. Banashkevich V, J. A. Bogart, and A. Shapiro; SUNY Upstate Medical University, Syracuse, NY

Purpose/Objective(s): Surgical resection for pancreatic adenocarcinoma offers a significantly improved prognosis with a distinct advantage of potentially curative (R0) versus palliative (R1/R2) surgery. Stereotactic body radiation therapy (SBRT) has emerged as a treatment option that has potential to pull the tumor off adjacent vascular structures and therefore improve surgical outcomes. We reviewed our rates of complete (R0) resection following neoadjuvant chemotherapy and SBRT for borderline resectable patients with pancreatic adenocarcinoma.

Materials/Methods: Retrospective review of patients treated with SBRT to the pancreas between October 2015 and November 2017.

Results: A total of 26 patients were treated with SBRT to pancreas. All patients were treated with 5 fraction SBRT after fiducial marker placement and 4D treatment planning. Mean dose is 3250 cGy. Eight of the 26 patients received simultaneous integrated boost (SIB) to tumor vessel interface. Mean SIB dose 4150 cGy.Twelve medically operable patients received neoadjuvant chemotherapy; 7 FOLFIRINOX, 4 gemcitabine/abraxane, and one gemcitabine/pemetrexed. Of the 12 medically operable patients, 9 were classified as borderline resectable, and 3 were classified as unresectable based on NCCN criteria. Eight of 9 borderline resectable patients underwent successful pancreatoduodenectomy with R0 resection (89%). No severe toxicity was observed.

Conclusion: SBRT provides a promising way to treat locally advanced and borderline resectable pancreatic cancer. A simultaneous integrated boost (SIB) to the region of vessel abutment or encasement during SBRT has the potential to downstage and improve the likelihood of R0 resection. Further exploration of SIB may be warranted in borderline resectable disease.

Author Disclosure: W.H. Ennis: None. R. Chaudhari: None. E.C. Daugherty: None. S. Tanny: None. A. Jain: None. A.V. Banashkevich: None. J.A. Bogart: Partner; Upstate University Radiation Oncology. Travel Expenses; Alliance Clinical Trials. Chair, Radiation Oncology Committee; Alliance.

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