Hypofractionated radiotherapy to the pancreas: U.K. experience.

Authors

null

Suliana Teoh

University of Oxford, Oxford, United Kingdom

Suliana Teoh , Ahmad Sabbagh , Jonathan Wadsley , Lori Low , Claire Harrison , Jolyne O'Hare , Rebecca Goody , Kitty Summers , David Wilson , Julie Walther , Fiona Wilson , Ganesh Radhakrishna , Katharine Aitken , Rob Owens , Somnath Mukherjee

Organizations

University of Oxford, Oxford, United Kingdom, Weston Park Hospital, Sheffield, United Kingdom, Belfast City Hospital, Belfast, United Kingdom, Leeds Cancer Centre, Leeds, United Kingdom, Musgrove Park Hospital, Somerset, United Kingdom, Christie Hospital, Manchester, United Kingdom, Royal Marsden NHS Foundation Trust, Surrey, United Kingdom, Oxford University Hospital NHS Trust, Oxford, United Kingdom

Research Funding

No funding received

Background: During the COVID19 pandemic, many centres in the UK, shifted towards utilising hypofractionated radiotherapy (RT) to pancreas. We aim to report the UK experience in hypofractionated radiotherapy to the pancreas in 2020. Methods: We retrospectively identified patients receiving either moderate hypofractionated (15 fractions) or ultra-hypofractionated (3-5 fractions) RT to the pancreas from 7 centres in the UK. Rates of toxicity, progression, death and potential prognostic factors were assessed. Univariate and multivariate Cox proportional hazards analyses were performed. Results: 92 patients from 7 centres were included in the analysis (median age 71 (range 49-88). 90% had performance status of 0-1. 66% had locally advanced disease. 53% had RT delivered over 3-5 fractions (n = 49, median: 30Gy/5f, range:30-40Gy in 3-5f). The rest had 15-fraction RT with or without concurrent chemotherapy (n = 43, median: 45Gy/15f, range: 36-45Gy/15f). Induction chemotherapy (CT) was used in 64% (FOLFIRINIOX –42/59). Median follow-up was 13 months from first treatment (induction CT or RT). Median overall survival (OS) among all patient was 17 months, (95% CI-14.5-19.5 months). On multivariable analysis, induction CT was the only predictor of improved PFS (median survival (MS) 12 vs 5 months; hazard ratio [HR] 0.23; 95% confidence interval [CI]: 0.12-0.44, p < 0.001) and OS (MS 24 vs 11 months; HR 0.15; 95% CI: 0.07 – 0.34, p < 0.001). There were no deaths. 4 patients had grade 3+ toxicities (transaminitis, cholecystitis and gall bladder perforation, small bowel obstruction and diarrhoea) –all had concurrent CT. Conclusions: Our survival outcome appears to be comparable with published data from CT + concurrent chemoradiotherapy. Induction CT appears to improve outcome. Careful selection of patients can help maximise advantage in this patient population.

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Abstract Details

Meeting

2022 ASCO Gastrointestinal Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session B: Cancers of the Pancreas, Small Bowel, and Hepatobiliary Tract

Track

Pancreatic Cancer,Hepatobiliary Cancer,Neuroendocrine/Carcinoid,Small Bowel Cancer

Sub Track

Impact of COVID-19

DOI

10.1200/JCO.2022.40.4_suppl.525

Abstract #

525

Poster Bd #

Online Only

Abstract Disclosures