Celiac plexus radiosurgery for pain management in advanced cancer: An international phase II trial, health-related quality of life (HRQOL) outcomes.

Authors

null

Yaacov Richard Lawrence

Sheba Medical Center, Ramat Gan, Israel;

Yaacov Richard Lawrence , Marcin Miszczyk , Aisling S Barry , Dayssy Alexandra Diaz Pardo , Artur Aguiar , Dror Limon , Raphael M. Pfeffer , Michael Buckstein , Ofer Margalit , Ronen Fluss , Tikva Meron , Adam P. Dicker , Camilla Zimmermann , David Hausner , Ofir Morag , Talia Golan , Laurence S Freedman , Maoz Ben-Ayun , Zvi Symon , Laura A. Dawson

Organizations

Sheba Medical Center, Ramat Gan, Israel; , Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland; , Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada; , Ohio State University, Columbus, OH; , Portuguese Institute of Oncology of Porto, Porto, Portugal; , Sourasky Medical Center, RGS Unit, Tel Aviv, Israel; , Assuta Medical Center, Tel Aviv, Israel; , Mount Sinai Medical Center, New York, NY; , The Department of Oncology, Sheba Medical Center, Ramat Gan, Israel; , The Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel; , Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA; , Princess Margaret - University Health Network, Toronto, ON, Canada; , Sheba Medical Center, Ra'anana, Israel; , The Gertner Institute, Ramat Gan, Israel;

Research Funding

Other Foundation
Gateway for Cancer Research, Israel Cancer Association

Background: Upper abdominal / lower back pain characterizes celiac plexus involvement from pancreatic and other cancers which may impair HRQOL; its satisfactory treatment is an unmet clinical need. We hypothesized that ablative radiation delivered to the celiac plexus would decrease pain and improve HRQOL. Methods: An international single arm Phase II study included patients with an average pain level ≥ 5/11 on the brief pain inventory (BPI), ECOG 0-2, and anatomical involvement of the celiac axis. The intervention was a single fraction of 25Gy delivered to the celiac plexus. The primary endpoint was ‘complete or partial (≥2 points) pain response’ based upon the BPI ‘average pain’ 11-point scale. Changes in Health-related QOL at 3 & 6 weeks compared to baseline were secondary endpoints as measured by FACT-Hep, > 8 point change being the minimal clinically important difference (MCID). Evaluable patients included eligible irradiated subjects, who had stable pain levels pre-treatment, and were alive 3 weeks’ post-treatment. The sample size was 90 evaluable patients, giving 90% power to show response rate ≥ 40%. Opioid usage was assessed using intravenous morphine equivalent dose. Sensitivity HRQOL analyses imputed worsened outcomes (-9 for total FACT-Hep) for missing data. Results: Between 2018 and 2022, 149 patients were enrolled, 90/125 who received treatment were evaluable. Median age was 65.5 years (range 28-88), 65% were female, 92% had pancreatic cancer, and 86% had metastatic disease. Median Zubrod PS was 1, median number of systemic treatment lines was 1 (range 0-5), and median baseline opioid use 31 mg/d. At 3 weeks, 48 (53.3%, 95% CI 42.5-63.9) had at least a partial pain, the BPI ‘average pain’ score decreased by a mean of 2.5 points at 3 weeks (86/90 reported) and 3.2 points at 6 weeks (67/90 reported), both p < 0.001. Opioid usage decreased by 0.6 mg/d at 3 weeks (NS) and 16.9 mg/d at 6 weeks (p = 0.005). The FACT-Hep total score increased by 7.8 points at 3 weeks (54/90 reported, NS diff. from 8) and 16.6 points at 6 weeks (45/90 reported, sig. > 8, p = 0.01), showing an improvement in patients’ HRQOL. Changes in FACT-Hep were especially noted in the Physical Well Being subscale. The Trial Outcome Index (sum of physical, functional & disease-specific concerns) increased markedly at 3 weeks (6.6 points, p = 0.005) after treatment and even more after 6 weeks (14.5 points, p < 0.). Sensitivity analyses demonstrated improvements in HRQOL at 3 and 6 weeks (1.1, 3.8), but these were less than MCID. Conclusions: Celiac plexus SBRT decreases pain and opioid use amongst patients with pancreatic cancer and other tumors invading the celiac axis. The treatment appears to improve HRQOL. Supported by Gateway for Cancer Research and the Israel Cancer Association. Clinical trial information: NCT03323489.

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Abstract Details

Meeting

2023 ASCO Gastrointestinal Cancers Symposium

Session Type

Rapid Oral Abstract Session

Session Title

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

Track

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

Sub Track

Therapeutics

Clinical Trial Registration Number

NCT03323489

Citation

J Clin Oncol 41, 2023 (suppl 4; abstr 662)

DOI

10.1200/JCO.2023.41.4_suppl.662

Abstract #

662

Abstract Disclosures

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