Systematic reviewSBRT in pancreatic cancer: What is the therapeutic window?
Section snippets
Methods
We performed a systematic literature search for fully published studies on SBRT in PDAC. English-language papers from 01/2000 to 11/2013 were searched. The inclusion criteria were: studies reporting clinical outcomes after SBRT for PDAC; studies specifically reporting toxicities after SBRT for upper abdominal tumours. To identify studies we used PubMed, EMBASE and Cochrane databases and the search was completed in May 2014. The search strategy was (sbrt [tw] OR sabr [tw] OR stereotactic [tw])
Results
We included a total of 16 studies with outcome data on SBRT of pancreatic cancer [13], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30]. One of the studies included patients from three previously reported prospective trials [31]. Another four studies of upper abdominal SBRT reporting on toxicity and providing sufficient dose information were additionally chosen for the toxicity analysis [32], [33], [34], [35], [36], [37], [38]. From the respective studies, a total of 572
Discussion
This analysis shows that SBRT was highly effective controlling local disease in about 75% with 75 Gy BED. Increasing dose beyond 75 Gy BED did neither prolong survival nor was it safe. Our analysis showed that the inverse correlation of survival with BED at the high dose end was probably caused by insufficient systemic therapy employed in SBRT series with high BED [21], [22], [23]. On the other hand high prescription doses clearly correlated with increased toxicity [13], [21], [36], [38]. We
Conflict of interest statement
None.
Acknowledgements
We would like to thank Ms Gerta Rücker from the Institute of Medical Biometry and Medical Informatics, University Medical Center Freiburg for her input for statistical analysis.
Mike Partridge is funded by the CRUK/MRC Oxford Institute for Radiation Oncology (grant ref. C5255/A15935).
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