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Abstract：
BACKGROUND: Metastatic pancreatic ductal adenocarcinoma (PDAC) carries a poor prognosis and significant morbidity from local tumor progression. We investigated outcomes among oligometastatic PDAC patients treated with stereotactic magnetic resonance image-guided ablative radiotherapy (SMART) to primary disease.
METHODS: We performed a retrospective multi-institutional analysis of oligometastatic PDAC at diagnosis or with metachronous oligoprogression during induction chemotherapy treated with primary tumor SMART. Outcomes of interest included overall survival (OS), progression-free survival (PFS), freedom from locoregional failure (FFLRF), and freedom from distant failure (FFDF). Acute and late toxicity were reported and in exploratory analyses patients were stratified by the number of metastases, SMART indication, and addition of metastasis-directed therapy.
RESULTS: From 2019 to 2021, 22 patients with oligometastatic PDAC (range: 1-6 metastases) received SMART to the primary tumor with a median follow-up of 11.2 months from SMART. Nineteen patients had de novo synchronous metastatic disease and three had metachronous oligoprogression. Metastasis location most commonly was liver only (40.9%), multiple organs (27.3%), lungs only (13.6%), or abdominal/pelvic nodes (13.6%). All patients received either FOLFIRINOX (64%) or gemcitabine/nab-paclitaxel (36%) followed by SMART (median 50 Gy, 5 fractions) for local control (77%), pain control (14%), or local progression (9%). Additionally, 41% of patients received other metastasis-directed treatments. The median OS from diagnosis and SMART was 23.9 months and 11.6 months, respectively. Calculated from SMART, the median PFS was 2.4 months with 91% of patients having distant progression, and 1-year local control was 68. Two patients (9%) experienced grade 3 toxicities, gastric outlet obstruction, and gastrointestinal bleed without grade 4 or 5 toxicity.
CONCLUSIONS: There was minimal morbidity of local disease progression after SMART in this cohort of oligometastatic PDAC. As systemic therapy options improve, additional strategies to identify patients who may derive benefits from local consolidation or metastasis-directed therapy are needed.
METHODS: We performed a retrospective multi-institutional analysis of oligometastatic PDAC at diagnosis or with metachronous oligoprogression during induction chemotherapy treated with primary tumor SMART. Outcomes of interest included overall survival (OS), progression-free survival (PFS), freedom from locoregional failure (FFLRF), and freedom from distant failure (FFDF). Acute and late toxicity were reported and in exploratory analyses patients were stratified by the number of metastases, SMART indication, and addition of metastasis-directed therapy.
RESULTS: From 2019 to 2021, 22 patients with oligometastatic PDAC (range: 1-6 metastases) received SMART to the primary tumor with a median follow-up of 11.2 months from SMART. Nineteen patients had de novo synchronous metastatic disease and three had metachronous oligoprogression. Metastasis location most commonly was liver only (40.9%), multiple organs (27.3%), lungs only (13.6%), or abdominal/pelvic nodes (13.6%). All patients received either FOLFIRINOX (64%) or gemcitabine/nab-paclitaxel (36%) followed by SMART (median 50 Gy, 5 fractions) for local control (77%), pain control (14%), or local progression (9%). Additionally, 41% of patients received other metastasis-directed treatments. The median OS from diagnosis and SMART was 23.9 months and 11.6 months, respectively. Calculated from SMART, the median PFS was 2.4 months with 91% of patients having distant progression, and 1-year local control was 68. Two patients (9%) experienced grade 3 toxicities, gastric outlet obstruction, and gastrointestinal bleed without grade 4 or 5 toxicity.
CONCLUSIONS: There was minimal morbidity of local disease progression after SMART in this cohort of oligometastatic PDAC. As systemic therapy options improve, additional strategies to identify patients who may derive benefits from local consolidation or metastasis-directed therapy are needed.
摘要：
背景：转移性胰腺导管腺癌（PDAC）的预后差，局部肿瘤进展的发病率高。我们调查了接受立体定向磁共振图像引导消融放疗（SMART）治疗原发性疾病的寡转移PDAC患者的结局。
方法：我们对原发性肿瘤SMART诱导化疗期间诊断或异时寡转移PDAC的多机构回顾性分析。感兴趣的结果包括总生存期（OS），无进展生存期（PFS），免于局部失效(FFLRF)，从遥远的失败（FFDF）自由。报告了急性和晚期毒性，在探索性分析中，根据转移数量对患者进行分层，智能指示,并增加转移导向治疗。
结果：从2019年到2021年，22例寡转移PDAC患者（范围：1-6个转移）接受了SMART治疗原发性肿瘤，中位随访时间为SMART11.2个月。19例患者患有从头同步转移性疾病，3例患有异时少进展。转移部位最常见的是肝脏（40.9%），多个器官（27.3%），仅肺（13.6%），或腹部/盆腔淋巴结（13.6%）。所有患者均接受FOLFIRINOX（64％）或吉西他滨/nab-紫杉醇（36％），然后接受SMART（中位数50Gy，5个分数)用于局部控制(77%)，疼痛控制（14%），或局部进展（9%）。此外,41%的患者接受其他转移导向治疗。诊断和SMART的中位OS分别为23.9个月和11.6个月，分别。根据SMART计算，中位PFS为2.4个月，91%的患者有远处进展，1年本地控制为68。两名患者（9%）经历了3级毒性，胃出口梗阻,和无4级或5级毒性的胃肠道出血。
结论：在该寡转移PDAC队列中，SMART后局部疾病进展的发病率最低。随着全身治疗方案的改进，需要采用其他策略来确定可能从局部巩固或转移导向治疗中获益的患者.
方法：我们对原发性肿瘤SMART诱导化疗期间诊断或异时寡转移PDAC的多机构回顾性分析。感兴趣的结果包括总生存期（OS），无进展生存期（PFS），免于局部失效(FFLRF)，从遥远的失败（FFDF）自由。报告了急性和晚期毒性，在探索性分析中，根据转移数量对患者进行分层，智能指示,并增加转移导向治疗。
结果：从2019年到2021年，22例寡转移PDAC患者（范围：1-6个转移）接受了SMART治疗原发性肿瘤，中位随访时间为SMART11.2个月。19例患者患有从头同步转移性疾病，3例患有异时少进展。转移部位最常见的是肝脏（40.9%），多个器官（27.3%），仅肺（13.6%），或腹部/盆腔淋巴结（13.6%）。所有患者均接受FOLFIRINOX（64％）或吉西他滨/nab-紫杉醇（36％），然后接受SMART（中位数50Gy，5个分数)用于局部控制(77%)，疼痛控制（14%），或局部进展（9%）。此外,41%的患者接受其他转移导向治疗。诊断和SMART的中位OS分别为23.9个月和11.6个月，分别。根据SMART计算，中位PFS为2.4个月，91%的患者有远处进展，1年本地控制为68。两名患者（9%）经历了3级毒性，胃出口梗阻,和无4级或5级毒性的胃肠道出血。
结论：在该寡转移PDAC队列中，SMART后局部疾病进展的发病率最低。随着全身治疗方案的改进，需要采用其他策略来确定可能从局部巩固或转移导向治疗中获益的患者.
