The Timing of Surgery Following Stereotactic Body Radiation Therapy Impacts Local Control for Borderline Resectable or Locally Advanced Pancreatic Cancer

Timothy Lin, Abhinav Reddy, Colin Hill, Shuchi Sehgal, Jin He, Lei Zheng, Joseph Herman, Jeffrey Meyer, Amol Narang

Research output: Contribution to journalArticlepeer-review

Abstract

We aimed to evaluate the impact of time from stereotactic body radiation therapy (SBRT) to surgery on treatment outcomes and post-operative complications in patients with borderline resectable or locally advanced pancreatic cancer (BRPC/LAPC). We conducted a single-institutional retrospective analysis of patients with BRPC/LAPC treated from 2016 to 2021 with neoadjuvant chemotherapy followed by SBRT and surgical resection. Covariates were stratified by time from SBRT to surgery. A Cox regression model was used to identify variables associated with survival outcomes. In 171 patients with BRPC/LAPC, the median time from SBRT to surgery was 6.4 (range: 2.7–25.3) weeks. Hence, patients were stratified by the timing of surgery: ≥6 and <6 weeks after SBRT. In univariable Cox regression, surgery ≥6 weeks was associated with improved local control (LC, HR 0.55, 95% CI 0.30–0.98; p = 0.042), pathologic node positivity, elevated baseline CA19-9, and inferior LC if of the male sex. In multivariable analysis, surgery ≥6 weeks (p = 0.013; HR 0.46, 95%CI 0.25–0.85), node positivity (p = 0.019; HR 2.09, 95% CI 1.13–3.88), and baseline elevated CA19-9 (p = 0.002; HR 2.73, 95% CI 1.44–5.18) remained independently associated with LC. Clavien–Dindo Grade ≥3B complications occurred in 4/63 (6.3%) vs. 5/99 (5.5%) patients undergoing surgery <6 weeks and ≥6 weeks after SBRT (p = 0.7). In summary, the timing of surgery ≥6 weeks after SBRT was associated with improved local control and low post-operative complication rates, irrespective of the surgical timing. Further investigation of the influence of surgical timing following radiotherapy is warranted.

Original languageEnglish (US)
Article number1252
JournalCancers
Volume15
Issue number4
DOIs
StatePublished - Feb 2023

Keywords

  • pancreatic adenocarcinoma
  • stereotactic body radiation therapy
  • timing of surgery

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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