Targeted radiotherapy safe and effective for elderly with pancreatic cancer

A highly targeted cancer radiation therapy may offer a safe and effective treatment option for elderly patients with pancreatic cancer who are unable to undergo surgery or combined chemotherapy and radiation therapy. This study was presented at the 55th annual meeting of the American Society for Radiation Oncology in Atlanta, Georgia.

This therapy is known as stereotactic body radiotherapy (SBRT), and its radiation can be highly targeted to the tumor while sparing the normal tissue around it. The study found that patients lived an average of 6 to 7 months longer following treatment, with minimal side effects, even when they had other severe comorbidities such as chronic obstructive pulmonary disease (COPD), heart disease, or diabetes.

"Elderly individuals, those ages 75 and older, account for approximately 40% of patients diagnosed with pancreatic cancer," said study lead author Raphael Yechieli, MD, of Henry Ford Hospital in Detroit, Michigan. "These patients are too ill to receive any other treatment, but with stereotactic body radiotherapy we're able to deliver a safe and effective treatment in 2 weeks that can provide them with a substantial quality of life with minimal side effects."

In 2013, there will be an estimated 45,220 new cases of pancreatic cancer, and approximately 38,460 will die from the disease, according to the National Cancer Institute. Most people diagnosed with the disease are older than 65 years.

Surgery is the only known cure for resectable pancreatic cancer, where the cancer is localized to the pancreas and hasn't spread. It is estimated that only 20% of patients with pancreatic cancer manifest tumors with localized disease amendable to surgical removal. A select number of those patients, however, are not candidates for surgery due to having other comorbidities such as COPD, heart disease, or diabetes. This leaves only chemotherapy and radiation, or a combination of the two, available for treatment. However, for a large portion of elderly patients with localized pancreatic cancer even chemotherapy and radiation therapy are not options.

This study sought to determine if SBRT was a viable option for this group of patients. SBRT provides a higher dose of radiation, meaning patients have fewer treatments. In this case, treatment averaged 2 weeks.

The study included 20 patients with a median age of 83 years, and all were medically unable to tolerate other treatment options. The patients in the study had a median overall survival of 6.7 months, and their median recurrence-free survival was 8.1 months. At 6 months post-treatment, 61% of patients were alive; two patients in the study survived nearly 2 years.

"National trends tell us that very few patients over the age of 75 are getting any treatment at all for pancreatic cancer due to comorbidity risks," notes Dr. Yechieli. "So we want to push the envelope to give them a treatment option that, while not a cure, is short, effective, and safe, and has the potential to give them a good quality of life."

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