Patient-Reported Outcomes of a Multi-Center Phase II Study Investigating Gemcitabine and Stereotactic Body Radiotherapy in Locally Advanced Pancreatic Cancer

Publication date: Available online 25 May 2016
Source:Practical Radiation Oncology
Author(s): Avani D. Rao, Elizabeth A. Sugar, Daniel T. Chang, Karyn A. Goodman, Amy Hacker-Prietz, Lauren M. Rosati, Laurie Columbo, Eileen O'Reilly, George A. Fisher, Lei Zheng, Jonathan S. Pai, Mary E. Griffith, Daniel A. Laheru, Christine A. Iacobuzio-Donahue, Christopher L. Wolfgang, Albert Koong, Joseph M. Herman
PurposeWe previously reported clinical outcomes and physician-reported toxicity of gemcitabine and hypofractionated stereotactic body radiation therapy (SBRT) in locally advanced pancreatic cancer (LAPC). Here we prospectively investigate the impact of gemcitabine and SBRT on patient-reported quality of life (QoL).Materials and MethodsForty-nine LAPC patients received 33Gy SBRT (6.6Gy daily fractions) upfront or after ≤3 doses of gemcitabine (1000mg/m²) followed by gemcitabine until progression. European Organization for Research and Treatment of Cancer QoL core cancer (EORTC QLQ-C30) and pancreatic cancer-specific (EORTC QLQ-PAN26) questionnaires were administered to patients pre-SBRT and at 4–6 weeks (1FUP) and 4months (2FUP) post-SBRT. Changes in QoL scores were deemed clinically relevant if median changes were at least 5 points in magnitude.ResultsForty-three (88%) patients completed pre-SBRT questionnaires. Of these, 88% and 51% completed questionnaires at 1FUP and 2FUP, respectively. There was no change in global QoL from pre-SBRT to 1FUP (p=0.17) or 2FUP (p>0.99). Statistical and clinical improvements in pancreatic pain (p=0.001) and body image (p=0.007) were observed from pre-SBRT to 1FUP.Patients with 1FUP and 2FUP questionnaires reported statistically and clinically improved body image (p=0.016) by 4months. Although pancreatic pain initially demonstrated statistical and clinical improvement (p=0.020), scores returned to enrollment levels by 2FUP (p=0.486). A statistical and clinical decline in role functioning (p=0.002) was observed in patients at 2FUP.ConclusionsGlobal QoL scores are not reduced with gemcitabine and SBRT. In this exploratory analysis, patients experience clinically relevant short-term improvements in pancreatic cancer-specific symptoms. Previously demonstrated acceptable clinical outcomes combined with these favorable QoL data indicate that SBRT can be easily integrated with other systemic therapies and may be a potential standard of care option in patients with LAPC.



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