Is there an oligometastatic state in pancreatic cancer? Practical clinical considerations raise the question

Abstract

Objectives: To evaluate the role of stereotactic body radiotherapy (SBRT) as a local ablative treatment (LAT) in oligometastatic pancreatic cancer. Methods: Patients affected by histologically confirmed stage IV pancreatic adenocarcinoma were included in this analysis. Endpoints are local control (LC), progression-free survival (PFS), and overall survival (OS). Results: From 2013 to 2017, a total of 41 patients were treated with SBRT on 64 metastases. Most common sites of disease were lung (29.3%) and liver (56.1%). LC at 1 and 2 years were 88.9% (95% CI 73.2-98.6) and 73.9% (95% CI 50-87.5), respectively. Median LC was 39.9 months (95% CI 23.3-not reached). PFS rates at 1 and 2 years were 21.9% (95% CI 10.8-35.4) and 10.9% (95% CI 3.4-23.4), respectively. Median PFS was 5.4 months (95%CI 3.1-11.3). OS rates at 1 and 2 years were 79.9% (95% CI 63.7-89.4) and 46.7% (95% CI 29.6-62.2). Median OS was 23 months (95%CI 14.1-31.8). Conclusions: Our results, although based on a retrospective analysis of a small number of patients, show that patients with oligometastatic pancreatic cancer may benefit from local treatment with SBRT. Larger studies are warranted to confirm these results. Advances in knowledge: Selected patients affected by oligometastatic pancreatic adenocarcinoma can benefit from local ablative approaches, like SBRT.