Role of Cyberknife Stereotactic Radiation Therapy (SBRT) Followed by Gemcitabine for Patients With Locally Advanced Pancreatic Cancer

The purpose of this phase I/II study is to evaluate the efficacy and toxicity of a different stereotactic body radiation therapy regimen combined with gemcitabine. In the present study, 5 daily fractions of 6 Gray will be given over two weeks. Stereotactic body radiation therapy will be given with the Cyberknife system. This treatment technique allows to give a higher dose to the tumor as compared to conventional external beam radiation while lowering the dose to the normal tissues around. This treatment system is also capable of following the motion that the pancreas assumes during respiration as well as during treatment. This enables us to reduce the margin of security and further reduce dose to surrounding normal tissue.

The primary objective of this study is to evaluate acute and chronic toxicity of this regimen of stereotactic radiation therapy followed by gemcitabine. Quality of life, local control and overall survival will also be evaluated.

Inclusion criteria

• Pancreatic Adenocarcinoma, histologically and/or cytologically proven
• Locally advanced pancreatic cancer, surgically non resectable
• No distant metastasis
• Work-up including medical history, physical exam, biochemistry, chest X-ray, CT-scan of abdomen and pelvis
• ECOG performance status : ≤ 2
• Primary tumor visible on CT-scan
• Maximum tumor diameter of 6 cm (including primary tumor and regional lymph nodes)
• White blood cell count > 3000 /uL, Neutrophils > 1500 /uL, Platelets > 100 000/uL, Hemoglobin > 95 mg/L, Total bilirubin < 1,5 normal limit, AST/ALT < 2,5 normal limit, normal creatinin
• ≥ 18 years of age
• Signed informed consent

Exclusion criteria

• Prior abdominal radiation therapy
• Connective tissue disease (scleroderma, lupus)
• Prior treatment for pancreatic cancer such as radiation therapy, chemotherapy or surgery.