SpringerLink
Log in

Prospective study on stereotactic body radiotherapy for small pancreatic neuroendocrine tumors: tolerance and effectiveness analysis

  • BRIEF RESEARCH ARTICLE
  • Published:
Clinical and Translational Oncology Aims and scope Submit manuscript

Abstract

Introduction

Surgery is the standard treatment for pancreatic neuroendocrine tumors (pNETs), obtaining favorable results but associating high morbidity and mortality rates. This study assesses stereotactic body radiation therapy (SBRT) as a radical approach for small (< 2 cm) nonfunctioning pNETs.

Materials and methods

From January 2017 to June 2023, 20 patients with small pNETs underwent SBRT in an IRB-approved study. Endpoints included local control, tolerance, progression-free survival, and overall survival (OS). Diagnostic assessments comprised endoscopy, CT scans, OctreScan or PET-Dotatoc, abdominal MRI, and histological confirmatory samples.

Results

In a 30-month follow-up of 20 patients (median age 55.5 years), SBRT was well-tolerated with no grade > 2 toxicity. 40% showed morphological response, 55% remained stable. Metabolically, 50% achieved significant improvement. With a median OS of 41.5 months, all patients were alive without local or distant progression or need for surgical resection.

Conclusion

SBRT is a feasible and well-tolerated approach for small neuroendocrine pancreatic tumors, demonstrating effective local control. Further investigations are vital for validation and extension of these findings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Canada)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

All data will be available at a reasonable request.

References

  1. Franko J, Feng W, Yip L, Genovese E, Moser AJ. Non-functional neuroendocrine carcinoma of the pancreas: incidence, tumor biology, and outcomes in 2,158 patients. J Gastrointest Surg. 2010;14(3):541–8.

    Article  PubMed  Google Scholar 

  2. Halfdanarson TR, Rabe KG, Rubin J, Petersen GM. Pancreatic neuroendocrine tumors (PNETs): incidence, prognosis and recent trend toward improved survival. Ann Oncol. 2008;19(10):1727–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Hill JS, McPhee JT, McDade TP, Zhou Z, Sullivan ME, Whalen GF, et al. Pancreatic neuroendocrine tumors: the impact of surgical resection on survival. Cancer. 2009;115(4):741–51.

    Article  PubMed  Google Scholar 

  4. Gratian L, Pura J, Dinan M, Roman S, Reed S, Sosa JA. Impact of extent of surgery on survival in patients with small nonfunctional pancreatic neuroendocrine tumors in the United States. Ann Surg Oncol. 2014;21(11):3515–21.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Zhou C, Zhang J, Zheng Y, Zhu Z. Pancreatic neuroendocrine tumors: a comprehensive review. Int J cancer. 2012;131(5):1013–22.

    Article  CAS  PubMed  Google Scholar 

  6. Falconi M, Bartsch DK, Eriksson B, Klöppel G, Lopes JM, O’Connor JM, et al. ENETS Consensus Guidelines for the management of patients with digestive neuroendocrine neoplasms of the digestive system: well-differentiated pancreatic non-functioning tumors. Neuroendocrinology. 2012;95(2):120–34.

    Article  CAS  PubMed  Google Scholar 

  7. Bettini R, Partelli S, Boninsegna L, Capelli P, Crippa S, Pederzoli P, et al. Tumor size correlates with malignancy in nonfunctioning pancreatic endocrine tumor. Surgery. 2011;150(1):75–82.

    Article  PubMed  Google Scholar 

  8. Birnbaum DJ, Gaujoux S, Cherif R, Dokmak S, Fuks D, Couvelard A, et al. Sporadic nonfunctioning pancreatic neuroendocrine tumors: prognostic significance of incidental diagnosis. Surgery. 2014;155(1):13–21.

    Article  PubMed  Google Scholar 

  9. Haynes AB, Deshpande V, Ingkakul T, Vagefi PA, Szymonifka J, Thayer SP, et al. Implications of incidentally discovered, nonfunctioning pancreatic endocrine tumors: short-term and long-term patient outcomes. Arch Surg. 2011;146(5):534–8.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Kuo EJ, Salem RR. Population-level analysis of pancreatic neuroendocrine tumors 2 cm or less in size. Ann Surg Oncol. 2013;20(9):2815–21.

    Article  PubMed  Google Scholar 

  11. Cheema A, Weber J, Strosberg JR. Incidental detection of pancreatic neuroendocrine tumors: an analysis of incidence and outcomes. Ann Surg Oncol. 2012;19(9):2932–6.

    Article  PubMed  Google Scholar 

  12. Sadot E, Reidy-Lagunes DL, Tang LH, Do RKG, Gonen M, D’Angelica MI, et al. Observation versus resection for small asymptomatic pancreatic neuroendocrine tumors: a matched case-control study. Ann Surg Oncol. 2016;23(4):1361–70.

    Article  PubMed  Google Scholar 

  13. Yang G, Ji M, Chen J, Chen R, Chen Y, Fu D, et al. Surgery management for sporadic small (≤2 cm), non-functioning pancreatic neuroendocrine tumors: a consensus statement by the Chinese Study Group for Neuroendocrine Tumors (CSNET). Int J Oncol. 2017;50(2):567–74.

    Article  PubMed  Google Scholar 

  14. Perri G, Prakash LR, Katz MHG. Pancreatic neuroendocrine tumors. Curr Opin Gastroenterol. 2019;35(5):468–77.

    Article  CAS  PubMed  Google Scholar 

  15. Howe JR, Merchant NB, Conrad C, Keutgen XM, Hallet J, Drebin JA, et al. The North American Neuroendocrine Tumor Society consensus paper on the surgical management of pancreatic neuroendocrine tumors. Pancreas. 2020;49(1):1–33.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Smith JK, Ng SC, Hill JS, Simons JP, Arous EJ, Shah SA, et al. Complications after pancreatectomy for neuroendocrine tumors: a national study. J Surg Res. 2010;163(1):63–8.

    Article  PubMed  Google Scholar 

  17. Gaujoux S, Partelli S, Maire F, D’Onofrio M, Larroque B, Tamburrino D, et al. Observational study of natural history of small sporadic nonfunctioning pancreatic neuroendocrine tumors. J Clin Endocrinol Metab. 2013;98(12):4784–9.

    Article  CAS  PubMed  Google Scholar 

  18. Lee LC, Grant CS, Salomao DR, Fletcher JG, Takahashi N, Fidler JL, et al. Small, nonfunctioning, asymptomatic pancreatic neuroendocrine tumors (PNETs): role for nonoperative management. Surgery. 2012;152(6):965–74.

    Article  PubMed  Google Scholar 

  19. Strosberg J, Hoffe S, Gardner N, Choi J, Kvols L. Effective treatment of locally advanced endocrine tumors of the pancreas with chemoradiotherapy. Neuroendocrinology. 2007;85(4):216–20.

    Article  CAS  PubMed  Google Scholar 

  20. Tennvall J, Ljungberg O, Ahrén B, Gustavsson A, Nillson LO. Radiotherapy for unresectable endocrine pancreatic carcinomas. Eur J Surg Oncol. 1992;18(1):73–6.

    CAS  PubMed  Google Scholar 

  21. Torrisi JR, Treat J, Zeman R, Dritschilo A. Radiotherapy in the management of pancreatic islet cell tumors. Cancer. 1987;60(6):1226–31.

    Article  CAS  PubMed  Google Scholar 

  22. Moore FT, Nadler H, Radefeld DA, Zollinger RM. Prolonged remission of diarrhea due to nonbeta islet cell tumor of the pancreas by radiotherapy. Am J Surg. 1968;115(6):854–5.

    Article  CAS  PubMed  Google Scholar 

  23. Iwata T, Ueno H, Itami J, Ito Y, Inaba K, Morizane C, et al. Efficacy of radiotherapy for primary tumor in patients with unresectable pancreatic neuroendocrine tumors. Jpn J Clin Oncol. 2017;47(9):826–31.

    Article  PubMed  Google Scholar 

  24. Mahadevan A, Miksad R, Goldstein M, Sullivan R, Bullock A, Buchbinder E, et al. Induction gemcitabine and stereotactic body radiotherapy for locally advanced nonmetastatic pancreas cancer. Int J Radiat Oncol Biol Phys. 2011;81(4):e615–22.

    Article  CAS  PubMed  Google Scholar 

  25. Koong AC, Le QT, Ho A, Fong B, Fisher G, Cho C, et al. Phase I study of stereotactic radiosurgery in patients with locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys. 2004;58(4):1017–21.

    Article  PubMed  Google Scholar 

  26. Chuong MD, Springett GM, Freilich JM, Park CK, Weber JM, Mellon EA, et al. Stereotactic body radiation therapy for locally advanced and borderline resectable pancreatic cancer is effective and well tolerated. Int J Radiat Oncol Biol Phys. 2013;86(3):516–22.

    Article  PubMed  Google Scholar 

  27. Mellon EA, Hoffe SE, Springett GM, Frakes JM, Strom TJ, Hodul PJ, et al. Long-term outcomes of induction chemotherapy and neoadjuvant stereotactic body radiotherapy for borderline resectable and locally advanced pancreatic adenocarcinoma. Acta Oncol. 2015;54(7):979–85.

    Article  CAS  PubMed  Google Scholar 

  28. Zhong J, Patel K, Switchenko J, Cassidy RJ, Hall WA, Gillespie T, et al. Outcomes for patients with locally advanced pancreatic adenocarcinoma treated with stereotactic body radiation therapy versus conventionally fractionated radiation. Cancer. 2017;123(18):3486–93.

    Article  PubMed  Google Scholar 

  29. Chen-Zhao X, Hernando O, López M, Sánchez E, Montero A, García-Aranda M, et al. A prospective observational study of the clinical and pathological impact of stereotactic body radiotherapy (SBRT) as a neoadjuvant strategy of chemoradiation in pancreatic cancer. Clin Transl Oncol. 2020;22:1499–505.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Hospital Universitario HM Sanchinarro, HM Hospitales, Oña 10, 28050, Madrid, Spain

    Mercedes López Gonzalez, Ovidio Hernando-Requejo, Raquel Ciervide Jurío, Ángel Montero Luis, Carmen Saiz Guisasola, Emilio Sánchez Saugar, Beatriz Álvarez Rodríguez, **n Chen-Zhao, Mariola García-Aranda, Jeannette Valero Albarran, Rosa Alonso Gutierrez & Carmen Rubio

  2. Department of Nuclear Medicine, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain

    Lina García Cañamaque

  3. Department of Gastroenterology, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain

    Susana Prados

  4. Department of Surgery, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain

    Yolanda Quijano & Emilio de Vicente

Authors
  1. Mercedes López Gonzalez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ovidio Hernando-Requejo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Raquel Ciervide Jurío
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ángel Montero Luis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carmen Saiz Guisasola
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Emilio Sánchez Saugar
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Beatriz Álvarez Rodríguez
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. **n Chen-Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Mariola García-Aranda
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jeannette Valero Albarran
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Rosa Alonso Gutierrez
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Lina García Cañamaque
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Susana Prados
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Yolanda Quijano
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Emilio de Vicente
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Carmen Rubio
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mercedes López Gonzalez.

Ethics declarations

Conflict of interest

None.

Ethical approval, Research involving human participants and/or animals and Informed consent

All procedures performed were in accordance with the ethical standards of the Institutional Research Committee and with the Helsinkli Declaration and informed consent was obtained from all individuals participants included in this study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

López Gonzalez, M., Hernando-Requejo, O., Ciervide Jurío, R. et al. Prospective study on stereotactic body radiotherapy for small pancreatic neuroendocrine tumors: tolerance and effectiveness analysis. Clin Transl Oncol (2024). https://doi.org/10.1007/s12094-024-03538-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12094-024-03538-w

Keywords

Search

Navigation