Stereotactic ablative radiotherapy or best supportive care in patients with localized pancreatic cancer not receiving chemotherapy and surgery (PANCOSAR): a nationwide multicenter randomized controlled trial according to a TwiCs design

D. Doppenberg, M. G. Besselink, C. H.J. van Eijck, M. P.W. Intven, B. Groot Koerkamp, G. Kazemier, H. W.M. van Laarhoven, M. Meijerink, I. Q. Molenaar, J. J.M.E. Nuyttens, R. van Os, H. C. van Santvoort, G. van Tienhoven, H. M. Verkooijen, E. Versteijne, J. W. Wilmink, F. J. Lagerwaard, A. M.E. Bruynzeel*

*Corresponding author for this work

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Abstract

Background: Significant comorbidities, advanced age, and a poor performance status prevent surgery and systemic treatment for many patients with localized (non-metastatic) pancreatic ductal adenocarcinoma (PDAC). These patients are currently treated with ‘best supportive care’. Therefore, it is desirable to find a treatment option which could improve both disease control and quality of life in these patients. A brief course of high-dose high-precision radiotherapy i.e. stereotactic ablative body radiotherapy (SABR) may be feasible. Methods: A nationwide multicenter trial performed within a previously established large prospective cohort (the Dutch Pancreatic cancer project; PACAP) according to the ‘Trial within cohorts’ (TwiCs) design. Patients enrolled in the PACAP cohort routinely provide informed consent to answer quality of life questionnaires and to be randomized according to the TwiCs design when eligible for a study. Patients with localized PDAC who are unfit for chemotherapy and surgery or those who refrain from these treatments are eligible. Patients will be randomized between SABR (5 fractions of 8 Gy) with ‘best supportive care’ and ‘best supportive care’ only. The primary endpoint is overall survival from randomization. Secondary endpoints include preservation of quality of life (EORTC-QLQ-C30 and -PAN26), NRS pain score response and WHO performance scores at baseline, and, 3, 6 and 12 months. Acute and late toxicity will be scored using CTCAE criteria version 5.0: assessed at baseline, day of last fraction, at 3 and 6 weeks, and 3, 6 and 12 months following SABR. Discussion: The PANCOSAR trial studies the added value of SBRT as compared to ‘best supportive care’ in patients with localized PDAC who are medically unfit to receive chemotherapy and surgery, or refrain from these treatments. This study will assess whether SABR, in comparison to best supportive care, can relieve or delay tumor-related symptoms, enhance quality of life, and extend survival in these patients. Trial registration: Clinical trials, NCT05265663, Registered March 3 2022, Retrospectively registered.

Original languageEnglish
Article number1363
JournalBMC Cancer
Volume22
Issue number1
DOIs
Publication statusPublished - 29 Dec 2022

Bibliographical note

Funding
The Dutch Cancer society (KWF Kankerbestrijding) Reference: Letter of approval (toekenningsbrief) / 2021–1/ 13251 See attached file – Funding KWF grant PANCOSAR trial.

This funding source had no role in the design of this study and will not have any role during its execution, analyses, interpretation of the data, or decision to submit/disseminate results. The study protocol has undergone full external peer review by the funding as part of the peer review process.

Publisher Copyright: © 2022, The Author(s).

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