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©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
Robotic radiosurgery in pancreatic cancer: A systematic review
Milly Buwenge, Francesco Cellini, Nicola Silvestris, Savino Cilla, Francesco Deodato, Gabriella Macchia, Gian C Mattiucci, Vincenzo Valentini, Alessio G Morganti
Milly Buwenge, Francesco Deodato, Gabriella Macchia, Department of Radiation Oncology, Università Cattolica del Sacro Cuore, 86100 Campobasso, Italy
Francesco Cellini, Radiation Oncology Department, Policlinico Universitario Campus Bio-Medico, 00144 Rome, Italy
Nicola Silvestris, Medical Oncology Unit, National Cancer Research Centre "Giovanni Paolo II", 70124 Bari, Italy
Savino Cilla, Department of Medical Physics, Università Cattolica del Sacro Cuore; Fondazione di Ricerca e Cura, 86100 Campobasso, Italy
Gian C Mattiucci, Vincenzo Valentini, Department of Radiation Oncology, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
Alessio G Morganti, Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, S.Orsola-Malpighi Hospital, Bologna 40138, Italy
Author contributions: Buwenge M and Cellini F contributed equally to this work; Morganti AG and Buwenge M designed the research; Buwenge M and Cellini F performed the literature research; Buwenge M, Cellini F, Silvestris N, Cilla S, Deodato F, Macchia G, Mattiucci GC analyzed the data; Buwenge M and Cellini F wrote the paper; Cilla S, Deodato F, Macchia G double-checked the data and analysis; Silvestris N and Mattiucci GC reviewed the paper; Morganti AG and Valentini V supervised the project.
Conflict-of-interest statement: No actual or potential conflicts of interest exist regarding this paper. This article does not contain any studies with human or animal subjects performed by any of the authors.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nicola Silvestris, MD, Medical Oncology Unit, National Cancer Research Centre "Giovanni Paolo II", Viale Orazio Flacco, 65, 70124 Bari, Italy.
n.silvestris@oncologico.bari.it
Telephone: +39-80-5555419 Fax: +39-80-5555419
Received: September 30, 2014
Peer-review started: October 1, 2014
First decision: November 26, 2014
Revised: December 21, 2014
Accepted: April 3, 2015
Article in press: April 3, 2015
Published online: August 21, 2015
Processing time: 323 Days and 19.9 Hours
AIM: To present a systematic review of techniques and clinical results.
METHODS: A systematic review of published literature was performed. Only studies reporting patient outcome after radiosurgery (single fraction) delivered with robotic devices [i.e., robotic radiosurgery (RRS)] have been analyzed.
RESULTS: A total of 96 patients from 5 studies were included. The studies are characterized by small series and different methods in terms of dose, target definition, combination with chemotherapy and/or standard fractionated radiotherapy and evaluation modalities. Preliminary results are positive in terms of tumor response (ORR = 56%) and local control of the tumor (crude rate of local progressions: 19.5%). Results for median overall survival (11.4 mo) seem comparable with the ones of prolonged chemoradiation (range: 8.6-13.0 mo). However, gastrointestinal toxicity seems to be the main limitation of RRS, especially at the duodenal level.
CONCLUSION: RRS allows for local treatment in a shortened time (1 fraction) compared to traditional treatments (about 1 mo), providing the possibility for an easy integration with systemic therapies. Preliminary results did not show any outcome differences compared to standard chemoradiation. Thus, further efforts to reduce gastrointestinal toxicity are strongly needed.
Core tip: Robotic radiosurgery, a type of stereotactic body radiotherapy, has been applied in a few experiences as an alternative to long course, conventional radiotherapy. As described in this systematic review, results suggest a good profile of efficacy. Its use in further trials appears justified to treat pancreatic lesions. Particular attention is needed to manage acute and late toxicity. Its potential is highly interesting for the opportunity of integration with chemotherapy and surgery.
