How Safe Is Pancreatic Stereotactic Body Radiotherapy?
A recent retrospective study found that pancreatic stereotactic body radiotherapy (SBRT) was associated with a low 90-day mortality rate, but early hospitalizations and adverse events, including infections and gastrointestinal (GI) toxicities, were common.
METHODOLOGY:
SBRT is increasingly used for treating pancreatic cancer, but data on acute morbidity, mortality, and the risk for severe late GI toxicity following the procedure remain limited.
Using a single-institution registry, researchers analyzed data from 507 patients with pancreatic cancer (median age, 70 years; 49.7% women) who received SBRT between February 2006 and July 2023, with outcomes abstracted from electronic medical records.
GI toxicities were categorized as early (occurring within 90 days of SBRT) or late events of grade 3 or higher, which included upper GI bleeding, pseudoaneurysm, and fistula.
SBRT was delivered at 9-12 Gy in three fractions (n = 278; 54.8%), 18-25 Gy in a single fraction (n = 78; 15.4%), or 5-8 Gy in five fractions (n = 147; 29.0%). The total radiation dose was converted to the biologically effective dose (BED).
Overall, 37.5% of patients received SBRT preoperatively or postoperatively; 49.5% of patients were treated for unresectable or medically inoperable disease. Median follow-up from the end of SBRT was 21.2 months, and median overall survival was 18 months.
TAKEAWAY:
Median overall survival in the full cohort of patients was 18.0 months; 7.5% of patients (n = 38) died within 90 days of receiving SBRT, with most causes of death attributed to disease progression (47.3%), and 18.4% (n = 7) died from infection (n = 6) or pulmonary embolism (n = 1). The cause of death for the remaining 13 patients was unknown.
Almost 1 in 4 patients (24.3%) were hospitalized within 90 days, most often due to infection, followed by acute GI toxicity. Among patients with sufficient follow-up to assess late GI toxicity, the crude rate of radiation therapy-attributed toxicity of grade 3 or higher was 13.3%. Of those patients, 32 had upper GI bleeding, 11 had radiation enteritis, 8 had pseudoaneurysm, and 3 had fistula. The median time to high-grade GI bleeding was 10.9 months.
After adjusting for SBRT dose, surgical resection was associated with a significantly reduced risk for high-grade GI toxicity (hazard ratio, 0.57; P = .047).
Lower-dose regimens were also associated with lower risk for severe GI toxicity: 2-year actuarial risks for high-grade GI toxicity were 25.0%, 19.4%, and 16.0% for very high, high, and moderate BED, respectively.
IN PRACTICE:
'Our findings demonstrate that pancreatic SBRT is associated with relatively low mortality rates within the first 90 days after treatment,' the authors of the study wrote.
However, SBRT also came with notable risks for adverse events, especially infections and GI toxicity. 'Infections were a major cause of hospital admission. Severe gastrointestinal toxicity primarily occurred as a late event and was associated with the absence of prior surgery and the use of high-BED SBRT regimens,' the authors of the study wrote, adding that 'future radiation dose-escalation studies should mandate long-term follow-up to monitor patients for late-onset severe gastrointestinal toxicity.'
SOURCE:
This study, led by Susannah G. Ellsworth, MD, University of Pittsburgh Hillman Cancer Center, Pittsburgh, was published online in the Journal of the National Comprehensive Cancer Network.
LIMITATIONS:
Limitations included retrospective design and a large proportion of patients who were lost to follow-up. Changes in the SBRT regimen from single and three fractions to five fractions and evolving chemotherapy regimens could have introduced confounding and bias. Additionally, shorter survival in some subgroups might have led to an underestimation of late toxicity rates.
DISCLOSURES:
The authors reported receiving no funding for the study and disclosed having no relevant conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Medscape
39 minutes ago
- Medscape
Diabetes Technology Updates: We Should Be Proud
This transcript has been edited for clarity. Technology was once again at the front and center of the recent American Diabetes Association (ADA) meetings. Now, I'm not going to go through all of the details of all that was presented, but I think we should all be proud, as part of the diabetes community, in terms of where we've come and where we're going because our ability to use technology and help our patients has really made a difference. In many studies that were presented — and many of them were real-world data with all sorts of different automated insulin delivery (AID) systems and such — we really saw improvements in outcomes. I think this further cements our recommendations that these kinds of tools should be used in people with type 1 diabetes and insulin-requiring type 2 diabetes. My sadness to much of this is the difficulty in getting some of these devices for underresourced patients and the fact that, to some degree, technology does worsen some of the divide between those who are well-served and those who are underserved. I know these tools can be used to help everybody, and I think that regardless of socioeconomic status we can use these, but we need to be sure to use them in the appropriate context with the appropriate support. Suffice it to say that almost any system you want to look up was discussed, and pretty much all systems provide benefit in our patients with diabetes. It's true for patients with type 2 diabetes who are and aren't on insulin, as well as people who take insulin. There were even interesting abstracts about people who don't have diabetes yet, who have prediabetes, who are using the devices that they can get over the counter. This is a field that's evolving, and at each ADA meeting, there are even more interesting bits of data that you can learn as you go through the meeting. In addition to data on AID systems, there were data on continuous glucose monitoring use in a wide variety of settings, which included people with type 2 diabetes who weren't on insulin, people with prediabetes, and even people using the over-the-counter systems. We have much to learn from all the data that are being aggregated. It makes me happy because I've been such a fan of diabetes technology since it came on the market, and I think it's really spread out to help many people. The downside to this is that there are many people who don't have access to these expensive tools, and I think there's a large amount of effort that's been made both by the ADA and others to expand access. I think it's important that people recognize that we want to provide access to the tools that people need to appropriately manage their diabetes no matter what their socioeconomic status. Now, in terms of one specific device, I'm going to discuss the twiist system (Sequel Med Tech). The reason I'm discussing this is because it's just about to come on that market. It's a pump that's actually a circle, and it's called 'twiist' because it twists. It's different from other pump systems. It's designed by Dean Kamen, who is the man who designed the first Medtronic pumps, and it's got some interesting features. First of all, it uses the Loop algorithm. This is the do-it-yourself algorithm that was developed a while ago that has many features, including the fact that it's got a large amount of adjustability so you can set varying targets. I think it's a pretty good algorithm. I haven't used it with this pump yet, but my feeling is that embedded in the pump and used as an AID system, it's going to be very helpful. This pump also has an occlusion alert so that if there's an occlusion to the insulin delivery, it's going to make noise so that patients are alerted to this. It worries me a little bit because I think patients get occlusions all the time — like they sit funny and the catheter kinks or something. I think that for really bad occlusion issues, where people's glucose levels start to go to the 300s and 400s and they have to do troubleshooting, this might alert people in advance before they become very hyperglycemic so they can change out the infusion set. I think it's an interesting concept, this occlusion alarm. I think it's interesting that this pump uses the Loop algorithm, which is now FDA approved. It's a different pump in that it is physically different. It is a tethered pump, but I think that our patients are going to find this interesting and we're going to need to see how they like it because I can never tell for sure what I think about something until my patients tell me. It does work with the FreeStyle Libre 3 Plus, and that's what it's going to be launched with in terms of the sensor. It will also work with the Eversense 1-year implantable sensor within the next several months. Eventually, it will also integrate with the Abbott dual glucose ketone sensor. I think there are going to be many interesting different ways in which to use this, and we'll see what patients think and how it worked. They did present data from two trials. One, a small investigator-led study, and one, some real-world data, which showed that the pump was effective and there were improvements in time in range without a significant increase in time below range. This sounds promising. I love that my patients have more options, and we'll see what happens as our patients begin to use it and give us feedback. This has been Dr Anne Peters, for Medscape.
Forbes
2 hours ago
- Forbes
2 Reasons Why Uncertainty Fuels ‘Emotional Eating,' By A Psychologist
It's normal for everyone to have days where life feels uncertain, stress seems overwhelmingly high or everything around you feels too complicated for you to make sense of. In moments like these, you may often reach out to food, say, something like a bag of chips or cookies. You may even find yourself eating more than usual, which is completely okay. Craving food in these moments is often about comfort. It's your mind and body looking for something calming and satisfying when the world feels anything but. This is especially true for foods that are rich, calorie-dense or nostalgic. If you've ever reached for food in response to emotion, remember that you're not alone and more importantly, that you're not doing anything wrong. This is called 'emotional eating' and it is a deeply human response. It is not a sign of weakness or lack of control, as some would believe. When it comes to emotional eating, it's common for people to label these comfort foods as 'junk' or 'bad,' especially when they're high in sugar, carbs or fat. However, it's important to remember that these labels only create shame, and that food has always been more than fuel. This might seem contrary to modern wellness culture, but with the constant emphasis on 'eating right' and watching your diet, many forget that food offers comfort, cultural connection, safety and even a sense of certainty when life feels anything but predictable. A 2025 study focused on this very connection between uncertainty and food choices. Researchers set out to explore how environmental cues, like feelings of scarcity, danger or instability, might influence the kinds of foods people are drawn to. They exposed participants to different imagined scenarios. Some were exposed to scenarios where they felt safe and abundant, while others signaled ecological harshness, such as resource scarcity or threat. After this priming, participants were shown images of both high- and low-calorie foods and their eye movements were tracked. This was followed by a task where they rated how desirable each food seemed. This helped researchers understand participants' preferences and learn what captured their attention on a subconscious level. Based on the findings of the 2025 study, here are two reasons why you may crave more calorie-dense food in uncertain times. 1. Your Brain Thinks You're In Survival Mode One important finding was that when life feels uncertain, be it due to financial stress, emotional overwhelm or just a general sense of instability, your brain doesn't always know the difference between modern-day stress and ancient survival threats. It helps to look at how we have evolved to better understand this. In ancient times, uncertainty often meant real danger. For instance, a harsh season could mean less food, unpredictable weather or even a threat from predators or rival groups. In essence, these were real signals that survival could be at risk. Over time, our brains have adapted to look at any signs of instability as a cue to prepare for potential scarcity, especially when it comes to food. You may not be consciously aware of this, but it's deeply rooted in the way we function now. Today, you're not necessarily facing the same types of threats, but your brain still reads emotional stress or instability as a possible sign of danger. When this happens, it's almost like some kind of internal 'survival switch,' comes on; one that increases your desire for high-energy and calorie-rich foods. In the study, participants who were asked to imagine themselves in harsh and uncertain environments showed a clear bias toward high-calorie foods. They spent more time looking at those foods and even found them more desirable. They returned their gaze to them more frequently, even without realization. So the next time you find yourself reaching for that extra slice of cake or bag of chips on a stressful day, remember that it's your body's way of attempting to keep you safe and nourished in times of threat. This can shift the way you look at your cravings. Rather than seeing them as something to fix or feel ashamed about, you can begin to view them as signals from your body asking for reassurance or some grounding, and find other ways to offer it the same. 2. You Are Wired To Notice Calorie-Dense Foods First Research published in Neurobiology of Stress has shown that when the brain perceives a threat, whether physical or emotional, it shifts how it functions. In animal studies that informed human treatments for PTSD, scientists observed that high levels of stress hormones, like norepinephrine, impair the prefrontal cortex, which is the brain's center for decision-making and self-control. Instead, more primitive brain regions like the amygdala and basal ganglia, which are responsible for emotional and habitual responses, get activated. Simply speaking, during stress, your logical brain takes a backseat while your emotional brain steps forward. This has been observed through brain imaging and behavioral responses, and helps explain why people under stress tend to act more impulsively and emotionally, like craving comforting, high-calorie foods. This was also seen in the 2025 study. Participants who were asked to imagine themselves in ecologically harsh conditions spent significantly more time looking at high-calorie foods, like pastries or fried items, compared to those who imagined stable and secure environments. Eye-tracking technology showed they unconsciously returned their gaze to those foods more often. They later even rated those foods as more appealing. This wasn't just a conscious preference. It was an inherent shift in attention and perception. Their brains were prioritizing what felt safe and energy-rich. This tells you that stress doesn't just impact how you feel but also changes what you notice and value. Before you realize it, your brain flags certain foods as 'safe' and 'essential.' It's your attention being pulled, quite literally, toward what feels most likely to help you survive. Learning To Listen To Your Body Again Today, shaming yourself for what you eat has, unfortunately, become almost second nature for many. Popular media has managed to paint a picture of health and wellness as being a result of self-control. With some influencers and TikTok videos propagating rigid food rules that constantly flood your social media feed, it's easy to internalize the idea that only 'clean,' portioned or perfectly balanced meals are acceptable or rather the 'correct' way to eat. Anything outside of that seems to deserve guilt. However, shame does nothing to improve your relationship with food. In fact, all it does is distance you further from your body. Choosing a healthy lifestyle is, of course, valuable and empowering. It only becomes problematic when 'healthy' turns into hyper-vigilant. Being overly calculative or constantly policing your portions can take away from the actual experience of nourishment and taking care of yourself. To genuinely take care of yourself in a healthy way, you can choose intuitive eating, which offers a different path. This means learning to trust and listen to your body's internal cues of hunger and satiety. Practice this by responding to hunger without judgment and honoring fullness without fear. It simply invites you to listen and not restrict. Sometimes, this might look like coming home after a long and draining day of work, after feeling anxious and overstimulated, and allowing yourself to curl up with a cozy show and that tub of ice cream or cheesecake without having to think you're doing something wrong or counting those calories. Let yourself be and unwind. That's what care looks like for you in that moment. At the same time, developing other coping strategies can prevent emotional eating from becoming your only source of comfort or grounding. Speaking with a mental health professional can help you find the strategies that work for you. Wondering if you show signs of an unhealthy relationship with food? Take this science-backed test to find out: Eating Attitudes Test
Medscape
3 hours ago
- Medscape
These Markers May Predict Risk for Bone Loss in SLE
TOPLINE: Osteoporosis was prevalent in 41% of patients with systemic lupus erythematosus (SLE). Factors such as lupus nephritis classes III and IV, U1-ribonucleoprotein (RNP) antibodies, and longer disease duration were associated with lower areal bone mineral density (BMD), and active lupus nephritis was associated with osteoporosis. METHODOLOGY: Researchers analysed data of a subcohort of patients from a prospective observational study to identify factors associated with BMD and the risk for osteoporosis. They included 110 patients with SLE (mean age, 48 years; 92% women) from a hospital in Berlin between July 2015 and January 2022 who fulfilled the American College of Rheumatology/ European League Against Rheumatism 2019 SLE classification criteria and had current or prior glucocorticoid treatment. The analysis included SLE disease activity and a standardised bone health assessment with the DEXA scan and trabecular bone score measurement according to national guidelines. BMD- and osteoporosis-related factors were assessed. The following three co-primary endpoints were assessed: Areal BMD, expressed as the lowest DEXA-derived T score at the lumbar spine (L1-L4), total hip, or femoral neck A composite osteoporosis outcome (a femoral or lumbar spine T score ≤ -2.5 and/or history of a major fragility fracture and/or antiosteoporotic treatment) The prevalence of fragility fractures (any, vertebral, and non-vertebral). TAKEAWAY: Overall, 41% and 35% of patients with SLE had osteoporosis and lupus nephritis, respectively. Factors significantly associated with lower areal BMD included lupus nephritis classes III and IV (P = .025), U1-RNP antibodies (P = .009), higher C-reactive protein levels (P = .015), and longer disease duration (P = .001). Clinical remission (P = .033) and higher Health Assessment Questionnaire scores (P = .009) were positively correlated with areal BMD. Active lupus nephritis was strongly associated with osteoporosis in patients with SLE (odds ratio [OR], 7.42; P = .027), along with other factors such as older age (OR, 1.06; P = .003) and lower Health Assessment Questionnaire scores (OR, 0.29; P = .005). IN PRACTICE: "The identification of SLE-specific risk factors allows us to recognize patients at particular high risk for OP [osteoporosis]. This prompts us to suggest a thorough osteoporosis check-up in patients with high CRP [C-reactive protein], LN [lupus nephritis], or U1-RNP-antibodies," the authors wrote. SOURCE: This study was led by Edgar Wiebe, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Rheumatology and Clinical Immunology, Charitéplatz 1, Berlin, Germany. It was published online on July 28, 2025, in Arthritis Research & Therapy. LIMITATIONS: This monocentric cohort study primarily involved White Caucasians, thereby limiting the generalisability of the findings to other patient groups. A potential selection bias may have resulted in overrepresentation of patients with more severe disease courses who were at a high risk for osteoporosis. The cross-sectional design limited the ability to establish causality between identified factors and outcomes. DISCLOSURES: Open access funding was enabled and organised by Projekt DEAL. The prospective observational study received a joint funding from AbbVie, Amgen, Alfasigma, Almirall, Biogen, BMS, Chugai, Fresenius Kabi, Galapagos, GA Generic Assays, GSK, Hexal, Horizon Therapeutics, Lilly, Medac, Mundipharma, Novartis, Pfizer, Roche, Sanofi-Genzyme, and UCB. The authors declared having no conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
