Search

Simple Summary: The very poor prognosis and the absence of radical treatment options in cases of unresectable "locally advanced pancreatic cancer (LAPC)" focus its management on palliation. An "overall survival (OS)" benefit has been shown with new systemic therapy agents; however, not all patients are good candidates for systemic treatments at diagnosis, and LAPC is often associated with a high symptom burden that greatly impacts patients' quality of life. Studying dose optimization of radiation as an option for local progression cessation is therefore necessary. Research in this setting as opposed to other treatment sites is under-represented in the literature and the guidelines are based on very scarce data. We aim to present the outcomes of "stereotactic body radiotherapy (SBRT)" (ablative radiotherapy) vs. non-ablative radiotherapy through our patient population and the available data in the literature. We studied the dose–local control (LC) relationship in ablative vs. non-ablative radiotherapy in a non-radical treatment setting of "locally advanced pancreatic cancer (LAPC)" by comparing our patients (n = 89) treated with SBRT on the CyberKnife unit vs. conventional radiation between January 2005 and January 2021, and by reviewing the literature. A systematic search was performed leveraging Medline for references on SBRT use in pancreatic cancer without date terms or language restrictions. A total of 3702 references were identified and the search was then repeated in Embase and the Cochrane database. Ultimately, 12 studies were eligible for inclusion, which either compared SBRT to conventional radiation, or SBRT use in dose escalation for primary LAPC in a non-neoadjuvant setting. Our cohort's median overall survival was 152 days (CI 95%, 118–185); including 371 days (CI 95%, 230–511) vs. 126 days (CI 95%, 90–161) favoring SBRT, p = 0.004. The median time to local progression was 170 days (48–923) for SBRT vs. 107 days (27–489) for the non-ablative group. In our SBRT patients, no local progressions were seen with BED10 > 60 Gy. Even when palliating LAPC, SBRT should be considered as an alternative to conventional radiation, especially in patients with a low disease burden. BED10 ≥ 60–70 Gy offers better local control without increasing toxicity rates. Less local progression may provide a better quality of life to those patients who already have a short life expectancy. [ABSTRACT FROM AUTHOR]

Ambulatory cancer centers face a fluctuating patient demand and deploy specialized personnel who have variable availability. This undermines operational stability through the misalignment of resources to patient needs, resulting in overscheduled clinics, budget deficits, and wait times exceeding provincial targets. We describe the deployment of a Learning Health System framework for operational improvements within the entire ambulatory center. Known methods of value stream mapping, operations research and statistical process control were applied to achieve organizational high performance that is data-informed, agile and adaptive. We transitioned from a fixed template model by an individual physician to a caseload management by disease site model that is realigned quarterly. We adapted a block schedule model for the ambulatory oncology clinic to align the regional demand for specialized services with optimized human and physical resources. We demonstrated an improved utilization of clinical space, increased weekly consistency and improved distribution of activity across the workweek. The increased value, represented as the ratio of monthly encounters per nursing worked hours, and the increased percentage of services delivered by full-time nurses were benefits realized in our cancer system. The creation of a data-informed demand capacity model enables the application of predictive analytics and business intelligence tools that will further enhance clinical responsiveness. [ABSTRACT FROM AUTHOR]