Comparing outcomes of stereotactic body radiotherapy with intensity-modulated radiotherapy for patients with locally advanced unresectable pancreatic cancer

2015 ◽  
Vol 27 (3) ◽  
pp. 259-264 ◽  
Author(s):  
Jang-Chun Lin ◽  
Yee-Min Jen ◽  
Ming-Hsien Li ◽  
Hsing-Lung Chao ◽  
Jo-Ting Tsai
Keyword(s):  
Pancreatic Cancer ◽  
Stereotactic Body Radiotherapy ◽  
Locally Advanced ◽  
Intensity Modulated Radiotherapy ◽  
Unresectable Pancreatic Cancer ◽  
Intensity Modulated

Hypofractionated intensity-modulated radiotherapy in locally advanced unresectable pancreatic cancer: A pilot study

2019 ◽  
Vol 43 (5) ◽  
pp. 495-503 ◽  
Author(s):  
Francesca De Felice ◽  
Ilaria Benevento ◽  
Nadia Bulzonetti ◽  
Bianka Shima ◽  
Filippo Rubini ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Pilot Study ◽  
Locally Advanced ◽  
Intensity Modulated Radiotherapy ◽  
Unresectable Pancreatic Cancer ◽  
Intensity Modulated

scholarly journals Technical Assessment of an Automated Treatment Planning on Dose Escalation of Pancreas Stereotactic Body Radiotherapy

2019 ◽  
Vol 18 ◽  
pp. 153303381985152 ◽  
Author(s):  
Shuo Wang ◽  
Dandan Zheng ◽  
Chi Lin ◽  
Yu Lei ◽  
Vivek Verma ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Treatment Planning ◽  
Dose Escalation ◽  
Stereotactic Body Radiotherapy ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Intensity Modulated Radiotherapy ◽  
Intensity Modulated ◽  
Percentage Volume ◽  
Prescription Dose

Background: Stereotactic body radiotherapy has been suggested to provide high rates of local control for locally advanced pancreatic cancer. However, the close proximity of highly radiosensitive normal tissues usually causes the labor-intensive planning process and may impede further escalation of the prescription dose. Purpose: The present study aims to evaluate the consistency and efficiency of Pinnacle Auto-Planning for pancreas stereotactic body radiotherapy with original prescription and escalated prescription. Methods: Twenty-four patients with pancreatic cancer treated with stereotactic body radiotherapy were studied retrospectively. The prescription is 40 Gy over 5 consecutive fractions. Most of patients (n = 21) also had 3 other different dose-level targets (6 Gy/fraction, 5 Gy/fraction, and 4 Gy/fraction). Two types of plans were generated by Pinnacle Auto-Planning with the original prescription (8 Gy/fraction, 6 Gy/fraction, 5 Gy/fraction, and 4 Gy/fraction) and escalated prescription (9 Gy/fraction, 7 Gy/fraction, 6 Gy/fraction, and 5 Gy/fraction), respectively. The same Auto-Planning template, including beam geometry, intensity-modulated radiotherapy objectives and intensity-modulated radiotherapy optimization parameters, were utilized for all the auto-plans in each prescription group. The intensity-modulated radiotherapy objectives do not include any manually created structures. Dosimetric parameters including percentage volume of PTV receiving 100% of the prescription dose, percentage volume of PTV receiving 93% of the prescription dose, and consistency of the dose-volume histograms of the target volumes were assessed. Dmax and D1 cc of highly radiosensitive organs were also evaluated. Results: For all the pancreas stereotactic body radiotherapy plans with the original or escalated prescriptions, auto-plans met institutional dose constraints for critical organs, such as the duodenum, small intestine, and stomach. Furthermore, auto-plans resulted in acceptable planning target volume coverage for all targets with different prescription levels. All the plans were generated in a one-attempt manner, and very little human intervention is necessary to achieve such plan quality. Conclusions: Pinnacle3 Auto-Planning consistently and efficiently generate acceptable treatment plans for multitarget pancreas stereotactic body radiotherapy with or without dose escalation and may play a more important role in treatment planning in the future.

Concurrent high-dose intensity-modulated radiotherapy and chemotherapy for unresectable locally advanced and metastatic pancreatic cancer: a pilot study

2021 ◽  
pp. 1-6
Author(s):  
Kenichi Matsumoto ◽  
Akihiko Miyamoto ◽  
Tomoya Kawase ◽  
Taro Murai ◽  
Yuta Shibamoto
Keyword(s):  
Pancreatic Cancer ◽  
Locally Advanced ◽  
Intensity Modulated Radiotherapy ◽  
Dose Intensity ◽  
Progression Free Survival ◽  
Concurrent Chemotherapy ◽  
Metastatic Pancreatic Cancer ◽  
High Dose ◽  
Chemotherapy Group ◽  
Intensity Modulated

Abstract Aim: To evaluate the efficacy of concurrent chemotherapy and high-dose (≥55 Gy) intensity-modulated radiotherapy (CCIMRT) in comparison with chemotherapy alone and intensity-modulated radiotherapy (IMRT) alone for unresectable locally advanced or metastatic pancreatic cancer. Methods: Forty-six patients with pancreatic cancer undergoing CCIMRT (n = 17), chemotherapy alone (n = 16) or IMRT alone (n = 13) were analysed. Overall survival (OS), locoregional progression-free survival (LRPFS) and gastrointestinal toxicities were evaluated. The median radiation dose was 60 Gy (range, 55–60) delivered in a median of 25 fractions (range, 24–30). Gemcitabine (GEM) alone, GEM + S-1, S-1 alone, FOLFIRINOX and GEM + nab-paclitaxel were used in CCIMRT and chemo-monotherapy. Results: The 1-year OS rate was 69% in the CCIMRT group, 27% in the chemotherapy group and 38% in the IMRT group (p = 0·12). The 1-year LRPFS rate was 73, 0 and 40% in the 3 groups, respectively (p = 0·012). Acute Grade ≥ 2 gastrointestinal toxicity (nausea, diarrhea) was observed in 12% (2/17) in the CCIMRT group, 25% (4/16) in the chemotherapy group and 7·7% (1/13) in the IMRT group (p = 0·38). Late Grade 3 gastrointestinal bleeding was observed in 6·3% (1/16) in the chemotherapy group. Conclusion: High-dose CCIMRT yielded acceptable toxicity and favorable OS and LRPFS.

scholarly journals Stereotactic body radiotherapy for locally-advanced unresectable pancreatic cancer—patterns of care and overall survival

2017 ◽  
Vol 8 (5) ◽  
pp. 766-777 ◽  
Author(s):  
Michael J. Dohopolski ◽  
Scott M. Glaser ◽  
John A. Vargo ◽  
Goundappa K. Balasubramani ◽  
Sushil Beriwal
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Stereotactic Body Radiotherapy ◽  
Locally Advanced ◽  
Patterns Of Care ◽  
Unresectable Pancreatic Cancer

scholarly journals Radiobiological Model-based approach to determine the potential of dose-escalated robust intensity-modulated proton radiotherapy in reducing gastrointestinal toxicity in the treatment of locally advanced unresectable pancreatic cancer of the head.

2020 ◽  
Author(s):  
Vijay Parshuram Raturi ◽  
Hidehiro Hojo ◽  
Kenji Hotta ◽  
Hiromi Baba ◽  
Ryo Takehashi ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Small Bowel ◽  
Locally Advanced ◽  
High Dose ◽  
Target Coverage ◽  
Unresectable Pancreatic Cancer ◽  
Proton Radiotherapy ◽  
Intensity Modulated ◽  
Toxicity Risk ◽  
Gi Toxicity

Abstract Background: The purpose of this study was to determine the potential of escalated dose radiation (EDR) robust intensity-modulated proton radiotherapy (ro-IMPT) in reducing GI toxicity risk in locally advanced unresectable pancreatic cancer (LAUPC) of the head in term of normal tissue complication probability (NTCP) predictive model. Methods: For 9 patients, IMRT was compared with ro-IMPT. For all plans, the prescription dose was 59.4GyE (Gray equivalent) in 33 fractions with an equivalent organ at risk (OAR) constraints. Physical dose distribution was evaluated. GI toxicity risk for different endpoints was estimated using published NTCP Lyman Kutcher Burman (LKB) models for stomach, duodenum, small bowel, and combine stomach and duodenum (StoDuo). A Wilcoxon signed-rank test was used for dosimetry parameters and NTCP values comparison. Result: The dosimetric results have shown that, with similar target coverage, ro-IMPT achieves a significant dose-volume reduction in the stomach, small bowel, and stoduo in low to high dose range in comparison to IMRT. NTCP evaluation for the endpoint gastric bleeding of stomach (10.55% vs . 13.97%, P = 0.007), duodenum (1.87% vs . 5.02%, P = 0.004), and stoduo (5.67% vs. 7.81%, P = 0.008) suggest reduced toxicity by ro-IMPT compared to IMRT. ∆NTCP IMRT – ro-IMPT (using parameter from Pan et al. for gastric bleed) of ≥5 to <10% was seen in 3 patients (33%) for stomach and 2 patients (22%) for stoduo. An overall GI toxicity relative risk (NTCP ro-IMPT /NTCP IMRT ) reduction was noted (0.16-0.81) for all GI-OARs except for duodenum (>1) with endpoint grade ≥3 GI toxicity (using parameters from Holyoake et al .). Conclusion: With similar target coverage and better conformity, ro-IMPT has the potential to substantially reduce the risk of GI toxicity compared to IMRT in EDR of LAUPC of the head. This result needs to be further evaluated in future clinical studies.

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