Pancreatic SABR using peritumoral fiducials, triggered imaging and breath-hold.

Autor:	Kisivan K; Department of Radiotherapy, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary., Farkas A; Department of Radiotherapy, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary., Kovacs P; Department of Radiotherapy, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary., Glavak C; Department of Radiotherapy, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary., Lukacs G; Department of Medical Oncology, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary., Mahr K; Department of Medical Oncology, Zala County Szent Raphael Hospital, Zalaegerszeg, Hungary., Szabo Z; Department of Medical Oncology, Zala County Szent Raphael Hospital, Zalaegerszeg, Hungary., Csima MP; Institute of Education, Hungarian University of Agricultural and Life Sciences, Gödöllő, Hungary.; Faculty of Health Sciences, University of Pecs, Pecs, Hungary., Gulyban A; Department of Medical Physics, Institut Jules Bordet, Brussels, Belgium.; Radiophysics and MRI Physics Laboratory, Université Libre De Bruxelles (ULB), Brussels, Belgium., Toth Z; Medicopus Nonprofit Ltd., Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary.; PET Center, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary., Kaposztas Z; Department of Surgery, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary., Lakosi F; Department of Radiotherapy, Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary.; Faculty of Health Sciences, University of Pecs, Pecs, Hungary.
Jazyk:	angličtina
Zdroj:	Pathology oncology research : POR [Pathol Oncol Res] 2023 Dec 21; Vol. 29, pp. 1611456. Date of Electronic Publication: 2023 Dec 21 (Print Publication: 2023).
DOI:	10.3389/pore.2023.1611456
Abstrakt:	Background: We aim to present our linear accelerator-based workflow for pancreatic stereotactic ablative radiotherapy (SABR) in order to address the following issues: intrafractional organ motion management, Cone Beam CT (CBCT) image quality, residual errors with dosimetric consequences, treatment time, and clinical results. Methods: Between 2016 and 2021, 14 patients with locally advanced pancreatic cancer were treated with induction chemotherapy and SABR using volumetric modulated arc therapy (VMAT). Internal target volume (ITV) concept (5), phase-gated (4), or breath hold (5) techniques were used. Treatment was verified by CBCT before and after irradiation, while tumor motion was monitored and controlled by kV triggered imaging and beam hold using peritumoral surgical clips. Beam interruptions and treatment time were recorded. The CBCT image quality was scored and supplemented by an agreement analysis (Krippendorff's-α) of breath-hold CBCT images to determine the position of OARs relative to the planning risk volumes (PRV). Residual errors and their dosimetry impact were also calculated. Progression free (PFS) and overall survival (OS) were assessed by the Kaplan-Meier analysis with acute and late toxicity reporting (CTCAEv4). Results: On average, beams were interrupted once (range: 0-3) per treatment session on triggered imaging. The total median treatment time was 16.7 ± 10.8 min, significantly less for breath-hold vs. phase-gated sessions (18.8 ± 6.2 vs. 26.5 ± 13.4, p < 0.001). The best image quality was achieved by breath hold CBCT. The Krippendorff's-α test showed a strong agreement among five radiation therapists (mean K-α value: 0.8 (97.5%). The mean residual errors were <0.2 cm in each direction resulting in an average difference of <2% in dosimetry for OAR and target volume. Two patients received offline adaptation. The median OS/PFS after induction chemotherapy and SABR was 20/12 months and 15/8 months. No Gr. ≥2 acute/late RT-related toxicity was noted. Conclusion: Linear accelerator based pancreatic SABR with the combination of CBCT and triggered imaging + beam hold is feasible. Peritumoral fiducials improve utility while breath-hold CBCT provides the best image quality at a reasonable treatment time with offline adaptation possibilities. In well-selected cases, it can be an effective alternative in clinics where CBCT/MRI-guided online adaptive workflow is not available. Competing Interests: Author ZT was employed by the company Medicopus Nonprofit Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2023 Kisivan, Farkas, Kovacs, Glavak, Lukacs, Mahr, Szabo, Csima, Gulyban, Toth, Kaposztas and Lakosi.)
Databáze:	MEDLINE
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