Duodenal sparing stereotactic body radiation therapy for the treatment of locally advanced pancreatic cancer
| Autor: | Yijan Cao, E. Montchal, Lili Vijeh, Jonathan P.S. Knisely, Maged Ghaly, Mihala Marrero, Eric Xanthopoulos, Vincent Vinciguerra, Neeraj Kaushik, Beatrice Bloom, James Sullivan |
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| Rok vydání: | 2013 |
| Předmět: |
Cancer Research
medicine.medical_specialty Chemotherapy business.industry medicine.medical_treatment Stomach medicine.disease Gemcitabine medicine.anatomical_structure Oncology Pancreatic tumor Pancreatic cancer Duodenum Medicine Radiology business Radiation treatment planning Nuclear medicine Pancreas medicine.drug |
| Zdroj: | Journal of Clinical Oncology. 31:254-254 |
| ISSN: | 1527-7755 0732-183X |
| Popis: | 254 Background: The proximity of the pancreas to bowel presents a unique challenge for pancreatic cancer SBRT. This study explores the safety and effectiveness of a novel approach optimizing pancreatic tumor coverage and duodenal sparing. Methods: Eighteen patients with locally advanced pancreatic cancer (15 head/3 body) were treated with initial chemotherapy (Gemcitabine or 5-FU/Cisplatin) for 2- 6 months. All underwent endoscopic US-guided fiducial placement in and around the tumor and had a 4D treatment planning CT scan with oral contrast. This CT was used in conjunction with EUS findings, PET, and biphasic CT scans to identify the GrossTumorVolume (GTV) on the expiration phases. The planning target volume (PTV) was created by expanding the GTV by 2 mm. Dose-volume histogram (DVH) endpoints were constructed, keeping V7/15/20 (stomach/duodenum volumes that receive 7 Gy/15 Gy/20 Gy) 3 (median 39.5cm3). With a median follow-up of 10 months, 1 patient developed transient gastroparesis, 1 G 2 abdominal pain;1 G 2 hematologic toxicity. No late toxicity was observed in 15 patients with longer follow-up (median 12 month). All patients were free of local progression at the last follow-up visit (range 3-12 months). Conclusions: Linac-delivered organ-sparing SBRT with chemotherapy in locally advanced pancreatic cancer resulted in excellent local control and also was well tolerated acutely and subacutely. Longer follow-up is warranted. A phase I dose-escalation study is underway. |
| Databáze: | OpenAIRE |
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