Surgical spacer placement for proton radiotherapy in locally advanced pancreatic body and tail cancers: initial clinical results
| Autor: | Kentaro Tai, Takumi Fukumoto, Yoshiro Matsuo, Daiki Takahashi, Ryohei Sasaki, Naoko Nishimura, Dongha Lee, Sunao Tokumaru, Masaki Suga, Masahiro Kido, Tomoaki Okimoto, Kazuki Terashima, Yusuke Demizu, Hirochika Toyama, Shohei Komatsu |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Adult
Male lcsh:Medical physics. Medical radiology. Nuclear medicine medicine.medical_specialty Dose-volume histogram Dose volume histogram Proton radiotherapy medicine.medical_treatment lcsh:R895-920 Perforation (oil well) lcsh:RC254-282 030218 nuclear medicine & medical imaging 03 medical and health sciences Radiation toxicity 0302 clinical medicine Pancreatic cancer Proton Therapy medicine Humans Dosimetry Radiology Nuclear Medicine and imaging Aged Aged 80 and over Gastrointestinal tract business.industry Radiotherapy Planning Computer-Assisted Research Surgical spacer Radiotherapy Dosage Common Terminology Criteria for Adverse Events Middle Aged medicine.disease lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens Gastrointestinal Tract Pancreatic Neoplasms Radiation therapy medicine.anatomical_structure Oncology 030220 oncology & carcinogenesis Female Radiology Pancreas business |
| Zdroj: | Radiation Oncology, Vol 16, Iss 1, Pp 1-11 (2021) Radiation Oncology (London, England) |
| Popis: | Background Particle radiotherapy has increasingly gained acceptance for locally advanced pancreatic cancers owing to superior tumor conformity and dosimetry compared to conventional photon radiotherapy. However, the close proximity of the pancreas to the stomach and duodenum leads to radiation-induced gastrointestinal toxicities, which hinder the delivery of curative doses to the tumor. To overcome this problem, a surgical spacer was placed between the tumor and gastrointestinal tract, and subsequent proton radiotherapy was performed in this study. Methods Data from 9 patients who underwent surgical spacer placement and subsequent proton radiotherapy were analyzed. The safety and feasibility of the spacer placement surgery were evaluated; the impact of the spacer on dosimetry was also assessed using dose volume histogram (DVH) analyses, before and after surgical spacer placement. Results Surgical spacer placement and subsequent proton radiotherapy were successfully completed in all cases. Surgical spacer placement significantly improved the dose intensity covering 95%, mean, and minimum doses for the gross tumor volume, and the clinical and planning target volume based on the DVH, while respecting the dose constraints of the gastrointestinal tract. Based on the Common Terminology Criteria for Adverse Events, two patients (22.2%) developed gastrointestinal ulcer (Grade 2) at 1 and 35 months, and one patient (11.1%) developed gastric perforation (Grade 4) at 4 months after proton radiotherapy. Conclusions Surgical spacer placement in the locally advanced pancreatic body and tail cancers is relatively safe and technically feasible. Comparing radiation plans, surgical spacer placement seems to improve the dose distribution in the locally advanced pancreatic body and tail cancers, which are close to the gastrointestinal tract. |
| Databáze: | OpenAIRE |
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