Effectiveness and feasibility of concurrent chemoradiotherapy using simultaneous integrated boost-intensity modulated radiotherapy with and without induction chemotherapy for locally advanced pancreatic cancer

Abstract

PurposeTo evaluate the effectiveness and feasibility of chemoradiotherapy (CRT) using simultaneous integrated boost-intensity modulated radiotherapy (SIB-IMRT) in locally advanced pancreatic cancer (LAPC) patients.Materials and MethodsBetween January 2011 and May 2015, 47 LAPC patients received CRT using SIB-IMRT. Prior to SIB-IMRT, 37 patients (78.7%) received induction chemotherapy (IC-CRT group) and remaining 10 patients (21.3%) did not received induction chemotherapy (CRT group). During SIB-IMRT, all patients received concomitant chemotherapy, with gemcitabine (n = 37) and capecitabine (n = 10).ResultsAt the time of analysis, 45 patients had died and 2 patients remained alive and the median follow-up time was 14.2 months (range, 3.3 to 51.4 months). For all patients, the median times of local progression-free survival (LPFS), progression-free survival (PFS), and overall survival (OS) were 18.1, 10.3, and 14.2 months, respectively. The median time of LPFS between IC-CRT and CRT groups was similar (18.1 months vs. 18.3 months, p = 0.711). IC-CRT group had a higher trend in PFS (10.9 months vs. 4.1 months, p = 0.054) and had significantly higher OS (15.4 months vs. 9.5 months, p = 0.007) than CRT group. In multivariate analysis, the use of induction chemotherapy and tumor response were significant factors associated with OS (p < 0.05, each). During SIBIMRT, toxicity of grade ≥3 was observed in 7 patients (14.9%) in all patients.ConclusionsCRT using SIB-IMRT is feasible and promising in LAPC patients.

Efficacy and feasibility of proton beam radiotherapy using the simultaneous integrated boost technique for locally advanced pancreatic cancer

“…1 ). The dose-volume constraints for the OARs were described previously 15 , 16 , 27 . In brief, the maximum dose to the spinal cord was less than 27 GyE; the absolute volumes of the stomach receiving ≥ 37 GyE and bowel receiving ≥ 35 GyE were less than 2 cm 3 ; and the relative volumes of the liver receiving ≥ 27 GyE and kidney receiving ≥ 18 GyE were less than 60% and 35%, respectively.…”

Update on current pancreatic treatments: from molecular pathways to treatment

“…Finally in locally advanced it has been observed that there is a higher effectiveness when chemoradiotherapy is applied simultaneously for locally advanced pancreatic cancer 70. Regarding borderline resectable patients then it has been observed in a Phase II trial that preoperative FOLFIRINOX followed by individualized chemoradiotherapy in borderline resectable pancreatic cancer results in high rates of R0 resection and prolonged median PFS and median OS, supporting ongoing phase 3 trials 71.…”

Re-irradiation of recurrent glioblastoma using helical TomoTherapy with simultaneous integrated boost: preliminary considerations of treatment efficacy

“…Several authors have investigated the feasibility of the SIB technique for the treatment of primary and metastatic brain lesions 23,24,26,28,[33][34][35][36][37][38] . Rodrigues et al 24 delivered 60 Gy in 10 fractions to 1-3 brain metastases synchronously with 30 Gy whole brain irradiation (WBRT) using HT.…”