Effectiveness and Safety of Simultaneous Integrated Boost-Proton Beam Therapy for Localized Pancreatic Cancer

Abstract

Purpose:To evaluate the clinical effectiveness and feasibility of simultaneous integrated boost-proton beam therapy in patients with localized pancreatic cancer.Methods:Thirty-seven patients with localized pancreatic cancer underwent simultaneous integrated boost-proton beam therapy, and 8 (21.6%) patients received induction chemotherapy. The internal target volume was obtained by summing the gross tumor volumes in exhalation phase computed tomography images. Planning target volume 1 included internal target volume plus 3 to 5 mm margins, excluding the 5 mm expanded volume of gastrointestinal structures, and planning target volume 2 included the internal target volume plus 7 to 12 mm margins. The prescribed doses to planning target volume 1 and planning target volume 2 were 45 GyE (equivalent dose in 2 Gy, 54.4 GyE10) and 30 GyE (equivalent dose in 2 Gy, 32.5 GyE10) in 10 fractions, respectively.Results:Overall, treatment was well tolerated, with no grade of toxicity ≥3. Median overall survival was 19.3 months, and 1-year local progression-free survival, relapse-free survival, and overall survival rates were 64.8%, 33.2%, and 75.7%, respectively. Patients treated with simultaneous integrated boost-proton beam therapy after induction chemotherapy had a significantly higher median overall survival time compared to those with simultaneous integrated boost-proton beam therapy alone (21.6 months vs 16.7 months, P = .031). Multivariate analysis showed that induction chemotherapy was a significant factor for overall survival (P < .05).Conclusions:Simultaneous integrated boost-proton beam therapy could be feasible and promising for patients with localized pancreatic cancer.

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

“…Moreover, Nichols et al 22 analyzed 22 pancreatic and ampullary cancer patients treated with PBT (with 50–59.4 GyE in 28–33 fractions) and concurrent capecitabine and reported a safe toxicity profile, i.e., grade ≥ 3 GI toxicity of 0%. Clinical data on PBT for LAPC patients are still limited to date 21 , 25 , 27 . However, Terashima et al 21 analyzed 50 LAPC patients treated with PBT (with 50–70.2 GyE in 25–26 fractions) and concurrent gemcitabine and showed promising outcomes in terms of the 1-year OS and LRC rates (76.8% and 81.7%, respectively) and the grade ≥ 3 late toxicity rate (10%).…”

Hadron Therapy, Magnetic Nanoparticles and Hyperthermia: A Promising Combined Tool for Pancreatic Cancer Treatment

“…Therefore, highly and inherently conformal radiation therapy techniques, e.g., hadron therapy (HT), present promising alternative treatment options. As an emerging approach, the combination of these new modalities with more conventional therapeutical protocols seems to offer a more efficient way to kill cancer tissues and/or to control or possibly inhibit the tumor progression [ 7 , 8 , 9 ].…”

Dose–volume parameters of MRI-based active bone marrow predict hematologic toxicity of chemoradiotherapy for rectal cancer

“…Lymphocytes play a key role in these mechanisms. In colorectal cancer, baseline ALC and the ratio of lymphocytes to neutrocytes is are prognostic factors affecting overall and progression-free survival [ 5 , 31 , 32 ]. It is important to note that almost three quarters of the patients included in the current study had grade 3 lymphopenia.…”

“…On the other hand, radiotherapy may stimulate the immune system and augment the potential of immunotherapy [ 4 ]. As with other cancers, absolute lymphocyte count (ALC) before, during, and after radiotherapy (chemoradiotherapy) is known to serve as a predictive and prognostic marker in rectal cancer [ 5 – 7 ]. In addition, ALC can affect the incidence of complete clinical response, which allows implementation of a promising, cost-effective watch-and-wait strategy [ 6 , 8 ].…”