Evaluation of Normal Tissue Exposure in Patients Receiving Radiation Therapy for Pancreatic Cancer Based on RTOG 0848

Ling, Ted C.; Slater, James M.; Mifflin, Rachel; Nookala, Prashanth; Grove, Roger; Ly, A; Patyal, B; Slater, Jerry D.; Yang, Gary

doi:10.1016/j.ijrobp.2014.05.1165

Cited by 7 publications

(8 citation statements)

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“…A large cohort study with propensity matching reported that the outcome of SBRT was not inferior to IMRT and was at least improved over conventional radiation techniques [33]. As for proton beam therapy (PBT), some dosimetry studies have confirmed a physical advantage of proton beams over photon beams, namely a tissue-sparing benefit, leading to the idea that outcomes may be improved by safely increasing proton beam doses [34,35]. In the clinical PBT studies, the OS ranges from 31 to 45% at 2 years with an MST between 18.4 and 22.3 months although the reports are very few and the patient cohort was smaller than in photon beam studies [16,36,37].…”

Section: Discussionmentioning

confidence: 99%

Concurrent chemoradiotherapy using proton beams for unresectable locally advanced pancreatic cancer

Hiroshima

Fukumitsu

Saito

et al. 2019

Radiotherapy and Oncology

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Background and purpose: We investigated clinical outcomes of proton beam concurrent chemoradiotherapy (CCRT) for unresectable, locally advanced pancreatic cancer (LAPC) patients. Materials and methods: Records from 42 unresectable LAPC patients (21 male and 21 female, 39-83 years old) with IIB/III clinical staging of 1/41 treated by proton beam CCRT were retrospectively reviewed. Twelve patients received a conventional 50 Gray equivalents (GyE) in 25 fractions protocol and 30 others received a higher dose protocol of 54.0-67.5 GyE in 25-33 fractions. Gemcitabine or S-1 (Tegafur, Gimeracil and Oteracil) was used concurrently. Toxicity, overall survival (OS) and local control (LC) were examined. Results: Acute adverse events of grades 1, 2, 3 and 4 were found in 4, 15, 17 and 2 patients, respectively. All grade 3 and 4 events were hematologic. Late adverse events of grades 1 and 2 were found in 3 and 2 patients, respectively. No late adverse effects of grade 3 or higher were observed. The 1-year/2-year OS rates from the start of CCRT were 77.8/50.8% with median survival time (MST) of 25.6 months. The 1year/2-year LC rate from CCRT start was 83.3/78.9% with a median time to local recurrence of more than 36 months. Total irradiation dose was the only significant factor in univariate analyses of OS and LC (p = 0.015 and 0.023, respectively). Conclusion: Proton beam CCRT lengthened survival periods compared to previous photon CCRT data and higher dose irradiation prolonged LC and OS for unresectable LAPC patients. Proton beam therapy is therefore safe and effective in these cases.

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Section: Discussionmentioning

confidence: 99%

Concurrent chemoradiotherapy using proton beams for unresectable locally advanced pancreatic cancer

Hiroshima

Fukumitsu

Saito

et al. 2019

Radiotherapy and Oncology

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“…Since the early 2000s, the introduction of beam scanning methods led to further improvement of conformation. As shown by Ling et al in the frame of RTOG-0848, IMRT does slightly better than 3DCRT, but proton therapy (PT) outperforms both, with a clear reduction of deposited dose to OARs [27]. In their review, Rutenberg and Nichols concluded that PT is effective before or after surgical resection of PDAC.…”

Section: Dose Conformation Towards Dose Escalation and Hypofractionationmentioning

confidence: 99%

Could Protons and Carbon Ions Be the Silver Bullets Against Pancreatic Cancer?

Huart

Chen

Calvé

et al. 2020

IJMS

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Pancreatic cancer is a very aggressive cancer type associated with one of the poorest prognostics. Despite several clinical trials to combine different types of therapies, none of them resulted in significant improvements for patient survival. Pancreatic cancers demonstrate a very broad panel of resistance mechanisms due to their biological properties but also their ability to remodel the tumour microenvironment. Radiotherapy is one of the most widely used treatments against cancer but, up to now, its impact remains limited in the context of pancreatic cancer. The modern era of radiotherapy proposes new approaches with increasing conformation but also more efficient effects on tumours in the case of charged particles. In this review, we highlight the interest in using charged particles in the context of pancreatic cancer therapy and the impact of this alternative to counteract resistance mechanisms.

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“…After importing all image data of 15 patients into two systems, CyberKnife (CK) and EDGE, different SBRT treatment plans were designed by the same medical physicists The dose constrains of targets and normal tissue were set to meet the criteria of the RTOG 0848 and the report of AAPM Task Group No. 101 (AAPM TG-101) [31,32,33], as shown in Table1.…”

Section: Sbrt Planningmentioning

confidence: 99%

CyberKnife and EDGE in stereotactic body radiotherapy for pancreas cancer: a comparison of plan quality

Dai¹,

Ma²,

Cao³

et al. 2020

Preprint

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Purpose: To perform a comprehensive comparison of the different stereotactic body radiotherapy (SBRT) plans between the Varian EDGE and CyberKnife (CK) systems for pancreas cancer.Materials and methods: Fifteen patients with pancreas cancer were selected in this study. The median planning target volume (PTV) was 28.688cm 3 (5.736 to 49.246 cm 3 ). The SBRT plans for the EDGE and CK were generated in the Eclipse and Multiplan systems respectively with the same contouring and dose constrains for PTV and organ at risk (OAR). Dose distributions in PTV were evaluated in terms of coverage, conformity index (CI), new conformity index (nCI), homogeneity index (HI), and gradient index (GI). OARs, including spinal cord, bowel, stomach, duodenum and kidneys were statistically evaluated by different dose-volume metrics and equivalent uniform dose (EUD) . The volume covered by the different isodose lines (ISDL) ranging from 10% to 100% for normal tissue were also analyzed.Results: All SBRT plans for EDGE and CK met the clinical requirement for PTV and OARs. . For the PTV, the dosimetric metrics in EDGE plans were lower than that in CK, except that D 99 and GI were slightly higher. The EDGE plans with lower CI , nCI and HI were superior to offer the better conformity and homogeneity for PTV. For the normal tissue, the CK plans were better at OARs sparing. The radiobiological indices EUD of spinal cord, duodenum, stomach, and kidneys were lower for CK plans, except that liver were higher. The volumes of normal tissue covered by medium ISDLs (with range of 20%~70%) were lower for CK plans while that covered by high and low ISDLs were lower for EDGE plans.Conclusions: This study indicated that both EDGE and CK generated equivalent plan quality, and both systems can be considered as beneficial techniques for SBRT of pancreas cancer. EDGE plans offered the better conformity and homogeneity of dose distributions for PTV, while the CK plans could minimize the exposure of OARs.

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Evaluation of Normal Tissue Exposure in Patients Receiving Radiation Therapy for Pancreatic Cancer Based on RTOG 0848

Cited by 7 publications

References 0 publications

Concurrent chemoradiotherapy using proton beams for unresectable locally advanced pancreatic cancer

Concurrent chemoradiotherapy using proton beams for unresectable locally advanced pancreatic cancer

Could Protons and Carbon Ions Be the Silver Bullets Against Pancreatic Cancer?

CyberKnife and EDGE in stereotactic body radiotherapy for pancreas cancer: a comparison of plan quality

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Evaluation of Normal Tissue Exposure in Patients Receiving Radiation Therapy for Pancreatic Cancer Based on RTOG 0848

Cited by 7 publications

References 0 publications

Concurrent chemoradiotherapy using proton beams for unresectable locally advanced pancreatic cancer

Concurrent chemoradiotherapy using proton beams for unresectable locally advanced pancreatic cancer

Could Protons and Carbon Ions Be the Silver Bullets Against Pancreatic Cancer?

CyberKnife and EDGE in stereotactic body radiotherapy for pancreas cancer: a comparison of plan quality﻿

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CyberKnife and EDGE in stereotactic body radiotherapy for pancreas cancer: a comparison of plan quality