Stomach Dose–Volume Predicts Acute Gastrointestinal Toxicity in Chemoradiotherapy for Locally Advanced Pancreatic Cancer

Holyoake, D.; Warren, Daniel R.; Hurt, Chris; Aznar, Marianne C.; Partridge, Mike; Mukherjee, Somnath; Hawkins, M.

doi:10.1016/j.clon.2018.02.067

Cited by 9 publications

(4 citation statements)

References 33 publications

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“…More quantitative information was reported in the contexts of conventionally fractionated radiotherapy (i.e., 1.8-2.0 Gy/fr) and SBRT (delivered in 1-5 fractions). Concerning conventional fractionation, most studies were consistent in suggesting a prevalent dose effect when considering moderate/ severe duodenal and gastric toxicities, with the risk rapidly increasing for prescribed doses above 55-60 Gy and fractions of duodenum/stomach receiving more than 35-55 Gy above few %/few to tens of cubic centimeters (28,(36)(37)(38)(39)(40): similar findings were suggested for mild hypofractionation (2.15-2.25 Gy/fr) in a cohort of 105 patients treated with intensity-modulated radiotherapy (IMRT) for esophageal cancer at 60.2 Gy (29). Regarding SBRT, safe constraints for stomach and duodenum were suggested for one/three/five fractions, with quite consistent recent updates based on patient data, mostly for the duodenum with the 5-fraction scheme, as reviewed by Cattaneo and Marrazzo (36).…”

Section: Discussionmentioning

confidence: 88%

Stomach and duodenum dose–volume constraints for locally advanced pancreatic cancer patients treated in 15 fractions in combination with chemotherapy

et al. 2023

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PurposeTo assess dosimetry predictors of gastric and duodenal toxicities for locally advanced pancreatic cancer (LAPC) patients treated with chemo-radiotherapy in 15 fractions.MethodsData from 204 LAPC patients treated with induction+concurrent chemotherapy and radiotherapy (44.25 Gy in 15 fractions) were available. Forty-three patients received a simultaneous integrated boost of 48–58 Gy. Gastric/duodenal Common Terminology Criteria for Adverse Events v. 5 (CTCAEv5) Grade ≥2 toxicities were analyzed. Absolute/% duodenal and stomach dose–volume histograms (DVHs) of patients with/without toxicities were compared: the most predictive DVH points were identified, and their association with toxicity was tested in univariate and multivariate logistic regressions together with near-maximum dose (D0.03) and selected clinical variables.ResultsToxicity occurred in 18 patients: 3 duodenal (ulcer and duodenitis) and 10 gastric (ulcer and stomatitis); 5/18 experienced both. At univariate analysis, V44cc (duodenum: p = 0.02, OR = 1.07; stomach: p = 0.01, OR = 1.12) and D0.03 (p = 0.07, OR = 1.19; p = 0.008, OR = 1.12) were found to be the most predictive parameters. Stomach/duodenum V44Gy and stomach D0.03 were confirmed at multivariate analysis and found to be sufficiently robust at internal, bootstrap-based validation; the results regarding duodenum D0.03 were less robust. No clinical variables or %DVH was significantly associated with toxicity. The best duodenum cutoff values were V44Gy < 9.1 cc (and D0.03 < 47.6 Gy); concerning the stomach, they were V44Gy < 2 cc and D0.03 < 45 Gy. The identified predictors showed a high negative predictive value (>94%).ConclusionIn a large cohort treated with hypofractionated radiotherapy for LAPC, the risk of duodenal/gastric toxicities was associated with duodenum/stomach DVH. Constraining duodenum V44Gy < 9.1 cc, stomach V44Gy < 2 cc, and stomach D0.03 < 45 Gy should keep the toxicity rate at approximately or below 5%. The association with duodenum D0.03 was not sufficiently robust due to the limited number of events, although results suggest that a limit of 45–46 Gy should be safe.

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Section: Discussionmentioning

confidence: 88%

Stomach and duodenum dose–volume constraints for locally advanced pancreatic cancer patients treated in 15 fractions in combination with chemotherapy

et al. 2023

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“…On the other hand, Holyoake et al. reported that the volume of the ST that was irradiated with a moderately high dose (35–45 Gy) was a predictive factor of acute GI toxicity [ 27 ]. ST V40 and ST V30 were also identified as predictive factors in the present study, and a moderate dose to the ST was also shown to be a predictive factor of acute GI toxicities in a study on hypofractionation RT for pancreatic cancer [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of acute gastrointestinal toxicities between 3-dimensional conformal radiotherapy and intensity-modulated radiotherapy including prophylactic regions in chemoradiotherapy with S-1 for pancreatic cancer—importance of dose volume histogram parameters in the stomach as the predictive factors-

Umezawa

Nakagawa

Mizuma

et al. 2022

Journal of Radiation Research

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The purpose of this study was to compare acute gastrointestinal (GI) toxicities in patients who underwent 3-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) in chemoradiotherapy (CRT) with S-1 including prophylactic regions for pancreatic cancer. We also investigated the predictive factor of acute GI toxicities in dose volume histogram (DVH) parameters. Patients who received CRT with S-1 for pancreatic cancer between January 2014 and March 2021 were included. Radiotherapy (RT) with a total dose of 50-54 Gy was delivered. We examined the differences in the frequencies of acute GI toxicity of grade 2 or higher and DVH parameters of the stomach (ST) and duodenum (DU) between the 3DCRT group and the IMRT group. The RT-related predictive factors of acute GI toxicities were investigated by univariate and multivariate analyses. There were 25 patients in the 3DCRT group and 31 patients in the IMRT group. The frequencies of acute GI toxicity of G2 or higher were 36% in the 3DCRT group and 9.7% in the IMRT group (p = 0.035). ST V50 was the most predictive factor (p = 0.001), and the incidences of acute GI toxicity of G2 or higher in ST V50 ≥ 4.1 cc and < 4.1cc were 43.7% and 7.7%, respectively. ST V40 was also a significant predictive factor of acute GI toxicity (p = 0.002). IMRT could reduce acute GI toxicities in CRT with S-1 including prophylactic regions for pancreatic cancer. Acute GI toxicities may be affected by moderate to high doses to the ST.

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“…A generalized equivalent uniform dose (gEUD) of 46 Gy is associated with a 20% bleeding risk in patients without cirrhosis, while a gEUD of only 18 Gy is associated with a 20% bleeding risk in patients with cirrhosis [11]. Other than cirrhosis, old age, concurrent chemotherapy, and Helicobacter pylori -induced gastritis were reported as risk factors that can lower the threshold dose of the stomach [15]. In the present study, age was the only significant risk factor for hemorrhagic gastric disease.…”

Section: Discussionmentioning

confidence: 99%

Gastric Complications after Adjuvant Radiotherapy for Breast Cancer

et al. 2019

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PurposeIn some patients who receive adjuvant radiotherapy (RT) for the left breast, the stomach is located inside the RT field. This study investigates the incidence of gastric complications following adjuvant RT for breast cancer using data of the Health Insurance Review and Assessment Service in South Korea.MethodsWe identified 37,966 women who underwent surgery and received adjuvant RT for breast cancer. The cumulative incidence rate of gastric hemorrhage and gastric cancer was calculated and compared for left and right breast cancers.ResultsAmong 37,966 patients, 19,531 (51.4%) and 18,435 (48.6%) had right and left breast cancers, respectively. After a median follow-up duration of 6.3 years, the cumulative incidence of gastric cancer and gastric hemorrhage did not differ between right and left breast cancers (p = 0.414 and p = 0.166, respectively). The multivariable analysis revealed that old age was the only factor associated with the development of gastric cancer (p < 0.001) and gastric hemorrhage (p < 0.001). The incidence of gastric cancer and hemorrhage did not differ between patients who received adjuvant RT for right and left breast cancers.ConclusionIrradiation-related chronic complications of the stomach in patients with breast cancer are minimal. A study with a longer follow-up duration might be needed to assess the risk of gastric cancer.

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Stomach Dose–Volume Predicts Acute Gastrointestinal Toxicity in Chemoradiotherapy for Locally Advanced Pancreatic Cancer

Abstract: In chemoradiotherapy for LAPC the volume of stomach irradiated to a moderately high dose (35-45 Gy) predicts the incidence and severity of acute toxicity. Other predictive factors can include age, sex, recent weight loss and concomitant chemotherapy agents.

Cited by 9 publications

References 33 publications

Stomach and duodenum dose–volume constraints for locally advanced pancreatic cancer patients treated in 15 fractions in combination with chemotherapy

Stomach and duodenum dose–volume constraints for locally advanced pancreatic cancer patients treated in 15 fractions in combination with chemotherapy

Gastric Complications after Adjuvant Radiotherapy for Breast Cancer

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