The role of surgical clips in the evaluation of interfractional uncertainty for treatment of hepatobiliary and pancreatic cancer with postoperative radiotherapy

Abstract

PurposeTo evaluate the utility of implanted surgical clips for detecting interfractional errors in the treatment of hepatobiliary and pancreatic cancer with postoperative radiotherapy (PORT).Methods and MaterialsTwenty patients had been treated with PORT for locally advanced hepatobiliary or pancreatic cancer, from November 2014 to April 2016. Patients underwent computed tomography simulation and were treated in expiratory breathing phase. During treatment, orthogonal kilovoltage (kV) imaging was taken twice a week, and isocenter shifts were made to match bony anatomy. The difference in position of clips between kV images and digitally reconstructed radiographs was determined. Clips were consist of 3 proximal clips (clip_p, ≤2 cm) and 3 distal clips (clip_d, >2 cm), which were classified according to distance from treatment center. The interfractional displacements of clips were measured in the superior-inferior (SI), anterior-posterior (AP), and right-left (RL) directions.ResultsThe translocation of clip was well correlated with diaphragm movement in 90.4% (190/210) of all images. The clip position errors greater than 5 mm were observed in 26.0% in SI, 1.8% in AP, and 5.4% in RL directions, respectively. Moreover, the clip position errors greater than 10 mm were observed in 1.9% in SI, 0.2% in AP, and 0.2% in RL directions, despite respiratory control.ConclusionQuantitative analysis of surgical clip displacement reflect respiratory motion, setup errors and postoperative change of intraabdominal organ position. Furthermore, position of clips is distinguished easily in verification images. The identification of the surgical clip position may lead to a significant improvement in the accuracy of upper abdominal radiation therapy.

Patterns of initial failure after resection for gallbladder cancer: implications for adjuvant radiotherapy

“…With the development of radiotherapy techniques, 3D-CRT or IMRT has become widely used to treat abdominal malignancies, allowing optimal qualitative treatment with reduced toxicity [ 26 ]. In addition, Sun et al [ 27 ] conducted plan comparison between conformal radiotherapy and IMRT in the treatment of gallbladder cancer, and showed that IMRT reduced radiation dose to liver and right kidney, significantly.…”

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

“…2,3,7,8 With recent advances in RT techniques, intensity-modulated RT (IMRT), stereotactic body RT (SBRT), and proton beam therapy (PBT) can deliver high doses to the tumor as well as minimizing the radiation dose to surrounding normal tissues. [9][10][11][12][13][14][15][16][17] Because of the apparent physical properties of proton beams that can deposit high doses of radiation to the target without an exit dose outside the target, PBT has been attracting attention. Conceptually, PBT has potential advantages of an accelerated RT, known as simultaneous integrated boost (SIB), which different doses can be delivered simultaneously to different targets.…”

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

“…When considering the combinations of radiotherapy and chemotherapy in LAPC patients, its effects of local and distant tumor control as well as its tolerability might be important. Previous studies which treated LAPC patients with CRT using conventional RT reported 27%–77% of grade ≥3 toxicity and median OS duration of 8–12 months [ 3 , 4 , 6 - 11 , 19 , 20 ]. Recently, IMRT technique has been applied in LAPC patients to improve local tumor control by delivering the higher dose to tumor and to minimize potential of toxicity by reducing radiation to surrounding normal tissues, such as adjacent gastrointestinal structures, and several studies have shown lower rate (15%–24%) of grade ≥3 toxicity and promising median OS (12–15.3 months) [ 14 - 17 , 21 ].…”