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• W2024309189 abstract "A more accurate identification of tumors by image-guided radiation therapy (IGRT) and improved radiation delivery by advanced technology have led to a wider use of hypofractionated radiation schedules for the treatment of locally advanced pancreatic cancer (LAPC). However, few data have been published on accelerated hypofractionation in association with chemotherapy and elective locoregional node irradiation in this anatomical site. We present our preliminary data on the impact of hypofractionated radiation therapy on tumor volume and locoregional lymph nodes in patients with inoperable LAPC. From July 2011 to August 2013, 15 consecutive patients with non resectable LAPC were enrolled onto a prospective IRB-approved study at our center. Median age was 65 years (range 42-78). Patients were treated as follows: gemcitabine (GEM) and oxaliplatin (OX) regimen every two weeks for 4 cycles, 15 days off, hypofractionated radiation therapy, 15 days off, a further 4 cycles of GEMOX, restaging. A multiphase four-dimensional-CT scan with and without contrast medium was acquired for radiation therapy planning. Three different target volumes were identified: gross tumor volume (GTV), clinical target volume (CTV) 1 including all visible adenopathies, and CTV 2 including regional lymph nodes at risk of microscopic tumor spread. The identified organs at risk (OAR) were the liver, kidneys, spinal cord, small intestine and, in particular, duodenum and stomach. Treatment was delivered by helical tomotherapy at a dose of 35 Gy (with an inhomogeneous dose distribution inside the target volume of up to 30% of the prescription dose) in 7 fractions (one fraction per day) over 9 days on the GTV; 28 Gy-35 Gy was administered on the CTV1-CTV2 on the basis of nodal status. Radiation therapy was well tolerated and the most frequently encountered adverse events were mild to moderate nausea and vomiting, abdominal pain and fatigue. Three out of 15 patients underwent palliative radiation/chemotherapy for distant progression during the first 4 cycles of GEMOX. All but one of the remaining 12 patients obtained a radiological/metabolic partial tumor response at restaging. Of these, 6 underwent surgical laparotomy (4 radical pancreatic resection and 2 explorative laparotomy). The median overall survival (OS) was 16 months at a median follow-up of 31 months. Our results show the feasibility of using accelerated hypofractionated radiation therapy on tumor volume and locoregional lymph nodes in LAPC. Treatment was well tolerated and median OS rates are promising. This approach also shows potential as neoadjuvant treatment for pancreatic cancers evaluated initially as unresectable." @default.
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• W2024309189 date "2014-09-01" @default.
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• W2024309189 title "Locoregional Hypofractionated Radio-Chemotherapy for Unresectable Nonmetastatic Pancreatic Cancer" @default.
• W2024309189 doi "https://doi.org/10.1016/j.ijrobp.2014.05.1162" @default.
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