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• W2169709295 abstract "Attempts at escalating radiation dose using stereotactic body radiation therapy (SBRT) for locally advanced pancreatic cancer (LAPC) have provided some success, but there is no standard of care to date. Acute toxicity has been reported and therefore attention to organs at risk (OAR) is imperative. This study involves the observation of various dosimetric factors involved with successfully creating an SBRT-based protocol for LAPC. Fifteen previously treated patients with LAPC were reviewed. SBRT-based treatment plans were created using 7-11 fields with Intensity Modulated Radiation Therapy. The attempted prescribed dose was 30 Gy in 5 fractions to the planning target volume (PTV). The PTV was defined as a uniform three-dimensional 5mm margin around the gross tumor volume (GTV). Planning parameters included V28.5Gy - PTV > 95%, V28.5Gy - GTV = 100%. OAR constraints, in line with previous reports, included the duodenum (maximum point dose < 32 Gy, D1cc < 30 Gy, V15Gy < 30cc and the 50% isodose line prohibited from circumferentially enclosing the duodenum), stomach (D10cc < 28 Gy), jejunum/ileum (D5cc < 19 Gy). Dosimetric parameters that could potentially hinder achieving the goals were measured. These included tumor size, volume overlap between the PTV and duodenum and minimum distance from the GTV to any gastrointestinal (GI) hollow viscous organ. A t-test of these parameters was performed between the cohorts where a successful SBRT plan could or could not be completed. The majority of tumors were located in the head of the pancreas. Mean volume overlap between duodenum and PTV for all patients was 11.1 cc (range, 0.2-28.2 cc). The percentage of PTV containing duodenum was 8.5% (range, 0.3-21.3%). Mean PTV volume was 127.3 cc (range, 53-232 cc) and mean GTV-GI distance was 0.24 cm (range, 0.00-0.95 cm). Of the 15 patients, 6 of the patients' plans were successful in meeting the goals of the prescription while maintaining constraints to OARs. One patient (body lesion) could be escalated to 35 Gy in 5 fractions while meeting constraints. The group of successful plans had lower duodenal-PTV volume overlap (3.39 vs. 16.2 cc; p < 0.001) and lower percentages of PTV containing duodenum (4.4 vs. 11.2%; p = 0.015). Successfully escalated plans also had lower PTV volumes (86.7 vs. 154.3 cc; p = 0.010) and larger minimum GTV-GI distances (0.54 vs. 0.04 cm; p = 0.016). Dose escalation for LAPC using SBRT technique and dose of at least 30 Gy in 5 fractions is feasible depending upon duodenal involvement within the PTV. Additionally, smaller tumor size and proximity of the GTV to GI structures are also significant in determining whether or not SBRT is feasible. We are currently developing a protocol to prospectively study these parameters." @default.
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• W2169709295 date "2010-11-01" @default.
• W2169709295 modified "2023-09-27" @default.
• W2169709295 title "Feasibility and Investigation of Risk-based Stereotactic Body Radiation Therapy (SBRT) for Locally Advanced Carcinoma of the Pancreas" @default.
• W2169709295 doi "https://doi.org/10.1016/j.ijrobp.2010.07.755" @default.
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