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- W2610433626 abstract "Radiotherapy for inoperable pancreatic cancer can be limited by toxicity due to the proximity and interfraction variability of the adjacent luminal gastrointestinal organs-at-risk (GI-OARs). We investigated the role of daily adaptive MRI guided radiation therapy (MR-IGRT) to adjust for interfraction motion and allow dose-escalated pancreatic radiotherapy. Four patients with inoperable pancreatic cancer were planned to 50 – 60 Gy in 15 fractions on an integrated MRI Co-60 delivery system. All patients received concurrent chemotherapy. Anatomy was resegmented daily using on-board MRI. If doses to GI-OARs did not meet pre-determined constraints, a new radiotherapy plan was created and delivered. Cumulative dose to gross tumor volume (GTV) was estimated and amount of interfraction motion of GI-OARs was calculated via Euclidean distance transformation. Patient tolerance and early response were reviewed. Four patients have completed therapy with at least 6 months of follow-up. Average treatment time was 72 minutes. Of the 60 fractions administered, a total of 51 adaptive plans were delivered. The cumulative dose to 95% of the GTV ranged from 65.6% - 89.9% of the prescription dose. The average interfraction movement of the stomach, duodenum, small bowel and large bowel was 21 mm, 11 mm, 14 mm and 12 mm. No grade 3+ toxicity occurred during the follow-up period. After completion of radiotherapy, one patient underwent surgery, 1 patient had distant disease progression, and 2 patients had CA 19-9 response with radiographically stable disease. Early clinical experience with high dose adaptive MR-IGRT for inoperable pancreatic cancer demonstrates the capability of delivering high cumulative GTV doses while adapting to meet GI-OAR constraints. Further work will continue developing tools to assess interfraction cumulative dose to GI-OARs, improve the efficiency of the adaptive process and measure clinical outcomes in a larger set of patients treated with this technique." @default.
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- W2610433626 date "2017-06-01" @default.
- W2610433626 modified "2023-10-04" @default.
- W2610433626 title "(P031) Early Clinical Experience in High Dose MRI Guided Adaptive Radiation Therapy for Inoperable Pancreatic Cancer" @default.
- W2610433626 doi "https://doi.org/10.1016/j.ijrobp.2017.02.126" @default.
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