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• W2896751775 abstract "To analyze dosimetric impact of inter-fractional anatomic variations in patients with locally advanced pancreatic cancer (PC) treated with stereotactic radiotherapy (SBRT) using a diagnostic in-room CT with a linear accelerator and to correlate OAR (Organ at Risk) volumes with acute toxicity in a prospective phase 2 study. Thirty-five PC patients treated with SBRT (40 Gy/5 fr) underwent a CT scan in treatment position before each of the first three fractions of the treatment. OAR (stomach, duodenum, and bowel) and a summation organ (Gastro-Intestinal Organ, GIO) were manually delineated. Image-based matching with planning CT and dose distribution overlay was performed. The planned dose or volume of the OAR was compared to the mean dose or volume of the OAR of the 3 daily fractions (fraction dose or volume). Acute toxicity was scored with CTCAE v4.03. Median delivered fraction D2 and Dmax of GIO increased in median of 5% and 13 % compared to planned values, respectively. Median planned V35 of GIO was 0.2 cc and increased to a median fraction volume of 1.6 cc. The largest dose increase was seen in the stomach and duodenum. No grade 3-5 acute toxicity was reported. Acute toxicity consisted of grade ≤2 nausea, pain and diarrhea in 11 (31%), 15 (43%) and 4 (11%) patients, respectively. Nausea was related to increased daily V35 (mean 1.2 vs 0.6 cc, p=0.025) and D10 (mean 26.8 vs 19.8 Gy, p=0.01) in duodenum, and to D10 in GIO (30.9 vs 26.3 Gy, p=0.01). Higher D10 in GIO (23.4 vs 15.3 Gy, p=0.034) was found in patients with diarrhea. Interfractional anatomic variations led to a significant increase in dose to the OAR. No grade 3-5 acute toxicity was found. Acute toxicity was significantly associated with V35, and D10 of the Organs at Risk. Daily imaging using integrated CT/Linac should be warranted future evaluation for clinical application.Abstract SU_18_2179; Table 1V35 (in cc)D2 (in Gy)D10 (in Gy)Dmax (in Gy)Duodenummedian planned (IQR)0.0 (0.0-1.7)30.7 (24.3-32.8)24.0 (14.2-27.1)36.1 (34.2-37.2)median daily (IQR)0.4 (0.0-3.2)32.3 (24.7-34.0)23.1 (15.8-28.2)39.7 (37.0-43.0)median difference (IQR)+0.3 (-0.2-3.9)+1.8% (0.0-9.4)+2.3% (-1.4-10.0)+11.2% (3.6-16.0)Stomachmedian planned (IQR)0.0 (0.0-0.3)27.6 (21.1-32.7)20.6 (14.9-27.2)36,6 (32.7-37-7)median daily (IQR)0.5 (0.0-1.0)29.2 (24.9-33.6)21.6 (17.1-27.1)38.9 (35.7-40.8)median difference (IQR)+0.2 (-0.1-9.6)+2.6% (-2.4-12.7)0.0% (-7.0-11.2)+5.9% (1,1-11,6)Bowelmedian planned (IQR)0.0 (0.0-0.1)19.6 (14.0-28.7)15.6 (10.1-22.5)31.7 (21.2-36.3)median daily (IQR)0.0 (0.0-0.2)20.9 (14.9-27.6)16.1 (9.9-21.0)32.3 (23.4-38.8)median difference (IQR)0.0 (0.0-0.2)+1.0% (-10.8-10.6)-2.7% (-16.0-28.8)+2.6% (-8.7-21.0)GIOmedian planned (IQR)0.2 (0.0-0.9)33.3 (30.7-34.0)29.1 (20.8-30.8)37.2 (36.4-40.4)median daily (IQR)1.6 (0.6-3.0)34.6 (31.1-36.2)29.8 (22.6-31.7)42.2 (41.0-44.7)median difference (IQR)1.0 (0.2-2.6)+4.4% (0.4-10.8)+3.3% (-0.4-7.1)+12.0% (5.0-18.9) Open table in a new tab" @default.
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• W2896751775 date "2018-11-01" @default.
• W2896751775 modified "2023-10-18" @default.
• W2896751775 title "Locally Advanced Pancreatic Cancer Treated with SBRT: Interfractional Bowel Movements, Measured Dose, and Acute Toxicity" @default.
• W2896751775 doi "https://doi.org/10.1016/j.ijrobp.2018.07.424" @default.
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