Background
Methods
Review criteria
Equivalent dose calculation and nomenclature
NTCP LKB Model, Maximum likelihood fitting, and confidence intervals
Statistical analysis
Results
Study characteristics
Author (reference) | N | Median follow-up (months) | Radiotherapy |
EQD
4
1.8
| Chemo (%) | Surgery (%) | Late GI complications | Complication rate | Total GI toxicity rate |
---|---|---|---|---|---|---|---|---|---|
Mahadevan et al. [7] | 36 | 24 | 30 Gy 3 fxa (median) | 72 | 86.1 % | None | GI bleeding requiring transfusion, grade ≥ 3 | 2/36 (5.6 %) | 5.6 % |
Mahadevan et al. [8] | 39 | 21 | 24 Gy 3 fxa (median) | 50 | 100 % | None | GI bleeding requiring transfusion, grade 3 | 2/39 (5.1 %) | 7.7 % |
Gastric outlet obstruction, grade 3 | 1/39 (2.6 %) | ||||||||
Lominska et al. [9] | 28 | 5.9 | 21 Gy 3 fxa + 50.4 Gyc (median) | 90 | 71 % | 29 % | Bowel obstruction, grade 3 | 1/28 (3.6 %) | 7.1 % |
Gastric perforation, grade 3 | 1/28 (3.6 %) | ||||||||
Chang et al. [10] | 77 | 6 | 25 Gy 1 fxa (exact) | 125 | 96 % | None | Biliary stricture, grade 3 | 2/77 (2.6 %) | 9.1 % |
Duodenal stricture, grade 3 | 1/77 (1.3 %) | ||||||||
Small bowel perforation, grade 4 | 1/77 (1.3 %) | ||||||||
Gastric ulcer, grade 3 | 3/77 (3.9 %) | ||||||||
Hoyer et al. [11] | 22 | 3 | 45 Gy 3 fxa (median) | 147 | None | 13.6 % | Duodenum or stomach severe mucositisd
| 2/22 (9.1 %) | 22.7 % |
Duodenum or stomach ulcerationd
| 2/22 (9.1 %) | ||||||||
Stomach perforationd
| 1/22 (4.5 %) | ||||||||
Chuong et al. [12] | 73 | 10.5 | 30 Gy 5 fxa (median) | 52 | 100 % | 56 % | GI bleeding requiring embolization, grade 3 | 3/73 (4.1 %) | 5.5 % |
Anorexia resulting in feeding tube placement, grade 3 | 1/73 (1.4 %) | ||||||||
Schellenberg et al. [13] | 20 | 11.8 | 25 Gy 1 fxa (exact) | 125 | 100 % | None | Duodenal perforation, grade ≥ 3 | 1/20 (5.0 %) | 5.0 % |
Didolkar et al. [14] | 85 | Unknown | 25.5 Gy 3 fxa (median) | 55 | 100.0 % | 16.5 % | Late duodenitis (upper GI hemorrhage or obstruction), grade ≥ 3 | 7/85 (8.2 %) | 8.2 % |
Polistina et al. [15] | 23 | 9 | 30 Gy 3 fxa (exact) | 72 | 100 % | None | Late GI toxicity, grade ≥ 3 | 0/23 (0 %) | 0.0 % |
Rwigema et al. [16] | 71 | 12.7 | 24 Gy 1 fxa (median) | 116 | 90 % | 39 % | Late GI toxicity, grade ≥ 3 | 0/71 (0 %) | 0.0 % |
Ogawa et al. [17] | 210 | 26.3 | 25 Gy 1 fxb (median) | 125 | 54.3 % | 100 % | GI toxicity unspecified, grade 3 | 3/210 (1.4 %) | 3.3 % |
Colitis, grade 4 | 1/210 (0.5 %) | ||||||||
GI bleeding, grade 4 | 2/210 (1.0 %) | ||||||||
Ileus, grade 4 | 1/210 (0.5 %) | ||||||||
Willett et al. [18] | 150 | 17 | 20 Gy 1 fxb + 50.4 Gyc (median) | 133 | 100 % | 82 % | Bleeding secondary to duodenal ulcer or erosion requiring medical interventiond
| 16/150 (10.6 %) | 15.0 % |
Fatal duodenal bleeding, Grade 5 | 2/150 (1.3 %) | ||||||||
Duodenal obstructiond
| 1/150 (0.6 %) | ||||||||
Abdominal wall dehiscenced
| 1/150 (0.6 %) | ||||||||
Otherd
| 2/150 (1.3 %) | ||||||||
Mohiuddin et al. [19] | 49 | 28 | 20 Gy 1 fxb + 50 Gyc (median) | 133 | 100 % | None | Cholangitis, grade ≥ 3 | 2/49 (4.1 %) | 16.3 % |
GI bleeding, gastric antrum or transverse colon, grade ≥ 3 | 3/49 (6.1 %) | ||||||||
Bowel obstruction, grade ≥ 3 | 2/49 (4.1 %) | ||||||||
Enteritis, grade ≥ 3 | 1/49 (2 %) | ||||||||
Nishimura et al. [20] | 55 | Unknown | 26 Gy 1 fxb + 44 Gyc (mean) | 178 | 34.2 % | 100 % | GI ulcer (non-perforating)d
| 11/55 (20.0 %) | 32.7 % |
Intestinal perforationd
| 2/55 (3.6 %) | ||||||||
Abdominal abscessd
| 3/55 (5.5 %) | ||||||||
Ileusd
| 2/55 (3.6 %) | ||||||||
71 | 29.3 Gy 1 fxb + 41 Gyc (mean) | 209 | 27.4 % | None | GI ulcer (non-perforating)d
| 7/71 (9.9 %) | 19.7 % | ||
Intestinal perforationd
| 2/71 (2.8 %) | ||||||||
Abdominal abscessd
| 1/71 (1.4 %) | ||||||||
Duodenal fibrosisd
| 3/71 (4.2 %) | ||||||||
Ileusd
| 1/71 (1.4 %) | ||||||||
Okamoto et al. [21] | 68 | Unknown | 20 Gy 1 fxb + 50 Gyc (median) | 135 | 8.8 % | 94.1 % | Duodenal ulcer, bleedingd
| 2/68 (2.9 %) | 2.9 % |
64 | 20 Gy 1 fxb + 50 Gyc (median) | 135 | None | 100 % | Duodenal ulcer, fatal hemorrhagic shock, grade 5 | 1/64 (1.6 %) | 1.6 % | ||
Goldson et al. [22] | 19 | Unknown | 22.5 Gy 1 fxb (median) | 102 | None | None | GI ulcers, bile duct obstructiond
| 2/19 (10.5 %) | 10.5 % |
Author (reference) | Nc
| Median follow-Up (months) | Radiotherapy |
EQD
4
1.8
| Chemo (%) | Surgery (%) | Late GI complications | Complication rate | Total GI toxicity rate |
---|---|---|---|---|---|---|---|---|---|
Ahmadu-Suka et al. [23] | 4 | 4.8 | 17.5 Gy 1 fxa + 50 Gyb (exact) | 126 | none | 100 % | 0/4 (0 %) | 0 % | |
3 | 25 Gy 1 fxa + 50 Gyb (exact) | 177 | none | 100 % | 0/3 (0 % | 0 % | |||
4 | 32.5 Gy 1 fxa + 50 Gyb (exact) | 256 | none | 100 % | Non-perforated duodenal ulcersd
| 3/4 (75 %) | 100 % | ||
Perforated ulcersd
| 1/4 (25 %) | ||||||||
4 | 40 Gy 1 fxa + 50 Gyb (exact) | 355 | none | 100 % | Non-perforated duodenal ulcersd
| 1/4 (25 %) | 100 % | ||
Perforated ulcersd
| 3/4 (75 %) | ||||||||
Halberg et al. [24] | 2 | 6 | 30 Gy 1 fxa (exact) | 176 | none | 100 % | Duodenal ulceration, grade 3 | 2/2 (100 %) | 100 % |
Toxicity
Canine data
NTCP model
NTCP model assumptions | NTCP model parameters | |||
---|---|---|---|---|
α/β | Volume | n (95 % CI) | m (95 % CI) | TD50 (95 % CI) |
3 | 1 % | 0.50 (0.47–0.53) | 0.49 (0.46–0.52) | 41.0 (36.2–47.4) |
3 | 2 % | 0.38 (0.35–0.42) | 0.49 (0.46–0.52) | 91.0 (80.3–105.4) |
3 | 3 % | 0.42 (0.38–0.46) | 0.49 (0.46–0.52) | 95.0 (83.9–110.1) |
3 | 4 % | 0.50 (0.46–0.54) | 0.49 (0.46–0.52) | 81.9 (72.3–94.9) |
3 | 5 % | 0.63 (0.58–0.67) | 0.49 (0.46–0.52) | 63.0 (55.6–72.9) |
4 | 1 % | 0.48 (0.45–0.51) | 0.48 (0.45–0.51) | 39.0 (34.7–44.7) |
4 | 2 % | 0.59 (0.56–0.62) | 0.48 (0.45–0.51) | 35.0 (31.1–40.1) |
4 | 3 % | 0.45 (0.42–0.50) | 0.48 (0.45–0.51) | 71.0 (63.1–81.5) |
4 | 4 % | 0.45 (0.42–0.50) | 0.48 (0.45–0.51) | 81.0 (71.9–92.9) |
4 | 5 % | 0.43 (0.40–.48) | 0.48 (0.45–0.51) | 95.0 (84.4–109.1) |
Univariate logistic regression
Variable |
P value |
---|---|
Median follow-up | 0.82 |
Median radiation dose |
0.01
|
Number of dose fractions | 0.53 |
Modality (IORT vs SBRT) | 0.29 |
% of patients receiving chemotherapy | 0.22 |
% of patients receiving surgery | 0.98 |
Median overall survival | 0.53 |