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25.04.2018 | Original Article

Linac-based stereotactic body radiation therapy for unresectable locally advanced pancreatic cancer: risk-adapted dose prescription and image-guided delivery

verfasst von: Rosario Mazzola, MD, Sergio Fersino, Dario Aiello, Fabiana Gregucci, Umberto Tebano, Stefanie Corradini, Gioacchino Di Paola, Massimo Cirillo, Luca Tondulli, Giacomo Ruffo, Ruggero Ruggieri, Filippo Alongi

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 9/2018

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Abstract

Background

Stereotactic body radiation therapy (SBRT) represents a new treatment option for locally advanced pancreatic cancer (LAPC). An accurate treatment planning with risk-adapted dose prescription with adherence to specific dose constraints for organs at risk (OARs) and the use of daily cone beam CT (CBCT) for image guidance could allow an effective and safe treatment delivery. Here, feasibility and efficacy of SBRT in LAPC treated in our cancer care center are reported.

Patients and methods

33 unresectable LAPC patients underwent SBRT. In order to respect OAR dose constraints, a risk-adapted dose prescription strategy was adopted, choosing between the following schedules: 42 Gy or 45 Gy in 6 daily fractions with a biologically effective dose (BED) > 70 Gy₁₀ or 36 Gy/6 fractions (estimating a BED 57.6 Gy₁₀). SBRT was delivered with volumetric modulated arc technique (VMAT) and flattening filter-free (FFF) mode. Image guidance was performed by means of CBCT before every treatment session. The patients were evaluated at the end of treatment for acute toxicity and at 3, 6, and 12 months for late toxicity and treatment response.

Results

At the time of analysis, the median follow-up was 18 months (range 5–34 months). Prior to SBRT, 24 out of 33 patients received induction chemotherapy. Although all patients were previously judged as unresectable, 6 out of 33 (18%) underwent surgery after SBRT; all of them received a BED > 70 Gy₁₀. One-year LC and OS were 81% and 75%, respectively. A total of 12 patients (37%) had an extra-pancreatic progression. No cases of ≥G3 acute or late toxicity were reported.

Conclusion

In our experience, risk-adapted dose prescription and image-guided SBRT represents an effective treatment option for LAPC patients.

Gillen S, Schuster T, Meyer Zum Büschenfelde C et al (2010) Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. Plos Med 7(4):e1000267CrossRefPubMedPubMedCentral

Andriulli A, Festa V, Botteri E et al (2012) Neoadjuvant/Preoperative gemcitabine for patients with localized pancreatic cancer: a meta-analysis of prospective studies. Ann Surg Oncol 19(5):1644–1662CrossRefPubMed

De Bari B, Porta L, Mazzola R et al (2016) Hypofractionated radiotherapy in pancreatic cancer: lessons from the past in the era of stereotactic body radiation therapy. Crit Rev Oncol Hematol 103:49–61CrossRefPubMed

Mahadevan A, Miksad R, Goldstein M et al (2011) Induction gemcitabine and stereotactic body radiotherapy for locally advanced nonmetastatic pancreas cancer. Int J Radiat Oncol Biol Phys 81(4):e615–22CrossRefPubMed

Alongi F, Mazzola R, Ricchetti F et al (2015) Volumetric-modulated arc therapy with vaginal cuff simultaneous integrated boost as an alternative to brachytherapy in adjuvant irradiation for endometrial cancer: a prospective study. Anticancer Res 35(4):2149–2155PubMed

Ferrera G, Mortellaro G, Mannino M et al (2015) Moderate hypofractionation and simultaneous integrated boost by helical tomotherapy in prostate cancer: monoinstitutional report of acute tolerability assessment with different toxicity scales. Radiol Med 120(12):1170–1176CrossRefPubMed

Mazzola R, Ferrera G, Alongi F et al (2015) Organ sparing and clinical outcome with step-and-shoot IMRT for head and neck cancer: a mono-institutional experience. Radiol Med 120(8):753–758CrossRefPubMed

NCCN Clinical Practice Guidelines in Oncology (2017) Pancreatic adenocarcinoma. Version 2. http://www.nccn.org/professionals/physician_gls/PDF/pancreatic.pdf. Accessed 1 May 2017

Comito T, Cozzi L, Clerici E et al (2017) Can Stereotactic body radiation therapy be a viable and efficient therapeutic option for unresectable locally advanced pancreatic adenocarcinoma? Results of a phase 2 study. Technol Cancer Res Treat 16(3):295–301CrossRefPubMed

10.

Comito T, Cozzi L, Zerbi A et al (2017) Clinical results of stereotactic body radiotherapy (SBRT) in the treatment of isolated local recurrence of pancreatic cancer after R0 surgery: a retrospective study. Eur J Surg Oncol 43(4):735–742CrossRefPubMed

11.

Schwartz LH, Litière S, de Vries E et al (2016) RECIST 1.1-Update and clarification: From the RECIST committee. Eur J Cancer 62:132–137CrossRefPubMedPubMedCentral

12.

Wahl RL, Jacene H, Kasamon Y et al (2009) From RECIST to PERCIST: Evolving considerations for PET response criteria in solid tumors. J Nucl Med 50(suppl 1):122S–150SCrossRefPubMedPubMedCentral

13.

Expert Panel on Radiation Oncology-Gastrointestinal, Small W Jr, Hayes JP, Suh WW et al (2016) ACR appropriateness criteria® borderline and unresectable pancreas cancer. Oncology 30(7):619–24, 627, 632

14.

Schellenberg D, Goodman KA, Lee F et al (2008) Gemcitabine chemotherapy and single-fraction stereotactic body radiotherapy for locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 72(3):678–686CrossRefPubMed

15.

Koong AC, Le QT, Ho A et al (2004) Phase I study of stereotactic radiosurgery in patients with locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 58(4):1017–1021CrossRefPubMed

16.

Koong AC, Christofferson E, Le QT et al (2005) Phase II study to assess the efficacy of conventionally fractionated radiotherapy followed by a stereotactic radiosurgery boost in patients with locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 63(2):320–323CrossRefPubMed

17.

Shen ZT, Wu XH, Li B et al (2010) Preliminary efficacy of CyberKnife radiosurgery for locally advanced pancreatic cancer. Chin J Cancer 29(9):802–809CrossRefPubMed

18.

Herman JM, Chang DT, Goodman KA et al (2015) Phase 2 multi-institutional trial evaluating gemcitabine and stereotactic body radiotherapy for patients with locally advanced unresectable pancreatic adenocarcinoma. Cancer 121(7):1128–1137CrossRefPubMed

19.

Toesca DAS, Pollom EL et al (2017) Assessing local progression after stereotactic body radiation therapy for unresectable pancreatic adenocarcinoma: CT versus PET. Pract Radiat Oncol. https://doi.org/10.1016/j.prro.2016.09.002 CrossRefPubMed

20.

Brunner TB, Nestle U, Adebahr S et al (2016) Simultaneous integrated protection: a new concept for high-precision radiation therapy. Strahlenther Onkol 192(12):886–894CrossRefPubMedPubMedCentral

21.

Panje C, Andratschke N, Brunner TB et al (2016) Stereotactic body radiotherapy for renal cell cancer and pancreatic cancer: literature review and practice recommendations of the DEGRO Working Group on Stereotactic Radiotherapy. Strahlenther Onkol 192(12):875–885CrossRefPubMed

22.

Chang DT, Schellenberg D, Shen J et al (2009) Stereotactic radiotherapy for unresectable adenocarcinoma of the pancreas. Cancer 115:665–672CrossRefPubMed

23.

Goyal K, Einstein D, Ibarra RA et al (2012) Stereotactic body radiation therapy for nonresectable tumors of the pancreas. J Surg Res 174(2):319–325CrossRefPubMed

Titel: Linac-based stereotactic body radiation therapy for unresectable locally advanced pancreatic cancer: risk-adapted dose prescription and image-guided delivery
verfasst von: Rosario Mazzola, MD
Sergio Fersino
Dario Aiello
Fabiana Gregucci
Umberto Tebano
Stefanie Corradini
Gioacchino Di Paola
Massimo Cirillo
Luca Tondulli
Giacomo Ruffo
Ruggero Ruggieri
Filippo Alongi
Publikationsdatum: 25.04.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 9/2018
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-018-1306-2

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Linac-based stereotactic body radiation therapy for unresectable locally advanced pancreatic cancer: risk-adapted dose prescription and image-guided delivery