Acute Toxicity of Proton Versus Photon Chemoradiation Therapy for Pancreatic Adenocarcinoma: A Cohort Study

Lukens, John N.; Demas, Kristina; Apisarnthanarax, Smith; Metz, James M.; McCall, Deborah; O’Dwyer, Peter J.; Teitelbaum, Ursina R.; Both, Stefan; Plastaras, John P.

doi:10.1016/j.ijrobp.2013.06.817

Cited by 3 publications

(3 citation statements)

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“…reported clinical outcomes of 13 patients with pancreatic cancer (1 intact, 12 postoperative) treated with passive scatter PBT and concurrent chemotherapy. 19 Acute grade ≥3 GI AEs occurred in 1 patient (8%), which compared favorably with a rate of 24% in a contemporaneous cohort of 17 patients treated with photon RT and concurrent chemotherapy. Additionally, a prospective phase 1/2 trial examining a preoperative passive scatter PBT regimen of 25 Gy in 5 fractions found a 4.1% rate of grade 3 acute AEs.…”

Section: Discussionmentioning

confidence: 89%

“…However, limited data exist on the role of PBT for the treatment of pancreatic cancer. 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 Although demonstrating favorably low rates of GI AEs, the previously reported series have limitations with regard to their inclusion of heterogeneous patient cohorts and treatment techniques, lack of technical treatment details, lack of comparative dosimetric data with advanced photon-based techniques, and use of passive scatter PBT as opposed to more advanced pencil-beam scanning (PBS)/intensity modulated proton therapy (IMPT) techniques.…”

Section: Introductionmentioning

confidence: 99%

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Initial experience with intensity modulated proton therapy for intact, clinically localized pancreas cancer: Clinical implementation, dosimetric analysis, acute treatment-related adverse events, and patient-reported outcomes

Jethwa

Tryggestad

Whitaker

et al. 2018

Advances in Radiation Oncology

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PurposePencil-beam scanning intensity modulated proton therapy (IMPT) may allow for an improvement in the therapeutic ratio compared with conventional techniques of radiation therapy delivery for pancreatic cancer. The purpose of this study was to describe the clinical implementation of IMPT for intact and clinically localized pancreatic cancer, perform a matched dosimetric comparison with volumetric modulated arc therapy (VMAT), and report acute adverse event (AE) rates and patient-reported outcomes (PROs) of health-related quality of life.Methods and materialsBetween July 2016 and March 2017, 13 patients with localized pancreatic cancer underwent concurrent capecitabine or 5-fluorouracil-based chemoradiation therapy (CRT) utilizing IMPT to a dose of 50 Gy (radiobiological effectiveness: 1.1). A VMAT plan was generated for each patient to use for dosimetric comparison. Patients were assessed prospectively for AEs and completed PRO questionnaires utilizing the Functional Assessment of Cancer Therapy-Hepatobiliary at baseline and upon completion of CRT.ResultsThere was no difference in mean target coverage between IMPT and VMAT (P > .05). IMPT offered significant reductions in dose to organs at risk, including the small bowel, duodenum, stomach, large bowel, liver, and kidneys (P < .05). All patients completed treatment without radiation therapy breaks. The median weight loss during treatment was 1.6 kg (range, 0.1-5.7 kg). No patients experienced grade ≥3 treatment-related AEs. The median Functional Assessment of Cancer Therapy-Hepatobiliary scores prior to versus at the end of CRT were 142 (range, 113-163) versus 136 (range, 107-173; P = .18).ConclusionsPencil-beam scanning IMPT was feasible and offered significant reductions in radiation exposure to multiple gastrointestinal organs at risk. IMPT was associated with no grade ≥3 gastrointestinal AEs and no change in baseline PROs, but the conclusions are limited due to the patient sample size. Further clinical studies are warranted to evaluate whether these dosimetric advantages translate into clinically meaningful benefits.

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Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Initial experience with intensity modulated proton therapy for intact, clinically localized pancreas cancer: Clinical implementation, dosimetric analysis, acute treatment-related adverse events, and patient-reported outcomes

Jethwa

Tryggestad

Whitaker

et al. 2018

Advances in Radiation Oncology

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“…While several studies investigated the role proton therapy in the treatment of pancreatic cancer as reviewed above, few compared it with the photon modalities. The first comparison was carried out by Lukens et al at the University of Pennsylvania [ 69 ]. Thirteen patients with pancreatic adenocarcinoma, the majority of whom were staged as T3, received either proton therapy or photon therapy (3D-CRT/VMAT) at a dose of 54 Gy along with concurrent chemotherapy (5-FU/capecitabine).…”

Section: Clinical Datamentioning

confidence: 99%

Proton Therapy in the Management of Pancreatic Cancer

Kobeissi

Simone

Lin

et al. 2022

Cancers

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Radiation therapy plays a central role in the treatment of pancreatic cancer. While generally shown to be feasible, proton irradiation, particularly when an ablative dose is planned, remains a challenge, especially due to tumor motion and the proximity to organs at risk, like the stomach, duodenum, and bowel. Clinically, standard doses of proton radiation treatment have not been shown to be statistically different from photon radiation treatment in terms of oncologic outcomes and toxicity rates as per non-randomized comparative studies. Fractionation schedules and concurrent chemotherapy combinations are yet to be optimized for proton therapy and are the subject of ongoing trials.

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Treatment of primary or recurrent non-resectable pancreatic cancer with proton beam irradiation combined with gemcitabine-based chemotherapy

et al. 2023

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Acute Toxicity of Proton Versus Photon Chemoradiation Therapy for Pancreatic Adenocarcinoma: A Cohort Study

Cited by 3 publications

References 0 publications

Initial experience with intensity modulated proton therapy for intact, clinically localized pancreas cancer: Clinical implementation, dosimetric analysis, acute treatment-related adverse events, and patient-reported outcomes

Initial experience with intensity modulated proton therapy for intact, clinically localized pancreas cancer: Clinical implementation, dosimetric analysis, acute treatment-related adverse events, and patient-reported outcomes

Proton Therapy in the Management of Pancreatic Cancer

Treatment of primary or recurrent non-resectable pancreatic cancer with proton beam irradiation combined with gemcitabine-based chemotherapy

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