Daily breathing inconsistency in pancreas SBRT: a 4DCT study

Sarkar, Vikren; Lloyd, Shane; Paxton, Adam; Huang, Long; Su, Fan‐Chi Frances; Tao, Randa; Tward, Jonathan D.; Zhao, Hui; Salter, Bill J.

doi:10.21037/jgo.2018.09.08

Cited by 3 publications

(2 citation statements)

References 12 publications

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“…The results of a study on 4DCT of pancreatic tumors by Sarkar et al. showed the daily breathing inconsistency in the pancreas SBRT ( 23 ). This further indicated that the isotropic ITV edge expansion may not be appropriate because it cannot be fully considered the movement of inter- and intra-fractions.…”

Section: Discussionmentioning

confidence: 99%

Study on Motion Management of Pancreatic Cancer Treated by CyberKnife

Shenghua

Jiang

et al. 2021

Front. Oncol.

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PurposeWe investigated the movement characteristics of pancreas and the clinical accuracy of tracking pancreas with the Synchrony Respiratory Tracking System (SRTS) during the CyberKnife treatment. These data provide a clinical data basis for the expansion margins of pancreatic tumor target.Methods and MaterialsForty-two patients with pancreatic cancer treated by CyberKnife were retrospectively studied. The pancreatic displacement calculated from the x-ray images collected during the time interval between two consecutive movements constituted a data set.ResultsThe total mean motion amplitudes and standard deviations of pancreatic tumors in SI, LR, AP, and radial directions were 3.66 ± 1.71 mm, 0.97 ± 0.62 mm, 1.52 ± 1.02 mm, and 1.36 ± 0.49 mm, respectively. The overall mean correlation errors and standard deviations were 0.82 ± 0.46 mm, 0.47 ± 0.33 mm, 0.41 ± 0.24 mm, and 0.98 ± 0.37 mm, respectively. The overall mean prediction errors and standard deviations were 0.57 ± 0.14 mm, 0.62 ± 0.28 mm, 0.39 ± 0.17 mm, and 1.58 ± 0.36 mm, respectively. The correlation errors and prediction errors of pancreatic tumors at different anatomical positions in SI, LR, and AP directions were statistically significant (p < 0.05).ConclusionsThe tumor motion amplitude, the tumor location, and the treatment time are the main factors affecting the tracking accuracy. The pancreatic tumors at different anatomical locations should be treated differently to ensure sufficient dose coverage of the pancreatic target area.

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Section: Discussionmentioning

confidence: 99%

Study on Motion Management of Pancreatic Cancer Treated by CyberKnife

Shenghua

Jiang

et al. 2021

Front. Oncol.

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“…Journal of Gastrointestinal Oncology. For example, giving the best care possible may mean paying extra attention to radiation therapy planning to avoid unnecessary toxicity as exemplified by the analysis of the effect that breathing differences can have on radiation target coverage by Sarkar and colleagues (12). It may mean combing through big data to discover clues as to most successful real world practice patterns (13).…”

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confidence: 99%

Pancreas cancer, careful improvements and human connections

Lloyd

2018

J. Gastrointest. Oncol

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Pancreas cancer is a deadly disease." That sentence, or something like it, appears at the beginning of almost every paper on pancreas cancer that I've ever read or written. For decades practitioners have constantly striven to hone their skills and improve outcomes, yet the prognosis remains stubbornly poor. A review of the major advances in the field reveals a history of incremental improvements rather than major breakthroughs. The first pancreaticoduodenectomy was attempted in 1898 in Italy by Alessandro Codivilla (1) and resulted in a post-operative death. Unfortunately, there was little progress in improving the procedure until Allen Oldfather Whipple developed and refined it, performing it 37 times over the course of his career during the early to mid-20 th century (2). Outcomes remained poor but over the years surgical techniques continued to evolve and improve and now confer many months and even years of survival to appropriate patients (3). Meanwhile, systemic treatments have nudged survival upward, but only slightly. In the 1980's the small but randomized GITSG trial showed that adjuvant chemoradiation therapy with 5 FU followed by 2 years of 5-FU improved median survival by 9 months (4). Later trials placed the benefit of adjuvant radiation therapy in doubt (5) but again showed benefit with adjuvant chemotherapy, with Gemcitabine improving median survival by 3 months (6). Trials of chemotherapy for metastatic pancreas cancer have demonstrated that the right regimens-like FOLFIRINOX (7), and nabpaclitaxel plus gemcitabine (8)-can result in improvements in survival on the order of 2−5 months over their comparators. These regimens are being worked into definitive protocols with hopes of similar benefits. Meanwhile, neoadjuvant therapies are properly selecting the right patients for the right local treatments like radiation therapy and surgery, further improving outcomes. But the gains are not enough. With the advent of the immunotherapy age, advances are being made in many cancer types that were unheard of a few years ago. Disappointingly, immunotherapy advances in pancreas cancer don't seem as immediately forthcoming. This is in part due to pancreas cancer's dense desmoplastic reaction and immunosuppressive microenvironment. In the clinical setting, single agent immune checkpoint inhibitors have not shown acceptable response rates in pancreatic cancer (9). Therefore, our patients have to wait as we evaluate agents still in development and test strategies that engage several points of the cancerimmunity cycle (10). On a hopeful note, pioneering work studying the immune cells present in a select group of long-term survivors of pancreas cancer may help pave the way for new therapies targeting the immune system (11). All this goes to show that doctors who treat pancreas cancer have had to learn to be patient. More importantly, the patients waiting and hoping for that breakthrough have to be patient. We've had to settle on treatment algorithms that demand a very anxious kind of waiting on their part. It may be ...

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