Dosimetric and Clinical Toxicity Comparison of Critical Organ Preservation with Three-Dimensional Conformal Radiotherapy, Intensity-Modulated Radiotherapy, and RapidArc for the Treatment of Locally Advanced Cancer of the Pancreatic Head

Jin, Linzhi; Wang, R.; Jiang, Suping; Yue, Jinbo; Liu, T.; Dou, Xuelin; Zhu, Kangshun; Feng, Rui; Xu, Ximing; Chen, D.; Yin, Yong

doi:10.3747/co.23.2771

Cited by 10 publications

(7 citation statements)

References 34 publications

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“…The lack of significant differences in miRNA expression between pre-RT and control groups may indicate that these miRNAs are not tumor-specific in serum/plasma. The VMAT technique achieved highly conformal treatment plans and decreased the normal tissue toxicity compared with other conventional RT techniques (65). Therefore, no significant changes in the miRNA expression levels were observed.…”

Section: Discussionmentioning

confidence: 92%

Monitoring of platelet function parameters and microRNA expression levels in patients with prostate cancer treated with volumetric modulated arc radiotherapy

et al. 2018

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Radiotherapy (RT) may result in platelet activation and thrombosis development. To the best of our knowledge, the potential effect of volumetric-modulated arc therapy (VMAT), a novel radiotherapy technique, on platelet function and microRNA (miRNA/miR) expression has not been previously investigated. The present study aimed to determine the effect of VMAT on the alterations in platelet function parameters and miRNA expression levels. A total of 25 patients with prostate cancer and 25 healthy subjects were included in the present study. Blood samples were collected from the patient group on the day prior to RT (pre-RT), the day RT was completed (post-RT day 0), and 40 days following the end of therapy (post-RT day 40). Platelet count, mean platelet volume (MPV) value, platelet aggregation, plasma P-selectin, thrombospondin-1, platelet factor 4, plasma miR-223 and miR-126 expression levels were measured. A significant decrease in platelet count in the post-RT day 0 group was measured in comparison with the pre-RT and the post-RT day 40 groups. Pre-RT MPV values were higher than those of the post-RT day 0 and the post-RT day 40 groups. No significant differences were observed in the levels of platelet activation markers or miR-223 and miR-126 expression levels between the RT groups. Although RT may result in a reduction in platelet and MPV counts, the results of the present study indicate that platelet activation markers are not affected by VMAT. Therefore, it is possible that no platelet activation occurs during VMAT, owing to the conformal dose distributions, improved target volume coverage and the sparing of normal tissues from undesired radiation.

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Section: Discussionmentioning

confidence: 92%

Monitoring of platelet function parameters and microRNA expression levels in patients with prostate cancer treated with volumetric modulated arc radiotherapy

et al. 2018

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“…Jin and colleagues analysed DVHs of 20 patients treated for pancreatic cancers and found similar, comparatively low rates of higher grade toxicity. Additionally an advantage of VMAT compared to 3D conformal RT or intensity modulated RT (IMRT) regarding acute toxicities was described by several groups [27,28]. These findings are in contrast to the Phase-I/II study on radiation dose escalation reported by Ben-Josef and colleagues: They observed an increase of dose limiting toxicities with radiation doses higher than 55 Gy [18].…”

Section: Discussionmentioning

confidence: 99%

Dose-escalated radiotherapy for unresectable or locally recurrent pancreatic cancer: Dose volume analysis, toxicity and outcome of 28 consecutive patients

et al. 2017

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PurposeThe role of radiotherapy for unresectable pancreatic cancer is controversial. A benefit of additional radiotherapy is supported by some observations. A dose-effect relationship was recently found by dose escalation employing image guided and intensity modulated radiotherapy.MethodsWe retrospectively evaluated 28 consecutive patients, all with history of extensive prior therapies for unresectable locally advanced/ recurrent pancreatic cancer (LAPC/LRPC). Treatment was delivered by helical tomotherapy after daily position verification with computed tomography. Dose to the planned target volume (PTV) was 51 Gy, while the dose to the macroscopic tumor was escalated by a simultaneous integrated boost to a median cumulative dose of 66 Gy (60–66 Gy). Concomitant chemotherapy consisted mainly of capecitabine (n = 23).Results10 of 28 patients presented acute toxicities > grade 2, one patient succumbed to gastrointestinal bleeding after treatment. No correlations of toxicities and dose volume histograms (DVH) of retrospectively delineated small bowel loops were observed, although average small bowel volume receiving ≥ 20 Gy was 374 ml. DVH analyses revealed a correlation of splenic parameters and acute toxicity: Vomiting, anorexia, dehydration, hematologic toxicity, fatigue, combined gastro-intestinal toxicity wit R-values between 0.392 and 0.561 (all p-values > 0.05). Only one patient developed late toxicities > grade 2. With an average follow-up time in surviving patients of 14 months median overall survival time was 19 months and median time to local recurrence 13 months. In 8 patients with available imaging of local recurrence: 5 in field recurrences, 2 marginal recurrences and one lymph node recurrence outside the high dose radiation field were observed. In univariate analysis only ΔCA-19-9 during radiotherapy was associated with local control (p = 0.029) and overall survival (p = 0.049).ConclusionDose escalated normo-fractionated radiotherapy for LAPC/LRPC seems feasible and suitable to prolong local control and in consequence long-term survival. However, in-field local progression is still frequently observed and possibilities to increase the local effectiveness should be evaluated. Exposure of the spleen was predictive for acute toxicity and should be further investigated.

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“…The OARs for sparing included the small intestine, stomach, left kidney, right kidney, liver, and spinal cord. The dose constraints of the OARs were designated in Appendix 16 …”

Section: Tomotherapy Planningmentioning

confidence: 99%

A novel X‐Ray and γ‐Ray combination strategy for potential dose escalation in patients with locally advanced pancreatic cancer

et al. 2022

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Background Treatment of locally advanced pancreatic cancer (LAPC) has long been calling for advances in technology of radiotherapy. Patients who received radiotherapy still had high risks of local recurrence, while suffering from gastrointestinal side effects. Based on the inherent characteristics of the x‐ray and γ‐Ray radiation techniques, here we proposed and investigated an unexplored radiation therapy. Purpose To investigate the potential clinical benefit of a novel x‐ray and γ‐Ray combination radiation technique in patients with LAPC. Methods Retrospective intensity‐modulated radiotherapy (IMRT) treatment plans of 10 LAPC patients were randomly selected to compare with dual‐modality plans. The prescribed dose to PGTV was 60.2 Gy. The PGTV dose was further escalated in dual‐modality plan while maintaining clinically tolerable dose to organs at risk (OARs). Dosimetric comparisons were made and analyzed for three treatment plans (tomotherapy, standard dual‐modality plan, escalated dual‐modality plan) to assess the ability to increase dose to target volume while minimizing dose in adjacent OARs. Finally, radiobiological models were utilized for comparison. Results All strategies resulted in dosimetrically acceptable plans. Dual‐modality plans were present with similar conformity index (CI) and significantly lower gradient index (GI) compared with tomotherapy (3.64 ± 0.37 vs. 4.14 ± 0.61, p = 0.002; 3.64 ± 0.42 vs. 4.14 ± 0.61, p = 0.003). Dmean of PGTV (65.46 ± 3.13 vs. 61.56 ± 1.00, p = 0.009; 77.98 ± 5.86 vs. 61.56 ± 1.00, p < 0.001) and PCTV (55.04 ± 2.14 vs. 53.93 ± 1.67, p = 0.016; 58.24 ± 3.24 vs. 53.93 ± 1.67, p = 0.001) were significantly higher, while Dmean of the stomach was reduced in both dual‐modality plans (17.98 ± 10.23 vs. 19.34 ± 9.75, p = 0.024; 17.62 ± 9.92 vs. 19.34 ± 9.75, p = 0.040). The lower V30Gy in the liver (4.83 ± 5.87 vs. 6.23 ± 6.68, p = 0.015; 4.90 ± 5.93 vs. 6.23 ± 6.68, p = 0.016) and lower V45Gy of the small intestine (3.35 ± 3.30 vs. 4.06 ± 3.87, p = 0.052) were found in dual‐modality plans. Meanwhile, radiobiological models demonstrated higher probability of tumor control (29.27% ± 9.61% vs. 18.34% ± 4.70%, p < 0.001; 44.67% ± 18.16% vs. 18.34% ± 4.70%, p = 0.001) and lower probability of small intestine complication (2.16% ± 2.30% vs. 1.25% ± 2.72%, p = 0.048) in favor of dual‐modality strategy. Conclusions A novel dual‐modality strategy of x‐ray and γ‐Ray combination radiation appears reliable for target dose escalation and normal tissue dose reduction. This strategy might be beneficial for local tumor control and the protection of normal organs in patients with LAPC.

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Dosimetric and Clinical Toxicity Comparison of Critical Organ Preservation with Three-Dimensional Conformal Radiotherapy, Intensity-Modulated Radiotherapy, and RapidArc for the Treatment of Locally Advanced Cancer of the Pancreatic Head

Cited by 10 publications

References 34 publications

Monitoring of platelet function parameters and microRNA expression levels in patients with prostate cancer treated with volumetric modulated arc radiotherapy

Monitoring of platelet function parameters and microRNA expression levels in patients with prostate cancer treated with volumetric modulated arc radiotherapy

Dose-escalated radiotherapy for unresectable or locally recurrent pancreatic cancer: Dose volume analysis, toxicity and outcome of 28 consecutive patients

A novel X‐Ray and γ‐Ray combination strategy for potential dose escalation in patients with locally advanced pancreatic cancer

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