Dosimetric Feasibility Study of Dose Escalated Stereotactic Body Radiation Therapy (SBRT) in Locally Advanced Pancreatic Cancer (LAPC) Patients: It Is Time to Raise the Bar

Mazzarotto, Renzo; Simoni, N.; Guariglia, Stefania; Rossi, Gabriella; Micera, R.; Robertis, Riccardo De; Pierelli, A.; Zivelonghi, Emanuele; Malleo, Giuseppe; Paiella, Salvatore; Salvia, Roberto; Cavedon, Carlo; Milella, Michèle; Bassi, Claudio

doi:10.3389/fonc.2020.600940

Cited by 14 publications

(10 citation statements)

References 33 publications

(40 reference statements)

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“… 10 While PTV coverage in these studies appear higher than our study (D 95% 47.5 Gy from the SMART trial vs 44.8 Gy from our study), we note that the PTV definitions between each study differ in an important manner; the DE-PTV in our study was defined to be the summation of the GTV and the TVI, with the TVI often being a large contribution to the PTV, whereas the PTV of the SMART trial did not include a TVI target. Since the TVI is the most common location of recurrence and tumor control near the TVI sometimes results in restaging of unresectable tumors being resectable, an extra dose to the TVI through a simultaneous integrated boost technique can reduce local recurrence 30 , 31 and improve the probability of a negative surgical margin.…”

Section: Discussionmentioning

confidence: 99%

Dose Escalation for Pancreas SBRT: Potential and Limitations of using Daily Online Adaptive Radiation Therapy and an Iterative Isotoxicity Automated Planning Approach

Rhee¹,

Beddar²,

Jaoude³

et al. 2023

Advances in Radiation Oncology

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Section: Discussionmentioning

confidence: 99%

Dose Escalation for Pancreas SBRT: Potential and Limitations of using Daily Online Adaptive Radiation Therapy and an Iterative Isotoxicity Automated Planning Approach

Rhee¹,

Beddar²,

Jaoude³

et al. 2023

Advances in Radiation Oncology

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“…These results suggest that dose escalation may be the key determinant in achieving LC and thus conversion to surgical resectability. Currently, for five-fraction regimens, dose escalations of up to 60 Gy is feasible without compromising adequate target coverage and OAR constraints[ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Stereotactic radiotherapy and the potential role of magnetic resonance-guided adaptive techniques for pancreatic cancer

Ermongkonchai¹,

Khor²,

Muralidharan³

et al. 2022

WJG

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BACKGROUND Pancreatic cancer is a malignancy with one of the poorest prognoses amongst all cancers. Patients with unresectable tumours either receive palliative care or undergo various chemoradiotherapy regimens. Conventional techniques are often associated with acute gastrointestinal toxicities, as adjacent critical structures such as the duodenum ultimately limits delivered doses. Stereotactic body radiotherapy (SBRT) is an advanced radiation technique that delivers highly ablative radiation split into several fractions, with a steep dose fall-off outside target volumes. AIM To discuss the latest data on SBRT and whether there is a role for magnetic resonance-guided techniques in multimodal management of locally advanced, unresectable pancreatic cancer. METHODS We conducted a search on multiple large databases to collate the latest records on radiotherapy techniques used to treat pancreatic cancer. Out of 1229 total records retrieved from our search, 36 studies were included in this review. RESULTS Studies indicate that SBRT is associated with improved clinical efficacy and toxicity profiles compared to conventional radiotherapy techniques. Further dose escalation to the tumour with SBRT is limited by the poor soft-tissue visualisation of computed tomography imaging during radiation planning and treatment delivery. Magnetic resonance-guided techniques have been introduced to improve imaging quality, enabling treatment plan adaptation and re-optimisation before delivering each fraction. CONCLUSION Therefore, SBRT may lead to improved survival outcomes and safer toxicity profiles compared to conventional techniques, and the addition of magnetic resonance-guided techniques potentially allows dose escalation and conversion of unresectable tumours to operable cases.

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“…The number of indications for SBRT is expected to increase in the future. Establishing a method to protect OARs by using a minimum prescribed dose is necessary [ 7 ]. There are techniques for artificially moving the position of OARs (sometimes PTV) to exclude the heart from the irradiation field; for example, respiratory synchronization in breast conserving therapy of left breast cancer is performed to reduce the radiation dose to the heart.…”

Section: Discussionmentioning

confidence: 99%

Effect of stomach size on organs at risk in pancreatic stereotactic body radiotherapy

et al. 2022

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Background In clinical practice, the organs at risk (OARs) should be carefully determined when performing pancreatic stereotactic body radiotherapy (SBRT). We conducted a simulation study to examine the effect of the stomach size on the radiation dose to the OARs when performing pancreatic SBRT. Methods Twenty-five cases were included in this study. Pancreatic head and body tumors were 2-cm-sized pseudotumors, which were included as gross target volume (GTV) contours. The stomach, pancreas, small intestine, liver, kidneys, and spinal cord were considered as the OARs. The prescription dose for planning target volume (PTV) was 40 Gy/5fx, and the dose limit for the OARs was determined. The dose to X% of the OAR volume at X values of 0.1, 5.0, and 10.0 cc (DX) and the percentage of the OAR volume that received more than X Gy were recorded. Results In terms of the radiation dose to the pancreatic body tumors, the stomach size was positively correlated with a dose of D10cc [correlation coefficient (r) = 0.5516) to the stomach. The r value between the radiation dose to the pancreatic head tumor and the stomach size was 0.3499. The stomach size and radiation dose to the head and body of the pancreas were positively correlated (pancreatic head D10cc: r = 0.3979, pancreatic body D10cc: r = 0.3209). The larger the stomach, the larger the radiation dose to the healthy portion of the pancreas outside the PTV. Conclusions When performing pancreatic SBRT, the dose to the OARs depends on the stomach size. Reducing the dose to the stomach and pancreas can be achieved by shrinking the stomach.

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Dosimetric Feasibility Study of Dose Escalated Stereotactic Body Radiation Therapy (SBRT) in Locally Advanced Pancreatic Cancer (LAPC) Patients: It Is Time to Raise the Bar

Cited by 14 publications

References 33 publications

Dose Escalation for Pancreas SBRT: Potential and Limitations of using Daily Online Adaptive Radiation Therapy and an Iterative Isotoxicity Automated Planning Approach

Dose Escalation for Pancreas SBRT: Potential and Limitations of using Daily Online Adaptive Radiation Therapy and an Iterative Isotoxicity Automated Planning Approach

Stereotactic radiotherapy and the potential role of magnetic resonance-guided adaptive techniques for pancreatic cancer

Effect of stomach size on organs at risk in pancreatic stereotactic body radiotherapy

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