Full-Dose Gemcitabine and Concurrent Radiotherapy for Unresectable Pancreatic Cancer

Murphy, James D.; Adusumilli, Saroja; Griffith, Kent A.; Ray, Michael E.; Zalupski, Mark M.; Lawrence, Theodore S.; Ben‐Josef, Edgar

doi:10.1016/j.ijrobp.2006.12.053

Cited by 195 publications

(145 citation statements)

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“…In selected patients, neoadjuvant treatment can result in downstaging of pancreatic tumors and nodal spread [32] and adjuvant chemoradiotherapy should be considered after irradical resections [20]. However, previous randomized studies have reported significantly higher rates of hematologic and gastrointestinal toxicity with chemoradiotherapy [8,10,27]. Late toxicity after chemoradiotherapy to the upper abdomen includes bowel strictures [16,27] and radiation-induced nephropathy, which may manifest months to years post-treatment [7,15].…”

Section: Introductionmentioning

confidence: 99%

“…However, previous randomized studies have reported significantly higher rates of hematologic and gastrointestinal toxicity with chemoradiotherapy [8,10,27]. Late toxicity after chemoradiotherapy to the upper abdomen includes bowel strictures [16,27] and radiation-induced nephropathy, which may manifest months to years post-treatment [7,15]. Measures to reduce toxicity include omitting prophylactic radiotherapy of regional lymph nodes [27], decreasing mobility margins by individualized assessment and incorporation of target mobility [33], and the use of more conformal radiotherapy techniques.…”

Section: Introductionmentioning

confidence: 99%

“…Late toxicity after chemoradiotherapy to the upper abdomen includes bowel strictures [16,27] and radiation-induced nephropathy, which may manifest months to years post-treatment [7,15]. Measures to reduce toxicity include omitting prophylactic radiotherapy of regional lymph nodes [27], decreasing mobility margins by individualized assessment and incorporation of target mobility [33], and the use of more conformal radiotherapy techniques. In particular, use of intensity-modulated radiotherapy (IMRT) is associated with lower renal and bowel doses compared to conventional planning [2,4,23,24,31,34,37].…”

Section: Introductionmentioning

confidence: 99%

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Volumetric Modulated Arc Therapy for Advanced Pancreatic Cancer

et al. 2010

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Background: Intensity-modulated radiotherapy (IMRT) allows for improved sparing of organs at risk (OARs) in advanced pancreatic cancer. A planning study evaluated if volumetric modulated arc therapy (RapidArc™ [RA]) could be used as an alternative to IMRT in such cases. Patients and Methods: In ten patients, five-field IMRT (5f-IMRT) plans with fixed gantry positions were compared to RA plans using similar constraints for planning target volume (PTV) and OARs. PTV coverage, conformity indices (CI), and OAR doses were compared. One patient was treated using RA and calculated dose distributions were measured in coronal planes in a solid-water phantom. Results: RA plans showed superior mean CI of 1.09 ± 0.02 (± 1 SD [standard deviation]) versus 1.20 ± 0.10 in 5f-IMRT (p = 0.003). Both techniques achieved similar sparing of the right kidney, but RA significantly reduced left kidney doses with V 15 of 7.2% ± 5.3% and 15.9% ± 11.1%, respectively; p = 0.02. RA modestly decreased mean doses to liver (13.8 vs. 15.1 Gy; p = 0.003), stomach (16.7 vs. 17.9 Gy; p = 0.017), small bowel (19.8 vs. 22.1 Gy; p < 0.001), and duodenum (38.8 vs. 41.9 Gy; p = 0.004). Film dosimetry revealed excellent agreement between calculated and measured dose distributions. The delivery time for RA was < 3 min. Conclusion: RA planning achieved superior CI for pancreatic tumors compared to 5f-IMRT, and modestly reduced OAR doses. Fast treatment delivery using RA may decrease the risk of intrafractional organ motion. Ergebnisse: RA-Pläne zeigten einen günstigeren CI von 1,09 ± 0,02 (± 1 SD [Standardabweichung]) gegenüber 1,20 ± 0,10 bei 5f-IMRT (p = 0,003). Mit beiden Techniken gelang eine zufriedenstellende Dosisreduktion der rechten Niere, mittels RA konnten jedoch die V 15 der linken Niere signifikant reduziert werden (7,2% ± 5,3% vs. 15,9% ± 11,1% bei IMRT; p = 0,02). Geringer zeigte sich die Reduktion der mittleren Dosis der Leber (13,8 vs. 15,1 Gy; p = 0,003), des Magens (16,7 vs. 17,9 Gy; p = 0,017), des Dünndarms (19,8 vs. 22,1 Gy; p < 0,001) und des Duodenums (38,8 vs. 41,9 Gy; p = 0,004). Filmdosimetrische Überprüfungen zeigten hervorragende Übereinstimmungen bezüglich kalkulierter und tatsächlicher Dosisverteilung. Die Gesamtbestrahlungszeit betrug < 3 min. Schlussfolgerung: Mittels RA-Planung lässt sich im Vergleich zur 5f-IMRT sowohl ein günstigerer CI als auch moderate Dosisreduktion in den OAR erreichen. Durch die rasche Dosisapplikation vermindert sich das Risiko intrafraktionärer Bewegung der OAR.Schlüsselwörter: Pankreaskarzinom · "Volumetric modulated arc therapy" · Intensitätsmodulierte Radiotherapie · Planungsstudie · Risikoorgane

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Volumetric Modulated Arc Therapy for Advanced Pancreatic Cancer

et al. 2010

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“…It may be possible to identify more accurately to target delineations with increasing RT dose also improvements in both local control and OS rates using such as IMRT, SBRT, or proton therapy methods. Recently, SBRT can be applicated in only several days with achieving equivalent to or better tumor control rates than standart CRT regimes altough without CT with limited toxicity especially elderly and low ECOG performance patients with pancreatic cancer [57]. NS and H can also improved to treatment outcomes with using low total dose of radiation with standart IMRT or SBRT methods with or without CT by reducing toxicities and increasing cytotoxic effects [58][59][60][61][62].…”

Section: Discussionmentioning

confidence: 99%

Can Nigella Sativa and Pure Honey Improved Chemoradiotherapy Effects in Advanced Pancreatic Cancer

Mayadağlı¹

2017

JNHFE

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“…Since gemcitabine enhances the radiosensitivity of tumour cells in vitro and in vivo (3)(4)(5)(6)(7)(8)(9)(10), several phase I and II studies have investigated concurrent gemcitabine and radiotherapy. Unfortunately, acute gastrointestinal toxicity was encountered with standard doses of gemcitabine and radiotherapy, which depended on the irradiated volume (11)(12)(13)(14). Also in patients with nonsmall cell lung cancer (NSCLC) caution needs to be used, when gemcitabine and radiotherapy are applied concurrently (15).…”

Section: Introductionmentioning

confidence: 99%

Cyclopentenyl cytosine has biological and anti-tumour activity, but does not enhance the efficacy of gemcitabine and radiation in two animal tumour models

Kal¹

2009

Int J Oncol

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Abstract. Cyclopentenyl cytosine (CPEC), targetting the de novo biosynthesis of cytidine triphosphate (CTP), increases the cytotoxicity of gemcitabine (2',2'-difluoro-2'-deoxycytidine, dFdC) alone and in combination with irradiation in several human tumour cells in vitro. We investigated whether CPEC enhances the therapeutic ratio of gemcitabine and irradiation in human pancreatic BxPC-3 xenografts and in rat syngeneic L44 lung tumours. These models were selected because gemcitabine and radiation are used to treat both pancreatic and lung cancer patients and both models differ in growth capacity and in gemcitabine-induced radiosensitisation. A profound dose-dependent CTP-depletion was observed after a single injection of CPEC in both tumour tissue and in normal jejunum. In both models, CPEC alone induced a slight but significant tumour growth delay. The combination of CPEC with gemcitabine, at time intervals that showed CTP-depletion after CPEC, enhanced neither tumour growth delay nor toxicity as compared to gemcitabine alone. In addition, no beneficial effect of CPEC was observed in combination with gemcitabine and radiation. These results suggest that CPEC and gemcitabine alone as well as in combination with radiation target a similar cell population in both tumour models. In conclusion, future clinical development of CPEC as a modulator of gemcitabine combined with radiation is unlikely.

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Full-Dose Gemcitabine and Concurrent Radiotherapy for Unresectable Pancreatic Cancer

Cited by 195 publications

References 38 publications

Volumetric Modulated Arc Therapy for Advanced Pancreatic Cancer

Volumetric Modulated Arc Therapy for Advanced Pancreatic Cancer

Can Nigella Sativa and Pure Honey Improved Chemoradiotherapy Effects in Advanced Pancreatic Cancer

Cyclopentenyl cytosine has biological and anti-tumour activity, but does not enhance the efficacy of gemcitabine and radiation in two animal tumour models

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