Histopathological effects of preoperative chemoradiotherapy for pancreatic cancer: An analysis for the impact of radiation and gemcitabine doses

Hirata, Takero; Teshima, Teruki; Nishiyama, Kinji; Ogawa, Kazuhiko; Otani, Keisuke; Kawaguchi, Yoshifumi; Koyama, Koji; Tomita, Yoshihiro; Takahashi, Hidenori; Ohigashi, Hajime; Ishikawa, Osamu

doi:10.1016/j.radonc.2015.01.004

Cited by 30 publications

(16 citation statements)

References 46 publications

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“…A preoperative chemo-radiotherapy regimen adopted by Hirata et al also included dose escalation, targeted at the roots of the coeliac and superior mesenteric arteries, being at “high risk of perineural invasion but difficult to dissect completely”. The boost target volume was “personalised according to guidance from the surgeons or reduced if necessary to meet duodenal or stomach radiotherapy dose-volume constraints” [9].…”

Section: Discussionmentioning

confidence: 99%

“…Delivering a higher dose to the vessels could be therefore achieved with the aim to sterilize the margin in the area at highest risk, and Stereotactic Body Radiation Therapy (SBRT) offers the opportunity of delivering an ablative dose of RT with short overall treatment time. Retrospective institutional studies have demonstrated the feasibility of such an approach with standard [8], [9] or hypofractionation [10], [11] but in the case of SBRT a systematic method of defining the margin at risk has not been defined.…”

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confidence: 99%

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Conformity analysis to demonstrate reproducibility of target volumes for Margin-Intense Stereotactic Radiotherapy for borderline-resectable pancreatic cancer

Holyoake

Robinson

Grose

et al. 2016

Radiotherapy and Oncology

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Background and purposeMargin-directed neoadjuvant radiotherapy for borderline-resectable pancreatic cancer (BRPC) aims to facilitate clear surgical margins. A systematic method was developed for definition of a boost target volume prior to a formal phase-I study.Material and methodsReference structures were defined by two oncologists and one radiologist, target structures were submitted by eight oncologist investigators and compared using conformity indices. Resultant risk of duodenal bleed (NTCP) was modelled.ResultsFor GTV, reference volume was 2.1 cm3 and investigator mean was 6.03 cm3 (95% CI 3.92–8.13 cm3), for boost volume 1.1 cm3 and 1.25 cm3 (1.02–1.48 cm3). Mean Dice conformity coefficient for GTV was 0.47 (0.38–0.56), and for boost volume was significantly higher at 0.61 (0.52–0.70, p = 0.01). Discordance index (DI) for GTV was 0.65 (0.56–0.75) and for boost volume was significantly lower at 0.39 (0.28–0.49, p = 0.001). NTCP using reference contours was 2.95%, with mean for investigator contour plans 3.93% (3.63–4.22%). Correlations were seen between NTCP and GTV volume (p = 0.02) and NTCP and DI (correlation coefficient 0.83 (0.29–0.97), p = 0.01).ConclusionsBetter conformity with reference was shown for boost volume compared with GTV. Investigator GTV volumes were larger than reference, had higher DI scores and modelled toxicity risk. A consistent method of target structure definition for margin-directed pancreatic radiotherapy is demonstrated.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Conformity analysis to demonstrate reproducibility of target volumes for Margin-Intense Stereotactic Radiotherapy for borderline-resectable pancreatic cancer

Holyoake

Robinson

Grose

et al. 2016

Radiotherapy and Oncology

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“…However, the long-term survival of these patients remains unsatisfactory, with a median survival time of 10–28 months and a 5-year overall survival of 6–30% [1–5]. In recent years, new surgical approaches for resectable or borderline resectable pancreatic cancer, including the artery-first approach [6–9], superior mesenteric vein/portal vein resection and reconstruction [10–13], intraoperative radiotherapy [14, 15] and preoperative chemo-radiotherapy [16–18], have been increasingly applied to pancreaticoduodenectomy to achieve R0 resection for carcinomas of the head of the pancreas. Despite the highly aggressive nature of the disease and early regional lymph node metastasis, adenocarcinomas of the body and tail of the pancreas have attracted significantly less clinical attention.…”

Section: Introductionmentioning

confidence: 99%

Radical antegrade modular pancreatosplenectomy versus standard procedure in the treatment of left-sided pancreatic cancer: A systemic review and meta-analysis

Cao

et al. 2017

BMC Surg

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BackgroundRadical antegrade modular pancreatosplenectomy (RAMPS), first reported by Strasberg in 2003, has attracted increasing attention in the treatment of left-sided pancreatic cancer. The limited number of cases eligible for RAMPS makes it difficult to perform any prospective randomized trial of RAMPS versus the standard procedure. Therefore, we performed this systemic review and meta-analysis of the current data to clarify the role of the RAMPS procedure.MethodsA literature search was performed in electronic databases, including PubMed, Medline, Embase, CNKI and the Cochrane Library. Studies comparing RAMPS with the standard procedure were included in this meta-analysis. R0 resection rate, recurrence rate at the end of the follow-up, overall survival (OS) and disease-free survival (DFS) were measured as primary outcomes. Revman 5.3 was used to perform the analysis.ResultsSix retrospective cohort studies with a total number of 378 patients were included in our analysis. Meta-analysis revealed that RAMPS was correlated with higher R0 resection rates [Odds Ratio (OR) 95% confidence interval (CI), 2.19 (1.16 ~ 4.13); P = 0.02] and successful harvest of more lymph nodes [weighted mean difference (WMD) 95% CI, 7.06 (4.52 ~ 9.60); P < 0.01] compared with the standard procedure. However, no statistically significant difference was found between the procedures with respect to recurrence rates [OR 95% CI, 0.66 (0.40 ~ 1.09); P = 0.10], OS [Hazard ratio (HR) 95% CI, 0.65 (0.42 ~ 1.00); P = 0.05] or DFS [HR 95% CI, 1.02 (0.62 ~ 1.68); P = 0.93].ConclusionsRAMPS is safe and oncologically superior to the standard procedure for the treatment of left-sided pancreatic cancer. However, high-grade evidence will be necessary to confirm the potential survival benefits of RAMPS.Electronic supplementary materialThe online version of this article (doi:10.1186/s12893-017-0259-1) contains supplementary material, which is available to authorized users.

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“…Several grading systems for PDAC have been proposed12 13 18 38–42 and used interchangeably. The most widely used of these are the Evans,13 the College of American Pathologists (CAP)41 and the MD Anderson (MDA) grading systems12 ( box 1).…”

Section: Introductionmentioning

confidence: 99%

Regression grading in neoadjuvant treated pancreatic cancer: an interobserver study

et al. 2016

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Histopathological effects of preoperative chemoradiotherapy for pancreatic cancer: An analysis for the impact of radiation and gemcitabine doses

Cited by 30 publications

References 46 publications

Conformity analysis to demonstrate reproducibility of target volumes for Margin-Intense Stereotactic Radiotherapy for borderline-resectable pancreatic cancer

Conformity analysis to demonstrate reproducibility of target volumes for Margin-Intense Stereotactic Radiotherapy for borderline-resectable pancreatic cancer

Radical antegrade modular pancreatosplenectomy versus standard procedure in the treatment of left-sided pancreatic cancer: A systemic review and meta-analysis

Regression grading in neoadjuvant treated pancreatic cancer: an interobserver study

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