Pathologic response of the pancreas and duodenum to experimental intraoperative irradiation

Ahmadu-Suka, Faisal; Gillette, Edward L.; Withrow, Stephen J.; Husted, Paul W.; Nelson, A. Wendell; Whiteman, C. E.

doi:10.1016/0360-3016(88)90398-7

Cited by 55 publications

(37 citation statements)

References 9 publications

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“…Latter doses beyond 5Gy (V10, V20 and V40) were not associated with decrease in such biochemical levels. In the study of Ahmadu-Suka et al 21 RT doseresponse relationships were observed for the damage to the pancreas as a whole, for pancreatic fibrosis and decrease in normal acinar cells. In our study, mean pancreatic volume of all the patients was measured as 21 (12.46-30.80) after 1 year of RT.…”

Section: Discussionmentioning

confidence: 99%

“…In the study of Ahmadu-Suka et al 21 RT doseresponse relationships were observed for the damage to the pancreas as a whole, for pancreatic fibrosis and decrease in normal acinar cells. In our study, mean pancreatic volume of all the patients was measured as 21 (12.46-30.80) after 1 year of RT. In conclusion, pancreatic volumes of all the patients who underwent RT showed a statistically significant decrease.…”

Section: Discussionmentioning

confidence: 99%

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The Effect of Chemoradiotherapy at Gastric Cancer on Pancreatic Enzymes and Pancreas Volume.

Kandaz¹

2017

UHOD

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Post-operative chemoradiotherapy is one of the therapeutic approaches for operated gastric cancer. During radiotherapy planning, pancreas has not been accepted as a critical organ until now, thus toxicity to pancreas has not been considered. In our prospective study, serum pancreatic enzyme levels and pancreatic volume after RT is investigated. Seventy-one patients with gastric cancer were evaluated adjuvant chemoradiotherapy. Mean pancreas volume, mean pancreas radiotherapy dose and V5, V10, V20 and V40 values were calculated. Fasting blood glucose, insulin, amylase and glycosylated hemoglobin levels were evaluated before radiotherapy and re-evaluated at the end of radiotherapy, at 1th, 3rd, 6th and 12th months after radiotherapy. Pancreas volume was evaluated before radiotherapy and re-evaluated at 12th month after radiotherapy. Before the initiation, after the first session and at the 1th, 3th, 6th and 12th months of radiotherapy, difference between serum Fasting blood glucose (p= 0.179), insulin (p= 0.296), HbA1c (p= 0.468) and amylase levels (p= 0.069) levels were not statistically significant but there is statistically significant decrease in pancreatic volume after treatment (p= 0.002). Postoperative chemoradiotherapy is able to prolong survival and decrease recurrence in operated gastric cancer patients. In our prospective study, we could not identify any statistically significant finding related to pancreatic toxicity or its presentation on biochemical parameters except pancreas atrophy in one-year period. Although, there was not any self-reported diabetes mellitus at early period it, follow-up needed for late toxicity. Keywords: Chemoradiotherapy, Gastric cancer, Pancreatic enzymes, Pancreas volume ÖZET Mide Kanserinde Kemoradyoterapinin Pankreas Hacmi ve Pankreas Enzimleri Üzerine EtkisiPost-operatif kemoradyoterapi, ameliyat edilen mide kanseri için terapötik yaklaşımlardan biridir. Radyoterapi planlaması sırasında şimdiye kadar pankreas kritik bir organ olarak kabul edilmemiştir, bu nedenle pankreas toksisitesi dikkate alınmamıştır. Prospektif çalışmamızda, radyoterapi sonrası serum pankreatik enzim düzeyleri ve pankreas hacmi araştırılmıştır. Adjuvan kemoradyoterapi uygulanan 71 mide kanserli hasta değerlendirildi. Ortalama pankreas hacmi, ortalama pankreas radyoterapi dozu ve V5, V10, V20 ve V40 değerleri hesaplandı. Açlık kan şekeri, insülin, amilaz ve glikolize hemoglobin düzeyleri radyoterapi öncesi değerlendirildi ve radyoterapi bitiminde, radyoterapiden sonra 1, 3, 6. ve 12. aylarda yeniden değerlendirildi. Pankreas hacmi radyoterapi öncesi değerlendirildi ve radyoterapiden sonraki 12. ayda yeniden değerlendirildi. Radyoterapi öncesi, radyoterapi bitiminde, radyoterapiden sonra 1, 3, 6. ve 12. aylarda serum açlık kan glikozu (p= 0.179), insülin (p= 0.296), HbA1c (p= 0.468) ve amilaz düzeyleri istatistiksel olarak anlamlı değildi (p= 0.069), ancak tedavi sonrası pankreas hacminde istatistiksel olarak anlamlı bir azalma vardı (p= 0.002). Postoperatif kemoradyoterapi ameliyat edilen mide...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Effect of Chemoradiotherapy at Gastric Cancer on Pancreatic Enzymes and Pancreas Volume.

Kandaz¹

2017

UHOD

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“…Ahmadu-Suka et al [16] studied the tissue tolerance of the pancreas and duodenum to various doses of IORT and External Beam Radiotherapy in the beagle. To simulate the human treatment protocol 17.5-40 Gy IORT was delivered to the pancreas, and a Billroth II gastrojejunostomy was added.…”

Section: Discussionmentioning

confidence: 99%

The Reduced Canine Pancreas to Study the Effects of Intra-Operative Radiotherapy

Heijmans¹,

Mehta

Kleibeuker³

et al. 1993

Eur Surg Res

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A canine model is described to study the tolerance of the pancreas to intra-operative radiotherapy (IORT). The canine pancreas is a horseshoe-shaped organ. To create a homogeneous delivery of IORT to the whole pancreas surgical manipulation is necessary which may induce pancreatitis. A resection of the left and right lobes of the pancreas facilitates the delivery of IORT, reduces the risk of pancreatitis and will demonstrate, eventually, minimal functional changes in the exocrine and endocrine pancreas at an earlier stage. Sixteen beagles were used. Investigations before and after the reduction procedure were intravenous glucose tolerance tests, serum insulin levels, faecal fat excretion, blood chemistry tests and body weight. Eight weeks after the pancreas reduction 15 dogs underwent an IORT procedure in which 25, 30 or 35 Gy IORT was delivered to the pancreatic remnant. We conclude that the pancreas reduction technique used to study the effects of IORT to the canine pancreas is feasible without mortality or morbidity. Endocrine and exocrine pancreatic function remained normal with a minimal follow-up of 3 months.

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“…Ahmadu-Suka and colleagues treated the abdomen of dogs with a single fraction IORT dose up to 40 Gy followed by 50 Gy of EBRT two weeks after surgery [23]. Dogs treated with 17.5 or 25 Gy IORT disease (EQD 4 1.8 126 and 177, respectively) showed mucosal atrophy, but did not show any duodenal ulcers on autopsy 4.5 months after treatment.…”

Section: Canine Datamentioning

confidence: 99%

“…A total of 16 human studies and two canine studies were examined and are summarized in Tables 1 and 2 [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. Two studies included characteristic and outcome data for two separate cohorts and were therefore analyzed independently [19,21].…”

Section: Study Characteristicsmentioning

confidence: 99%

Late Gastrointestinal Tissue Effects After Hypofractionated Radiation Therapy of the Pancreas

Elhammali

Patel

Weinberg

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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Background: To consolidate literature reports of serious late gastrointestinal toxicities after hypofractionated radiation treatment of pancreatic cancer and attempt to derive normal tissue complication probability (NTCP) parameters using the Lyman-Kutcher-Burman model. Methods: Published reports of late grade 3 or greater gastrointestinal toxicity after hypofractionated treatment of pancreatic cancer were reviewed. The biologically equivalent dose in 1.8 Gy fractions was calculated using the EQD model. NTCP parameters were calculated using the LKB model assuming 1-5 % of the normal tissue volume was exposed to the prescription dose with α/β ratios of 3 or 4.

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Pathologic response of the pancreas and duodenum to experimental intraoperative irradiation

Cited by 55 publications

References 9 publications

The Effect of Chemoradiotherapy at Gastric Cancer on Pancreatic Enzymes and Pancreas Volume.

The Effect of Chemoradiotherapy at Gastric Cancer on Pancreatic Enzymes and Pancreas Volume.

The Reduced Canine Pancreas to Study the Effects of Intra-Operative Radiotherapy

Late Gastrointestinal Tissue Effects After Hypofractionated Radiation Therapy of the Pancreas

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