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Pancreas sbrt

W Campbell, M Miften, T Schefter, K Goodman, B Jones
PURPOSE: Pancreatic SBRT is uniquely challenging due to both the erratic/unstable motion of the pancreas and the close proximity of the radiosensitive small bowel. Respiratory gating can mitigate this effect, but the irregularity of motion severely affects traditional phase-based gating. The purpose of this study was to analyze real-time motion data of pancreatic tumors to optimize the efficacy and accuracy of respiratory gating, with the overall goal of enabling dose escalated pancreatic SBRT...
June 2016: Medical Physics
Z Cheng, L Rosati, L Chen, S Robertson, J Moore, L Peng, O Mian, A Narang, A Hacker-Prietz, J Herman, T McNutt
PURPOSE: Stereotactic body radiation therapy (SBRT) may be used to increase surgery candidacy in borderline resectable (BRPC) and locally advanced (LAPC) pancreatic cancer. However, the planning target volume (PTV) may need to be limited to avoid toxicity when the gross tumor volume (GTV) is anatomically involved with surrounding critical structures. Our study aims to characterize the coverage of GTV and investigate the association between modified PTV and pathologic (pCR) or near pathologic (npCR) complete response rates determined from the surgical specimen...
June 2016: Medical Physics
H Chung, C Jeong, S Cho, B Cho
PURPOSE: Actual delivered dose of moving tumors treated with gated volumetric arc therapy (VMAT) may significantly differ from the planned dose assuming static target. In this study, we developed a method which reconstructs actual delivered dose distribution of moving target by taking into account both tumor motion and dynamic beam delivery of gated VMAT, and applied to abdominal tumors. METHODS: Fifteen dual-arc VMAT plans (Eclipse, Varian Medical Systems) for 5 lung, 5 pancreatic, and 5 liver cancer patients treated with gated VMAT stereotactic body radiotherapy (SBRT) were studied...
June 2016: Medical Physics
P Halvorsen, I Iftimia, K Hunter
PURPOSE: Our past practice for liver and pancreas SBRT consisted of free breathing (FB) with gated treatment delivery using a 30-70% phase window. We have recently adopted an assessment method leading to individualized motion management to minimize target motion. We present our results from 47 patients treated with this new approach. METHODS: We perform an initial patient coaching and assessment session in our conventional simulator suite to observe the motion of the implanted fiducials with FB anterior and lateral 20-second cine acquisitions...
June 2016: Medical Physics
K Mittauer, S Rosenberg, M Geurts, M Bassetti, I Chen, L Henke, J Olsen, R Kashani, A Wojcieszynski, P Harari, Z Labby, P Hill, B Paliwal, P Parikh, J Bayouth
PURPOSE: Dose limiting structures, such as the duodenum, render the treatment of pancreatic cancer challenging. In this multi-institutional study, we assess dosimetric differences caused by interfraction pancreas-to-duodenum motion using MR-IGRT to determine the potential impact of adaptive replanning. METHODS: Ten patients from two institutions undergoing MRI-guided radiotherapy with conventional fractionation (n=5) or SBRT (n=5) for pancreatic cancer were included...
June 2016: Medical Physics
T Bichay, A Mayville
PURPOSE: CyberKnife is a well-documented modality for SRS and SBRT treatments. Typical tumors are small and 1-5 fractions are usually used. We determined the feasibility of using CyberKnife, with an InCise multileaf collimator option, for larger tumors undergoing standard dose and fractionation. The intent was to understand the limitation of using this modality for other external beam radiation treatments. METHODS: Five tumors from different anatomical sites with volumes from 127...
June 2016: Medical Physics
N Pettersson, J Murphy, D Simpson, L Cervino
PURPOSE: The use of respiratory gating for management of breathing motion during stereotactic body radiation therapy (SBRT) relies on a consistent relationship between the breathing signal and the actual position of the internal target. This relationship was investigated in patients treated for pancreatic cancer. METHODS: Four patients with pancreatic cancer undergoing SBRT that had implanted fiducials in the tumor were included in this study. Treatment plans were generated based on the exhale phases (30-70%) from the pre-treatment 4DCT...
June 2016: Medical Physics
S Wang, D Zheng, R Ma, C Lin, X Zhu, Y Lei, C Enke, S Zhou
PURPOSE: Stereotactic body radiation therapy (SBRT) has been suggested to provide high rates of local control for locally advanced pancreatic cancer. However, the close proximity of highly radiosensitive normal tissues usually causes the labor-intensive planning process, and may impede further escalation of the prescription dose. The present study evaluates the potential of an automatic planning system as a dose escalation strategy. METHODS: Ten pancreatic cancer patients treated with SBRT were studied retrospectively...
June 2016: Medical Physics
Jonathan W Lischalk, Aidan Burke, Jessica Chew, Christen Elledge, Marie Gurka, John Marshall, Michael Pishvaian, Sean Collins, Keith Unger
BACKGROUND: The majority of patients with pancreatic cancer are diagnosed with metastatic disease at presentation. Nevertheless, local progression is responsible for up to 30% of deaths and can lead to significant morbidity. As a consequence, further exploration of effective methods of local control and palliation is essential. Stereotactic body radiation therapy (SBRT) is a widely utilized technique for the treatment of localized pancreatic cancer. Here, we report our experience with SBRT and chemotherapy for the local treatment of the metastatic patient population...
January 3, 2017: Journal of Gastrointestinal Cancer
Eric A Mellon, William H Jin, Jessica M Frakes, Barbara A Centeno, Tobin J Strom, Gregory M Springett, Mokenge P Malafa, Ravi Shridhar, Pamela J Hodul, Sarah E Hoffe
BACKGROUND: Neoadjuvant therapy response correlates with survival in multiple gastrointestinal malignancies. To potentially augment neoadjuvant response for pancreas adenocarcinoma, we intensified treatment with stereotactic body radiotherapy (SBRT) following multi-agent chemotherapy. Using this regimen, we analyzed whether the College of American Pathology (CAP) tumor regression grade (TRG) at pancreatectomy correlated with established response biomarkers and survival. MATERIALS AND METHODS: We identified borderline resectable (BRPC) and locally advanced (LAPC) pancreatic cancer patients treated according to our institutional clinical pathway who underwent surgical resection with reported TRG (n = 81, median follow-up after surgery 24...
November 25, 2016: Acta Oncologica
Kristofer Kainz, Douglas Prah, Ergun Ahunbay, X Allen Li
"Burst-mode" modulated arc therapy (hereafter referred to as "mARC") is a form of volumetric-modulated arc therapy characterized by variable gantry rotation speed, static MLCs while the radiation beam is on, and MLC repositioning while the beam is off. We present our clinical experience with the planning techniques and plan quality assurance measurements of mARC delivery. Clinical mARC plans for five representative cases (prostate, low-dose-rate brain, brain with partial-arc vertex fields, pancreas, and liver SBRT) were generated using a Monte Carlo-based treatment planning system...
September 8, 2016: Journal of Applied Clinical Medical Physics
W Yang, Z Fan, J Pang, Z Deng, X Bi, B A Fraass, H M Sandler, N N Nissen, D Li, R Tuli
No abstract text is available yet for this article.
October 1, 2016: International Journal of Radiation Oncology, Biology, Physics
Kamran A Ahmed, Jimmy J Caudell, Ghassan El-Haddad, Anders E Berglund, Eric A Welsh, Binglin Yue, Sarah E Hoffe, Arash O Naghavi, Yazan A Abuodeh, Jessica M Frakes, Steven A Eschrich, Javier F Torres-Roca
PURPOSE/OBJECTIVES: Evidence from the management of oligometastases with stereotactic body radiation therapy (SBRT) reveals differences in outcomes based on primary histology. We have previously identified a multigene expression index for tumor radiosensitivity (RSI) with validation in multiple independent cohorts. In this study, we assessed RSI in liver metastases and assessed our clinical outcomes after SBRT based on primary histology. METHODS AND MATERIALS: Patients were identified from our prospective, observational protocol...
August 1, 2016: International Journal of Radiation Oncology, Biology, Physics
Samuel K Kim, Cheng-Chia Wu, David P Horowitz
With recent advances in imaging modalities and radiation therapy, stereotactic body radiotherapy (SBRT) has allowed for the delivery of high doses of radiation with accuracy and precision. As such, SBRT has generated favorable results in the treatment of several cancers. Although the role of radiation has been controversial for the treatment of pancreatic ductal adenocarcinoma (PDAC) due to rather lackluster results in clinical trials, SBRT may offer improved outcomes, enhance the quality of life, and aid in palliative care settings for PDAC patients...
June 2016: Journal of Gastrointestinal Oncology
Sten Myrehaug, Arjun Sahgal, Suzanne M Russo, Simon S Lo, Lauren M Rosati, Nina A Mayr, Michael Lock, William Small, Jennifer A Dorth, Rodney J Ellis, Bin S Teh, Joseph M Herman
Despite advances in surgical, medical, and radiation therapy for pancreatic cancer, the prognosis remains poor. At this time, the only chance for long-term survival is surgical resection. More challenging is the optimal management of unresectable locally advanced pancreatic cancer, which has historically been treated with concurrent chemoradiation or chemotherapy alone. However, the survival and local control benefit of conventional radiotherapy in addition to chemotherapy was unclear. More recently, stereotactic body radiotherapy (SBRT) is emerging as a viable approach to maximizing local tumor control with a tolerable side effect profile...
May 2016: Expert Review of Anticancer Therapy
Nergiz Dagoglu, Mark Callery, James Moser, Jennifer Tseng, Tara Kent, Andrea Bullock, Rebecca Miksad, Joseph D Mancias, Anand Mahadevan
OBJECTIVES: After adjuvant or definitive radiation for pancreas cancer, there are limited conventional treatment options for recurrent pancreas cancer. We explored the role of (Stereotactic Body Radiotherapy) SBRT for reirradiation of recurrent pancreas Cancer. METHODS: This is a retrospective study of patients reirradiated with SBRT for recurrent pancreas cancer. All patients were deemed unresectable and treated with systemic therapy. Fiducial gold markers were used...
2016: Journal of Cancer
Qichun Wei, Wei Yu, Lauren M Rosati, Joseph M Herman
Pancreatic cancer (PCA) is one of the most aggressive tumors with few effective treatment modalities. It is the 4th and 7th leading cause of cancer death in the United States and China, respectively. At the time of diagnosis, only 20% of cases present with a resectable tumor, and about 40% with a locally advanced tumor that is considered unresectable. Even resected patients still have a poor prognosis, with an incidence of local recurrence ranging from 20% to 60%. It is also reported that up to 30% of PCA patients die from locally obstructive disease with few or no distant metastases...
August 2015: Chinese Journal of Cancer Research, Chung-kuo Yen Cheng Yen Chiu
Yongbao Li, Jeremy D P Hoisak, Nan Li, Carrie Jiang, Zhen Tian, Quentin Gautier, Masoud Zarepisheh, Zhaoxia Wu, Yaqiang Liu, Xun Jia, Jona Hattangadi-Gluth, Loren K Mell, Steve Jiang, James D Murphy
Stereotactic body radiotherapy (SBRT) shows promise in unresectable pancreatic cancer, though this treatment modality has high rates of normal tissue toxicity. This study explores the dosimetric utility of daily adaptive re-planning with pancreas SBRT. We used a previously developed supercomputing online re-planning environment (SCORE) to re-plan 10 patients with pancreas SBRT. Tumor and normal tissue contours were deformed from treatment planning computed tomographies (CTs) and transferred to daily cone-beam CT (CBCT) scans before re-optimizing each daily treatment plan...
2015: Medical Dosimetry: Official Journal of the American Association of Medical Dosimetrists
Zhi-Yong Yuan, Mao-Bin Meng, Chun-Lei Liu, Huan-Huan Wang, Chao Jiang, Yong-Chun Song, Hong-Qing Zhuang, Dong Yang, Jing-Sheng Wang, Wang Wei, Feng-Tong Li, Lu-Jun Zhao, Ping Wang
The aim of this study was to evaluate the efficacy and toxicity of stereotactic body radiation therapy (SBRT) in the treatment of patients with liver metastases. Between August 2006 and July 2011, patients with 1-4 liver metastases were enrolled and treated with SBRT using the CyberKnife(®) system at Tianjin Medical University Cancer Institute and Hospital. The metastases were from different primary tumors, with a maximum tumor diameter of less than 6 cm. The primary endpoint was local control. Secondary endpoints were overall survival, progression-free survival, distant progression-free survival, and adverse events...
2014: OncoTargets and Therapy
Wensha Yang, Benedick A Fraass, Robert Reznik, Nicholas Nissen, Simon Lo, Laith H Jamil, Kapil Gupta, Howard Sandler, Richard Tuli
PURPOSE: To evaluate use of breath-hold CTs and implanted fiducials for definition of the internal target volume (ITV) margin for upper abdominal stereotactic body radiation therapy (SBRT). To study the statistics of inter- and intra-fractional motion information. METHODS AND MATERIALS: 11 patients treated with SBRT for locally advanced pancreatic cancer (LAPC) or liver cancer were included in the study. Patients underwent fiducial implantation, free-breathing CT and breath-hold CTs at end inhalation/exhalation...
January 9, 2014: Radiation Oncology
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