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Pancreatic sbrt

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
Julian C Hong, Brian G Czito, Christopher G Willett, Manisha Palta
Pancreatic cancer is a formidable malignancy with poor outcomes. The majority of patients are unable to undergo resection, which remains the only potentially curative treatment option. The management of locally advanced (unresectable) pancreatic cancer is controversial; however, treatment with either chemotherapy or chemoradiation is associated with high rates of local tumor progression and metastases development, resulting in low survival rates. An emerging local modality is stereotactic body radiation therapy (SBRT), which uses image-guided, conformal, high-dose radiation...
2016: OncoTargets and Therapy
Cédric Panje, Nikolaus Andratschke, Thomas B Brunner, Maximilian Niyazi, Matthias Guckenberger
PURPOSE: This report of the Working Group on Stereotactic Radiotherapy of the German Society of Radiation Oncology (DEGRO) aims to provide a literature review and practice recommendations for stereotactic body radiotherapy (SBRT) of primary renal cell cancer and primary pancreatic cancer. METHODS: A literature search on SBRT for both renal cancer and pancreatic cancer was performed with focus on prospective trials and technical aspects for clinical implementation...
October 24, 2016: Strahlentherapie und Onkologie: Organ der Deutschen Röntgengesellschaft ... [et Al]
C S Goldsmith, L Rice, A Edwards, P Price, T Cross, S A Loughlin, I R Cowley, N Plowman
No abstract text is available yet for this article.
October 1, 2016: International Journal of Radiation Oncology, Biology, Physics
A L Pearson, W Jin, E A Mellon, J M Frakes, T Strom, G M Springett, R Kim, A Mahipal, P J Hodul, J M Pimiento, R Shridhar, M P Malafa, S E Hoffe
No abstract text is available yet for this article.
October 1, 2016: International Journal of Radiation Oncology, Biology, Physics
Eric A Mellon, Tobin J Strom, Sarah E Hoffe, Jessica M Frakes, Gregory M Springett, Pamela J Hodul, Mokenge P Malafa, Michael D Chuong, Ravi Shridhar
BACKGROUND: Neoadjuvant multi-agent chemotherapy and stereotactic body radiation therapy (SBRT) are utilized to increase margin negative (R0) resection rates in borderline resectable pancreatic cancer (BRPC) or locally advanced pancreatic cancer (LAPC) patients. Concerns persist that these neoadjuvant therapies may worsen perioperative morbidities and mortality. METHODS: Upfront resection patients (n=241) underwent resection without neoadjuvant treatment for resectable disease...
August 2016: Journal of Gastrointestinal Oncology
Amar Kishan, Percy Lee
We read with great interest the results of the LAP07 study comparing capecitabine-based chemoradiation with gemcitabine-based therapy for non-progressive locally advanced pancreatic cancer (LAPC), following four months of gemcitabine-based therapy. The results, consistent with previous data, showed that standard chemoradiation improves local control (LC) but not overall survival. In this brief editorial, we emphasize that LC may still be very important in LAPC, as up to 30% of patients with LAPC may die from locally progressive disease...
July 13, 2016: Curēus
Avani D Rao, Elizabeth A Sugar, Daniel T Chang, Karyn A Goodman, Amy Hacker-Prietz, Lauren M Rosati, Laurie Columbo, Eileen O'Reilly, George A Fisher, Lei Zheng, Jonathan S Pai, Mary E Griffith, Daniel A Laheru, Christine A Iacobuzio-Donahue, Christopher L Wolfgang, Albert Koong, Joseph M Herman
PURPOSE: We previously reported clinical outcomes and physician-reported toxicity of gemcitabine and hypofractionated stereotactic body radiation therapy (SBRT) in locally advanced pancreatic cancer (LAPC). Here we prospectively investigate the impact of gemcitabine and SBRT on patient-reported quality of life (QoL). METHODS AND MATERIALS: Forty-nine LAPC patients received 33 Gy SBRT (6.6 Gy daily fractions) upfront or after ≤3 doses of gemcitabine (1000 mg/m(2)) followed by gemcitabine until progression...
May 25, 2016: Practical Radiation Oncology
Yi Cui, Jie Song, Erqi Pollom, Muthuraman Alagappan, Hiroki Shirato, Daniel T Chang, Albert C Koong, Ruijiang Li
PURPOSE: To identify prognostic biomarkers in pancreatic cancer using high-throughput quantitative image analysis. METHODS AND MATERIALS: In this institutional review board-approved study, we retrospectively analyzed images and outcomes for 139 locally advanced pancreatic cancer patients treated with stereotactic body radiation therapy (SBRT). The overall population was split into a training cohort (n=90) and a validation cohort (n=49) according to the time of treatment...
September 1, 2016: International Journal of Radiation Oncology, Biology, Physics
Walid L Shaib, Natalyn Hawk, Richard J Cassidy, Zhengjia Chen, Chao Zhang, Edith Brutcher, David Kooby, Shishir K Maithel, Juan M Sarmiento, Jerome Landry, Bassel F El-Rayes
PURPOSE: A challenge in borderline resectable pancreatic cancer (BRPC) management is the high rate of positive posterior margins (PM). Stereotactic body radiation therapy (SBRT) allows for higher radiation delivery dose with conformity. This study evaluated the maximal tolerated dose with a dose escalation plan level up to 45 Gy using SBRT in BRPC. METHODS AND MATERIALS: A single-institution, 3 + 3 phase 1 clinical trial design was used to evaluate 4 dose levels of SBRT delivered in 3 fractions to the planning target volume (PTV) with a simultaneous in-field boost (SIB) to the PM...
October 1, 2016: International Journal of Radiation Oncology, Biology, Physics
Karyn A Goodman
The role of radiation therapy in the management of pancreatic cancer represents an area of some controversy. However, local disease progression remains a significant cause of morbidity and even mortality for patients with this disease. Stereotactic body radiotherapy (SBRT) is an emerging treatment option for pancreatic cancer, primarily for locally advanced (unresectable) disease as it can provide a therapeutic benefit with significant advantages for patients' quality of life over standard conventional chemoradiation...
July 2016: Cancer Journal
Xian-Liang Zeng, Huan-Huan Wang, Mao-Bin Meng, Zhi-Qiang Wu, Yong-Chun Song, Hong-Qing Zhuang, Dong Qian, Feng-Tong Li, Lu-Jun Zhao, Zhi-Yong Yuan, Ping Wang
BACKGROUND AND AIM: The aim of this study is to evaluate the efficacy and safety of stereotactic body radiation therapy (SBRT) using CyberKnife in the treatment of patients with recurrent pancreatic adenocarcinoma at the abdominal lymph node or stump after surgery. PATIENTS AND METHODS: Between October 1, 2006 and May 1, 2015, patients with recurrent pancreatic adenocarcinoma at the abdominal lymph node or stump after surgery were enrolled and treated with SBRT at our hospital...
2016: OncoTargets and Therapy
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
Berardino De Bari, Laetitia Porta, Rosario Mazzola, Filippo Alongi, Anna Dorothea Wagner, Markus Schäfer, Jean Bourhis, Mahmut Ozsahin
The role of neoadjuvant and definitive radiotherapy combined or not to chemotherapy in the therapeutic approach to pancreatic cancer has not been yet elucidated. There is some evidence in favour of neoadjuvant local and/or systemic approaches that enable surgical resection in patients initially considered to be "borderline resectable". Nevertheless, most of these studies have been conducted using schedules of radiotherapy (treatment volumes, total doses, dose/fraction) that are nowadays considered not efficient enough and/or too toxic...
July 2016: Critical Reviews in Oncology/hematology
Manuela Burghelea, Dirk Verellen, Kenneth Poels, Cecilia Hung, Mitsuhiro Nakamura, Jennifer Dhont, Thierry Gevaert, Robbe Van den Begin, Christine Collen, Yukinori Matsuo, Takahiro Kishi, Viorica Simon, Masahiro Hiraoka, Mark de Ridder
BACKGROUND: Dynamic Wave Arc (DWA) is a clinical approach designed to maximize the versatility of Vero SBRT system by synchronizing the gantry-ring noncoplanar movement with D-MLC optimization. The purpose of this study was to verify the delivery accuracy of DWA approach and to evaluate the potential dosimetric benefits. METHODS: DWA is an extended form of VMAT with a continuous varying ring position. The main difference in the optimization modules of VMAT and DWA is during the angular spacing, where the DWA algorithm does not consider the gantry spacing, but only the Euclidian norm of the ring and gantry angle...
2016: Radiation Oncology
(no author information available yet)
No abstract text is available yet for this article.
April 2016: Oncology (Williston Park, NY)
Michael D Chuong, Jessica M Frakes, Nicholas Figura, Sarah E Hoffe, Ravi Shridhar, Eric A Mellon, Pamela J Hodul, Mokenge P Malafa, Gregory M Springett, Barbara A Centeno
BACKGROUND: While clinical outcomes following induction chemotherapy and stereotactic body radiation therapy (SBRT) have been reported for borderline resectable pancreatic cancer (BRPC) patients, pathologic response has not previously been described. METHODS: This single-institution retrospective review evaluated BRPC patients who completed induction gemcitabine-based chemotherapy followed by SBRT and surgical resection. Each surgical specimen was assigned two tumor regression grades (TRG), one using the College of American Pathologists (CAP) criteria and one using the MD Anderson Cancer Center (MDACC) criteria...
April 2016: Journal of Gastrointestinal Oncology
Henry W C Leung, Agnes L F Chan, Chih-Hsin Muo
PURPOSE: The purpose of this study was to evaluate the cost-effectiveness of gemcitabine plus modern radiotherapy versus gemcitabine alone in the treatment of locally advanced pancreatic cancer in Taiwan. METHODS: A Markov decision-analytic model was performed to compare the cost-effectiveness of 3 treatment regimens; gemcitabine alone (gem-alone), gemcitabine plus intensity-modulated radiotherapy (gem-IMRT), and gemcitabine plus stereotactic body radiotherapy (gem-SBRT)...
May 2016: Clinical Therapeutics
Christopher H Crane
The role of radiation in locally advanced unresectable pancreatic cancer (LAPC) is controversial. Randomized trials evaluating standard doses of chemoradiation have not shown a significant benefit from the use of consolidative radiation. Results from non-randomized studies of 3-5-fraction stereotactic body radiotherapy (SBRT) have been similar to standard chemoradiation, but with less toxicity and a shorter treatment time. Doses of SBRT have been reduced to subablative levels for the sake of tolerability. The benefit of both options is unclear...
August 2016: Journal of Radiation Research
Christy Goldsmith, Patricia Price, Timothy Cross, Sheila Loughlin, Ian Cowley, Nicholas Plowman
Pancreatic carcinoma is an aggressive disease and radiotherapy treatment delivery to the primary tumor is constrained by the anatomical close location of the duodenum, stomach, and small bowel. Duodenal dose tolerance for radiosurgery in 2-5 fractions has been largely unknown. The literature was surveyed for quantitative models of risk in 1-5 fractions and we analyzed our own patient population of 44 patients with unresectable pancreatic tumors who received 3 or 5 fractions of stereotactic body radiotherapy (SBRT) between March 2009 and March 2013...
April 2016: Seminars in Radiation Oncology
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