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Pancreatic sbrt

Yu Zhang, Xiaofei Zhu, Ri Liu, Xianglian Wang, Gaofeng Sun, Jiaqi Song, Jianping Lu, Huojun Zhang
OBJECTIVE: To identify whether the combination of pre-treatment radiological and clinical factors can predict the overall survival (OS) in patients with locally advanced pancreatic cancer (LAPC) treated with stereotactic body radiation and sequential S-1 (a prodrug of 5-FU combined with two modulators) therapy with improved accuracy compared with that of established clinical and radiologic risk models. METHODS: Patients admitted with LAPC underwent diffusion weighted imaging (DWI) scan at 3...
February 15, 2018: Translational Oncology
Brandon C Chapman, Ana Gleisner, Devin Rigg, Cheryl Meguid, Karyn Goodman, Brian Brauer, Csaba Gajdos, Richard D Schulick, Barish H Edil, Martin D McCarter
BACKGROUND AND OBJECTIVES: To compare outcomes in patients receiving neoadjuvant stereotactic body radiation therapy (SBRT) with those receiving intensity-modulated radiation therapy (IMRT) for pancreatic adenocarcinoma. METHODS: We analyzed patients receiving neoadjuvant SBRT for borderline resectable (BRPC) and locally advanced pancreatic cancer (LAPC) (2012-2016). Differences in baseline characteristics, perioperative outcomes, progression-free survival (PFS), and overall survival (OS) were compared...
February 15, 2018: Journal of Surgical Oncology
Yangsen Cao, Xiaofei Zhu, Xiaoping Ju, Yongming Liu, Chunshan Yu, Yongjian Sun, Zhitao Dai, Xueling Guo, Huojun Zhang
BACKGROUND: To identify optimization of dose distributions of target volumes and decrease of radiation doses to normal tissues during stereotactic body radiation therapy (SBRT) for pancreatic cancer with dose-limiting auto-shells. METHODS: With the same prescription dose, dose constraints of normal organs and calculation algorithm, treatment plans of each eligible patient were re-generated with 3 shells, 5 shells and 7 shells, respectively. The prescription isodose line and beam number of each patient in 3-shell, 5-shell and 7-shell plan remained the same...
January 22, 2018: Radiation Oncology
Ivaylo B Mihaylov, Eric A Mellon, Raphael Yechieli, Lorraine Portelance
PURPOSE: Inverse planning is trial-and-error iterative process. This work introduces a fully automated inverse optimization approach, where the treatment plan is closely tailored to the unique patient anatomy. The auto-optimization is applied to pancreatic stereotactic body radiotherapy (SBRT). MATERIALS AND METHODS: The automation is based on stepwise reduction of dose-volume histograms (DVHs). Five uniformly spaced points, from 1% to 70% of the organ at risk (OAR) volumes, are used...
2018: PloS One
Jim Zhong, Jeffrey Switchenko, Madhusmita Behera, David Kooby, Shishir K Maithel, Mark W McDonald, Jolinta Y Lin, Richard J Cassidy, Bassel El-Rayes, Jerome Landry, Pretesh R Patel
BACKGROUND: The LAP07 randomized trial calls into question the role of radiation therapy (RT) in the modern treatment of locally advanced pancreatic cancer (LAPC). However, advances in chemotherapy and RT limit application of the LAP07 results to current clinical practice. Here we utilize the National Cancer Database (NCDB) to evaluate the effects of RT in patients receiving chemotherapy for LAPC. METHODS: Using the NCDB, patients with American Joint Committee on Cancer (AJCC) clinical stage T2-4, N0-1, M0 adenocarcinoma of the pancreas from 2004 to 2014 were analyzed...
April 2018: Annals of Surgical Oncology
Raphaël Jumeau, Guila Delouya, David Roberge, David Donath, Dominic Béliveau-Nadeau, Marie-Pierre Campeau
INTRODUCTION: Despite advances in treatment, notably in systemic therapy, the prognosis of pancreatic adenocarcinoma (PADC) remains dismal. Stereotactic body radiotherapy (SBRT) is an emerging tool in the complex management of PADC. We review outcomes of SBRT for PADC at our institution. METHODS: We reviewed patients treated with SBRT for either unresectable PADC or locally recurrent PADC after surgery. Treatment was delivered using a robotic radiosurgery system with respiratory tracking...
December 21, 2017: Digestive and Liver Disease
Leila Tchelebi, Nicholas Zaorsky, Heath Mackley
The role of external beam radiation therapy (EBRT) in the management of upper gastrointestinal malignancies is constantly evolving. As radiation therapy techniques improve and are able to deliver more ablative doses of radiotherapy while sparing healthy tissue, radiation can be applied to a wider range of clinical scenarios. Stereotactic body radiation therapy (SBRT) allows a high dose of radiation to be delivered to a highly conformal treatment volume in a short amount of time. Another potential advantage of SBRT is its ability to increase tumor immunogenicity, while also having less of an immunosuppressive effect on the patient, as compared to conventionally fractionated radiation therapy...
January 3, 2018: Biomedicines
Lauren M Rosati, Megan N Kummerlowe, Justin Poling, Amy Hacker-Prietz, Amol K Narang, Eun J Shin, Dung T Le, Elliot K Fishman, Ralph H Hruban, Stephen C Yang, Matthew J Weiss, Joseph M Herman
Purpose: We report a very unique case of an esophageal metastasis from a pancreatic ductal adenocarcinoma (PDAC) primary. Methods: After obtaining consent from the patient, all relevant records of the case were obtained and retrospectively reviewed. Results: At presentation, the patient was diagnosed with synchronous pancreatic and esophageal cancer. He received six months of neoadjuvant therapy including FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin) and stereotactic body radiation therapy (SBRT) to the pancreatic tumor followed by a combined pancreaticoduodenectomy and Ivor Lewis esophagectomy...
November 21, 2017: Oncotarget
Christopher H Crane, Eileen M O'Reilly
Standard palliative doses of radiation for locally advanced unresectable pancreatic cancer have had minimal to no impact on survival. Randomized trials evaluating these palliative doses have not shown a significant survival benefit with the use of radiation as consolidation after chemotherapy. Results from nonrandomized studies of 3- to 5-fraction low-dose stereotactic radiation (SBRT) have likewise had a minimal impact, but with less toxicity and a shorter treatment time. Doses of SBRT have been reduced to half the level that is necessary (biological equivalent dose, BED of 53 Gy) to achieve tumor ablation in the treatment of other solid tumors (100 Gy BED) to protect the gastrointestinal (GI) tract...
November 2017: Cancer Journal
Philip Anthony Sutera, Mark E Bernard, Beant S Gill, Kamran K Harper, Kimmen Quan, Nathan Bahary, Steven A Burton, Herbert Zeh, Dwight E Heron
Background/introduction: Early reports of stereotactic body radiation therapy (SBRT) for pancreatic ductal adenocarcinoma (PDAC) used single fraction, but eventually shifted to multifraction regimens. We conducted a single institution review of our patients treated with single- or multifraction SBRT to determine whether any outcome differences existed. Methods and materials: Patients treated with SBRT in any setting for PDAC at our facility were included, from 2004 to 2014...
2017: Frontiers in Oncology
Michael J Dohopolski, Scott M Glaser, John A Vargo, Goundappa K Balasubramani, Sushil Beriwal
Background: Unresectable pancreatic cancer remains a challenging disease to treat. Stereotactic body radiotherapy (SBRT) allows for a higher biologically equivalent dose in an abbreviated course more convenient for patients and the integration of systemic therapy. We sought to investigate utilization trends and survival outcomes for patients treated with pancreatic SBRT versus conventionally fractionated radiotherapy (CFRT). Methods: We engaged the National Cancer Database (NCDB) from 1998-2012 and identified locally-advanced unresectable patients with histologically confirmed, non-metastatic, pancreatic adenocarcinoma who received radiotherapy...
October 2017: Journal of Gastrointestinal Oncology
Avani D Rao, Yufei Liu, Rie von Eyben, Charles C Hsu, Chen Hu, Lauren M Rosati, Arti Parekh, Kendall Ng, Amy Hacker-Prietz, Lei Zheng, Timothy M Pawlik, Daniel A Laheru, Elizabeth M Jaffee, Matthew J Weiss, Dung T Le, Ralph H Hruban, Ana De Jesus-Acosta, Christopher L Wolfgang, Amol K Narang, Daniel T Chang, Albert C Koong, Joseph M Herman
PURPOSE: To explore seromarker levels for associations with outcomes in locally advanced pancreatic cancer (LAPC) patients who received chemotherapy and stereotactic body radiation therapy (SBRT). METHODS AND MATERIALS: Serum from LAPC patients in 2 prospective trials of hypofractionated SBRT (5-6.6 Gy × 5) was collected before SBRT. Proximity ligation assay quantified the expression levels of 36 pancreatic cancer-specific candidate seromarkers: Axl, BMP2, CA 125, CA 19-9, CEA, CXCL-1/6/9/10, EGFR, Gas6, Her2, IGF-2, IGFBP-2/3/7, IL-6/6Ra/7/8/12, mesothelin, MMP-1/2/3/7, osteopontin, PDGFRa, PDK1, PF4, RegIV, SPARC, TGF-β, VEGF-A/D, and YKL40...
October 12, 2017: International Journal of Radiation Oncology, Biology, Physics
Grainne M O Kane, Jennifer J Knox
Pancreatic adenocarcinoma (PDAC) remains a highly fatal disease that is increasing in incidence. PDAC can be classified according to resectability status with 3 nonmetastatic groups defined: resectable, borderline resectable, and locally advanced PDAC (LAPC). Delineating these subtypes is important with the optimal treatment approach dictated by high-quality CT imaging and multidisciplinary team discussion. Patients with LAPC are thought unresectable and are therefore rarely cured. In these patients, chemotherapy remains the mainstay of treatment...
November 16, 2017: Current Problems in Cancer
Konstantina Karava, Stefanie Ehrbar, Oliver Riesterer, Johannes Roesch, Stefan Glatz, Stephan Klöck, Matthias Guckenberger, Stephanie Tanadini-Lang
BACKGROUND: Radiotherapy for pancreatic cancer has two major challenges: (I) the tumor is adjacent to several critical organs and, (II) the mobility of both, the tumor and its surrounding organs at risk (OARs). A treatment planning study simulating stereotactic body radiation therapy (SBRT) for pancreatic tumors with both the internal target volume (ITV) concept and the tumor tracking approach was performed. The two respiratory motion-management techniques were compared in terms of doses to the target volume and organs at risk...
November 9, 2017: Radiation Oncology
John F Ryan, Vincent P Groot, Lauren M Rosati, Amy Hacker-Prietz, Amol K Narang, Todd R McNutt, Juan F Jackson, Dung T Le, Elizabeth M Jaffee, Lei Zheng, Daniel A Laheru, Jin He, Timothy M Pawlik, Matthew J Weiss, Christopher L Wolfgang, Joseph M Herman
BACKGROUND: A standardized treatment regimen for unresectable isolated local recurrence (ILR) of pancreatic ductal adenocarcinoma has not been established. This study evaluated the outcomes for patients with ILR who underwent stereotactic body radiation therapy (SBRT). METHODS: The records of patients with ILR who underwent SBRT between 2010 and 2016 were retrospectively reviewed. Symptom palliation and treatment-related toxicity were recorded. Associations between patient or treatment characteristics and overall survival (OS), progression-free survival (PFS), and local progression-free survival (LPFS) were assessed...
January 2018: Annals of Surgical Oncology
Warren G Campbell, Moyed Miften, Lindsey Olsen, Priscilla Stumpf, Tracey Schefter, Karyn A Goodman, Bernard L Jones
PURPOSE: Stereotactic body radiation therapy (SBRT) for pancreatic cancer requires a skillful approach to deliver ablative doses to the tumor while limiting dose to the highly sensitive duodenum, stomach, and small bowel. Here, we develop knowledge-based artificial neural network dose models (ANN-DMs) to predict dose distributions that would be approved by experienced physicians. METHODS: Arc-based SBRT treatment plans for 43 pancreatic cancer patients were planned, delivering 30-33 Gy in five fractions...
October 10, 2017: Medical Physics
Theodore S Hong, Jennifer Y Wo, Darrell R Borger, Beow Y Yeap, Erin I McDonnell, Henning Willers, Lawrence S Blaszkowsky, Eunice L Kwak, Jill N Allen, Jeffrey W Clark, Shyam Tanguturi, Lipika Goyal, Janet E Murphy, John A Wolfgang, Lorraine C Drapek, Ronald S Arellano, Harvey J Mamon, John T Mullen, Kenneth K Tanabe, Cristina R Ferrone, David P Ryan, A John Iafrate, Thomas F DeLaney, Andrew X Zhu
Background: We evaluated the efficacy and safety of risk-adapted, proton-based stereotactic body radiation therapy (SBRT) for liver metastases from solid tumors. Methods: This single-arm phase II single institutional study (NCT01239381) included patients with limited extrahepatic disease, 800 mL or greater of uninvolved liver, and no cirrhosis or Child-Pugh A, who had received proton-based SBRT to one to four liver metastases from solid tumors. Treatment comprised 30 to 50 Gray equivalent (GyE) in five fractions based on the effective volume of liver irradiated...
September 1, 2017: Journal of the National Cancer Institute
Avani D Rao, Ziwei Feng, Eun Ji Shin, Jin He, Kevin M Waters, Stephanie Coquia, Robert DeJong, Lauren M Rosati, Lin Su, Dengwang Li, Juan Jackson, Stephen Clark, Jeffrey Schultz, Danielle Hutchings, Seong-Hun Kim, Ralph H Hruban, Theodore L DeWeese, John Wong, Amol Narang, Joseph M Herman, Kai Ding
PURPOSE: We assessed the feasibility and theoretical dosimetric advantages of an injectable hydrogel to increase the space between the head of the pancreas (HOP) and duodenum in a human cadaveric model. METHODS AND MATERIALS: Using 3 human cadaveric specimens, an absorbable radiopaque hydrogel was injected between the HOP and duodenum by way of open laparotomy in 1 case and endoscopic ultrasound (EUS) guidance in 2 cases. The cadavers were subsequently imaged using computed tomography and dissected for histologic confirmation of hydrogel placement...
December 1, 2017: International Journal of Radiation Oncology, Biology, Physics
Guangyin Wu, Vivek Verma, Matthias F Haefner, Sicong Li, Chi Lin
BACKGROUND: This is the first known report evaluating the feasibility of substituting oral contrast with water in efforts to delineate the duodenum for pancreatic stereotactic body radiotherapy (SBRT). METHODS: From January 2015 to August 2016, 13 patients were simulated after ingestion of 8 ounces of water approximately 15-20 min prior to their simulation scan. We examined the feasibility of contouring the duodenum thereafter, and measured the duodenal volume as well as its variation...
August 2017: Journal of Gastrointestinal Oncology
Amanda J Koong, Diego A S Toesca, Rie von Eyben, Erqi L Pollom, Daniel T Chang
PURPOSE: Locally recurrent pancreatic cancer after prior radiotherapy is a therapeutic challenge with limited treatment options. This study examines the safety and efficacy of stereotactic body radiation therapy (SBRT) for locally recurrent pancreatic adenocarcinoma after prior conventional fractionation radiotherapy (CRT). METHODS AND MATERIALS: Outcomes from all patients treated with SBRT for locally recurrent pancreatic adenocarcinoma after prior CRT at our institution were reviewed...
January 2017: Advances in Radiation Oncology
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