Ablative Five-Fraction Stereotactic Body Radiation Therapy for Inoperable Pancreatic Cancer Using Online MR-Guided Adaptation.
Ablative Five-Fraction Stereotactic Body Radiation Therapy for Inoperable Pancreatic Cancer Using Online MR-Guided Adaptation.
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DOI：
10.1016/j.adro.2020.06.010
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发表时间：
2021-01
影响因子：
2.3
通讯作者：
Kim H
中科院分区：
文献类型：
--
作者：
Hassanzadeh C;Rudra S;Bommireddy A;Hawkins WG;Wang-Gillam A;Fields RC;Cai B;Park J;Green O;Roach M;Henke L;Kim H
不能手术的胰腺腺癌患者的选择有限，传统的放化疗提供了适度的临床疗效，否则预后不良。胰腺癌的立体定向全身放射治疗受到接近危险器官（OAR）的限制。然而，立体定向磁共振引导的适应性放射治疗（SMART）已经显示出安全提供消融剂量的希望。我们试图通过每日表上适应的5分方法来证明SMART的好处。局部晚期，非转移性胰腺腺癌患者接受50 Gy的5次治疗（生物有效剂量10 - 100 Gy），规定目标为95%的计划靶体积覆盖率，95%的处方，优先考虑硬OAR限制。使用磁共振引导和表上再优化进行日常在线适应。评估患者预后、治疗因素和日常适应情况。2014 - 2019年，我院共44例患者接受SMART治疗。自诊断之日起的中位随访时间为16个月（范围6.7-51.6）。晚期毒性仅限于2例（4.6%）3级（胃肠道溃疡）和3例（6.8%）2级毒性（十二指肠穿孔、胃窦溃疡和胃出血）。肿瘤毗邻桨叶35例（79.5%），肿瘤侵袭桨叶5例（11.1%）。所有分数的93%进行了重新优化。中位总生存期为15.7个月（95%可信区间为10.2-21.2），1年和2年总生存率分别为68.2%和37.9%。1年局部控制率为84.3%。这是首次报道的使用50 Gy分5次治疗无法手术的胰腺癌的经验。SMART允许这种烧蚀剂量有希望的结果，同时尽量减少毒性。进一步的前瞻性试验评估疗效和安全性是必要的。
Patients with inoperable pancreatic adenocarcinoma have limited options, with traditional chemoradiation providing modest clinical benefit and an otherwise poor prognosis. Stereotactic body radiation therapy for pancreatic cancer is limited by proximity to organs-at-risk (OAR). However, stereotactic magnetic resonance-guided adaptive radiation therapy (SMART) has shown promise in delivering ablative doses safely. We sought to demonstrate the benefits of SMART using a 5-fraction approach with daily on-table adaptation. Patients with locally advanced, nonmetastatic pancreatic adenocarcinoma were treated with 50 Gy in 5 fractions (biologically effective dose10 100 Gy) with a prescribed goal of 95% planning target volume coverage by 95% of prescription, prioritizing hard OAR constraints. Daily online adaptation was performed using magnetic resonance-guidance and on-table reoptimization. Patient outcomes, treatment factors, and daily adaptation were evaluated. Forty-four patients were treated with SMART at our institution from 2014 to 2019. Median follow-up from date of diagnosis was 16 months (range, 6.7-51.6). Late toxicity was limited to 2 (4.6%) grade 3 (gastrointestinal ulcers) and 3 (6.8%) grade 2 toxicities (duodenal perforation, antral ulcer, and gastric bleed). Tumor abutted OARs in 35 patients (79.5%) and tumor invaded OARs in 5 patients (11.1%). Reoptimization was performed for 93% of all fractions. Median overall survival was 15.7 months (95% confidence interval, 10.2-21.2), while 1-year and 2-year overall survival rates were 68.2% and 37.9%, respectively. One-year local control was 84.3%. This is the first reported experience using 50 Gy in 5 fractions for inoperable pancreatic cancer. SMART allows this ablative dose with promising outcomes while minimizing toxicity. Additional prospective trials evaluating efficacy and safety are warranted.
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DOI：
10.1016/j.ijrobp.2015.12.003
发表时间：
2016-03-15
期刊：
International journal of radiation oncology, biology, physics
影响因子：
--
作者：
Krishnan S;Chadha AS;Suh Y;Chen HC;Rao A;Das P;Minsky BD;Mahmood U;Delclos ME;Sawakuchi GO;Beddar S;Katz MH;Fleming JB;Javle MM;Varadhachary GR;Wolff RA;Crane CH
通讯作者：
Crane CH
影响因子：
2
作者：
Crane CH
通讯作者：
Crane CH
影响因子：
4
作者：
Rudra, Soumon;Jiang, Naomi;Lee, Percy P.
通讯作者：
Lee, Percy P.
影响因子：
5.7
作者：
Henke, Lauren;Kashani, Rojano;Olsen, Jeffrey
通讯作者：
Olsen, Jeffrey
影响因子：
254.7
作者：
Siegel, Rebecca;Naishadham, Deepa;Jemal, Ahmedin
通讯作者：
Jemal, Ahmedin