Ablative 5-Fraction Stereotactic Magnetic Resonance-Guided Radiation Therapy With On-Table Adaptive Replanning and Elective Nodal Irradiation for Inoperable Pancreas Cancer
Ablative 5-Fraction Stereotactic Magnetic Resonance-Guided Radiation Therapy With On-Table Adaptive Replanning and Elective Nodal Irradiation for Inoperable Pancreas Cancer
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DOI：
10.1016/j.prro.2020.09.005
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发表时间：
2021-03-03
影响因子：
3.3
通讯作者：
Gutierrez, Alonso N.
中科院分区：
文献类型：
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作者：
Chuong, Michael D.;Bryant, John;Gutierrez, Alonso N.
目的：使用立体定向全身放射治疗的放射治疗剂量递增可以显着改善无法手术的胰腺癌患者的局部控制（LC）和总生存期（OS）。然而，由于存在对邻近正常器官造成严重损伤的风险，不能常规提供消融剂量。立体定向磁共振 (MR) 引导的适应性放射治疗 (SMART) 代表了一种新技术，可以实现安全地提供消融剂量并改善长期结果。 方法和材料：我们对 35 名连续接受 SMART 治疗的胰腺癌患者进行了单一机构回顾性分析，这些患者在 MR 直线加速器上吸气中期屏气。大多数人患有局部晚期疾病 (80%)，并在立体定向全身放射治疗前接受了中位诱导化疗 (91.4%) 3.9 个月。所有患者均按连续几天分 5 次给药，中位总剂量为 50 Gy (BED10 100 Gy(10))，通常热点为 120% 至 130%。 20 名患者（57.1%）接受了选择性淋巴结照射。没有患者放置基准标记，所有患者均接受连续分次内 MR 可视化和自动光束触发治疗。结果：SMART 中位随访时间为 10.3 个月，急性 (2.9%) 和晚期 (2.9%) 3 级毒性并不常见。一年 LC、无远处转移生存率、无进展生存率、病因特异性生存率和 OS 分别为 87.8%、63.1%、52.4%、77.6% 和 58.9%。 结论：据我们所知，这是在 MR 直线加速器上进行 5 分次胰腺 SMART 的第一份报告。我们观察到与治疗相关的严重毒性极小，并鼓励早期 LC。有必要对剂量强化 SMART 的可行性和长期临床结果进行前瞻性确认。 (C) 2020 作者。由爱思唯尔公司出版
Purpose: Radiation therapy dose escalation using stereotactic body radiation therapy may significantly improve both local control (LC) and overall survival (OS) for patients with inoperable pancreas cancer. However, ablative dose cannot be routinely offered because of the risk of causing severe injury to adjacent normal organs. Stereotactic magnetic resonance (MR)-guided adaptive radiation therapy (SMART) represents a novel technique that may achieve safe delivery of ablative dose and improve long-term outcomes.Methods and Materials: We performed a single institution retrospective analysis of 35 consecutive pancreatic cancer patients treated with SMART in mid-inspiration breath hold on an MR-linear accelerator. Most had locally advanced disease (80%) and received induction chemotherapy (91.4%) for a median 3.9 months before stereotactic body radiation therapy. All were prescribed 5 fractions delivered in consecutive days to a median total dose of 50 Gy (BED10 100 Gy(10)), typically with a 120% to 130% hotspot. Elective nodal irradiation was delivered to 20 (57.1%) patients. No patient had fiducial markers placed and all were treated with continuous intrafraction MR visualization and automatic beam triggering.Results: With median follow-up of 10.3 months from SMART, acute (2.9%) and late (2.9%) grade 3 toxicities were uncommon. One-year LC, distant metastasis-free survival, progression-free survival, cause-specific survival, and OS were 87.8%, 63.1%, 52.4%, 77.6%, and 58.9%, respectively.Conclusions: To our knowledge, this is the first report of 5-fraction pancreas SMART delivered on an MR-linear accelerator. We observed minimal severe treatment-related toxicity and encouraging early LC. Prospective confirmation of feasibility and long-term clinical outcomes of dose intensified SMART is warranted. (C) 2020 The Author(s). Published by Elsevier Inc.