open access

Vol 21, No 6 (2016)
Original research articles
Published online: 2016-11-01
Submitted: 2016-03-07
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Individually optimized stereotactic radiotherapy for pancreatic head tumors: A planning feasibility study

Milly Buwenge, Savino Cilla, Alessandra Guido, Lucia Giaccherini, Gabriella Macchia, Francesco Deodato, Silvia Cammelli, Francesco Cellini, Gian C. Mattiucci, Vincenzo Valentini, Markus Stock, Alessio G. Morganti
DOI: 10.1016/j.rpor.2016.09.003
·
Rep Pract Oncol Radiother 2016;21(6):548-554.

open access

Vol 21, No 6 (2016)
Original research articles
Published online: 2016-11-01
Submitted: 2016-03-07

Abstract

Aim

Aim of this study was to perform a planning feasibility analysis of a 3-level dose prescription using an IMRT-SIB technique.

Background

Radiation therapy of locally advanced pancreatic cancer should administer a minimum dose to the duodenum and a very high dose to the vascular infiltration areas to improve the possibility of a radical resection.

Materials and methods

Fifteen patients with pancreatic head adenocarcinoma and vascular involvement were included. The duodenal PTV (PTVd) was defined as the GTV overlapping the duodenal PRV. Vascular CTV (CTVv) was defined as the surface of contact or infiltration between the tumor and vessel plus a 5[[ce:hsp sp="0.25"/]]mm margin. Vascular PTV (PTVv) was considered as the CTVv plus an anisotropic margin. The tumor PTV (PTVt) was defined as the GTV plus a margin including the PTVv and excluding the PTVd. The following doses were prescribed: 30[[ce:hsp sp="0.25"/]]Gy (6[[ce:hsp sp="0.25"/]]Gy/fraction) to PTVd, 37.5[[ce:hsp sp="0.25"/]]Gy (7.5[[ce:hsp sp="0.25"/]]Gy/fraction) to PTVt, and 45[[ce:hsp sp="0.25"/]]Gy (9[[ce:hsp sp="0.25"/]]Gy/fraction) to PTVv, respectively. Treatment was planned with an IMRT technique.

Results

The primary end-point (PTVv Dmean[[ce:hsp sp="0.25"/]]>[[ce:hsp sp="0.25"/]]90%) was achieved in all patients. PTVv D98%[[ce:hsp sp="0.25"/]]>[[ce:hsp sp="0.25"/]]90% was achieved in 6 patients (40%). OARs constraints were achieved in all patients.

Conclusions

Although the PTVv D95%[[ce:hsp sp="0.25"/]]>[[ce:hsp sp="0.25"/]]95% objective was achieved only in 40% of patients, the study showed that in 100% of patients it was possible to administer a strongly differentiated mean/median dose. Prospective trials based on clinical application of this strategy seem to be justified in selected patients without overlap between PTVd and PTVv.

Abstract

Aim

Aim of this study was to perform a planning feasibility analysis of a 3-level dose prescription using an IMRT-SIB technique.

Background

Radiation therapy of locally advanced pancreatic cancer should administer a minimum dose to the duodenum and a very high dose to the vascular infiltration areas to improve the possibility of a radical resection.

Materials and methods

Fifteen patients with pancreatic head adenocarcinoma and vascular involvement were included. The duodenal PTV (PTVd) was defined as the GTV overlapping the duodenal PRV. Vascular CTV (CTVv) was defined as the surface of contact or infiltration between the tumor and vessel plus a 5[[ce:hsp sp="0.25"/]]mm margin. Vascular PTV (PTVv) was considered as the CTVv plus an anisotropic margin. The tumor PTV (PTVt) was defined as the GTV plus a margin including the PTVv and excluding the PTVd. The following doses were prescribed: 30[[ce:hsp sp="0.25"/]]Gy (6[[ce:hsp sp="0.25"/]]Gy/fraction) to PTVd, 37.5[[ce:hsp sp="0.25"/]]Gy (7.5[[ce:hsp sp="0.25"/]]Gy/fraction) to PTVt, and 45[[ce:hsp sp="0.25"/]]Gy (9[[ce:hsp sp="0.25"/]]Gy/fraction) to PTVv, respectively. Treatment was planned with an IMRT technique.

Results

The primary end-point (PTVv Dmean[[ce:hsp sp="0.25"/]]>[[ce:hsp sp="0.25"/]]90%) was achieved in all patients. PTVv D98%[[ce:hsp sp="0.25"/]]>[[ce:hsp sp="0.25"/]]90% was achieved in 6 patients (40%). OARs constraints were achieved in all patients.

Conclusions

Although the PTVv D95%[[ce:hsp sp="0.25"/]]>[[ce:hsp sp="0.25"/]]95% objective was achieved only in 40% of patients, the study showed that in 100% of patients it was possible to administer a strongly differentiated mean/median dose. Prospective trials based on clinical application of this strategy seem to be justified in selected patients without overlap between PTVd and PTVv.

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Keywords

Pancreatic neoplasms; IMRT; Stereotactic body radiotherapy; Simultaneous integrated boost

About this article
Title

Individually optimized stereotactic radiotherapy for pancreatic head tumors: A planning feasibility study

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 21, No 6 (2016)

Pages

548-554

Published online

2016-11-01

DOI

10.1016/j.rpor.2016.09.003

Bibliographic record

Rep Pract Oncol Radiother 2016;21(6):548-554.

Keywords

Pancreatic neoplasms
IMRT
Stereotactic body radiotherapy
Simultaneous integrated boost

Authors

Milly Buwenge
Savino Cilla
Alessandra Guido
Lucia Giaccherini
Gabriella Macchia
Francesco Deodato
Silvia Cammelli
Francesco Cellini
Gian C. Mattiucci
Vincenzo Valentini
Markus Stock
Alessio G. Morganti

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