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Lee RY, Nichols RC, Huh SN, et al. Proton therapy may allow for comprehensive elective nodal coverage for patients receiving neoadjuvant radiotherapy for localized pancreatic head cancers. J Gastrointest Oncol. 2013;4(4):374-9doi: 10.3978/j.issn.2078-6891.2013.043.
Lee, R. Y., Nichols, R. C., Huh, S. N., Ho, M. W., Li, Z., Zaiden, R., Awad, Z. T., Ahmed, B., & Hoppe, B. S. (2013). Proton therapy may allow for comprehensive elective nodal coverage for patients receiving neoadjuvant radiotherapy for localized pancreatic head cancers. Journal of gastrointestinal oncology, 4(4), 374-9. https://doi.org/10.3978/j.issn.2078-6891.2013.043
Lee, Richard Y, et al. "Proton therapy may allow for comprehensive elective nodal coverage for patients receiving neoadjuvant radiotherapy for localized pancreatic head cancers." Journal of gastrointestinal oncology vol. 4,4 (2013): 374-9. doi: https://doi.org/10.3978/j.issn.2078-6891.2013.043
Lee RY, Nichols RC, Huh SN, Ho MW, Li Z, Zaiden R, Awad ZT, Ahmed B, Hoppe BS. Proton therapy may allow for comprehensive elective nodal coverage for patients receiving neoadjuvant radiotherapy for localized pancreatic head cancers. J Gastrointest Oncol. 2013 Dec;4(4):374-9. doi: 10.3978/j.issn.2078-6891.2013.043. PMID: 24294509; PMCID: PMC3819780.
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J Gastrointest Oncol. 2013 Dec;4(4):374-9. doi: 10.3978/j.issn.2078-6891.2013.043.

Proton therapy may allow for comprehensive elective nodal coverage for patients receiving neoadjuvant radiotherapy for localized pancreatic head cancers.

Journal of gastrointestinal oncology

Richard Y Lee, Romaine C Nichols, Soon N Huh, Meng W Ho, Zuofeng Li, Robert Zaiden, Ziad T Awad, Bestoun Ahmed, Bradfors S Hoppe

Affiliations

  1. Radiation Medicine, Roswell Park Cancer Institute, University at Buffalo, NY, USA;

PMID: 24294509 PMCID: PMC3819780 DOI: 10.3978/j.issn.2078-6891.2013.043

Abstract

BACKGROUND: Neoadjuvant radiotherapy has the potential to improve local disease control for patients with localized pancreatic cancers. Concern about an increased risk of surgical complications due to small bowel and gastric exposure, however, has limited enthusiasm for this approach. Dosimetric studies have demonstrated the potential for proton therapy to reduce intestinal exposure compared with X-ray-based therapy. We sought to determine if neoadjuvant proton therapy allowed for field expansions to cover high-risk nodal stations in addition to the primary tumor.

METHODS: Twelve consecutive patients with nonmetastatic cancers of the pancreatic head underwent proton-based planning for neoadjuvant radiotherapy. Gross tumor volume was contoured using diagnostic computed tomography (CT) scans with oral and intravenous contrast. Four-dimensional planning scans were utilized to define an internal clinical target volume (ICTV). Five-mm planning target volume (PTV) expansions on the ICTV were generated to establish an initial PTV (PTV1). A second PTV was created using the initial PTV but was expanded to include the high-risk nodal targets as defined by the RTOG contouring atlas (PTV2). Optimized proton plans were generated for both PTVs for each patient. All PTVs received a dose of 50.4 cobalt gray equivalent (CGE). Normal-tissue exposures to the small bowel space, stomach, right kidney, left kidney and liver were recorded. Point spinal cord dose was limited to 45 CGE.

RESULTS: Median PTV1 volume was 308.75 cm(3) (range, 133.33-495.61 cm(3)). Median PTV2 volume was 541.75 cm(3) (range, 399.44-691.14 cm(3)). In spite of the substantial enlargement of the PTV when high-risk lymph nodes were included in the treatment volume, normal-tissue exposures (stomach, bowel space, liver, and kidneys) were only minimally increased relative to the exposures seen when only the gross tumor target was treated.

CONCLUSIONS: Proton therapy appears to allow for field expansions to cover high-risk lymph nodes without significantly increasing critical normal-tissue exposure in the neoadjuvant setting.

Keywords: Proton therapy; dosimetry; neoadjuvant radiotherapy; pancreatic

References

  1. CA Cancer J Clin. 2011 Jul-Aug;61(4):212-36 - PubMed
  2. Int J Radiat Oncol Biol Phys. 2000 Aug 1;48(1):277-88 - PubMed
  3. Int J Radiat Oncol Biol Phys. 2012 Feb 1;82(2):809-16 - PubMed
  4. Surg Oncol Clin N Am. 2004 Oct;13(4):685-96, x - PubMed
  5. Int J Radiat Oncol Biol Phys. 2007 Aug 1;68(5):1557-66 - PubMed
  6. Cancer. 1990 Jul 1;66(1):56-61 - PubMed
  7. Int J Radiat Oncol Biol Phys. 2011 Jan 1;79(1):151-7 - PubMed
  8. Surg Oncol Clin N Am. 2004 Oct;13(4):675-84, ix-x - PubMed
  9. Int J Radiat Oncol Biol Phys. 2012 May 1;83(1):158-63 - PubMed
  10. Int J Radiat Oncol Biol Phys. 2012 Jul 1;83(3):901-8 - PubMed
  11. Cancer. 1993 Oct 1;72(7):2118-23 - PubMed
  12. Acta Oncol. 2013 Apr;52(3):498-505 - PubMed
  13. Int J Radiat Oncol Biol Phys. 2011 Dec 1;81(5):1328-35 - PubMed
  14. N Engl J Med. 2004 Mar 18;350(12):1200-10 - PubMed
  15. Int J Radiat Oncol Biol Phys. 2001 May 1;50(1):279-80 - PubMed
  16. Cancer. 1976 Mar;37(3):1519-24 - PubMed
  17. J Clin Oncol. 2008 Jul 20;26(21):3487-95 - PubMed
  18. Cancer. 2012 Jun 15;118(12):3026-35 - PubMed
  19. Med Dosim. 2001 Fall;26(3):255-9 - PubMed
  20. J Clin Oncol. 1998 Jan;16(1):317-23 - PubMed

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