Dosimetric and clinical predictors of toxicity following combined chemotherapy and moderately hypofractionated rotational radiotherapy of locally advanced pancreatic adenocarcinoma

Giovanni M. Cattaneo, Paolo Passoni, Barbara Longobardi, Najla Slim, Michele Reni, Stefano Cereda, Nadia Di Muzio, Riccardo Calandrino

Research output: Contribution to journalArticle

Abstract

Background and purpose Hypofractionated radiotherapy (RT) of pancreatic adenocarcinoma is limited by the tolerance of adjacent normal tissues. A better understanding of the influence of dosimetric variables on the rate of toxicity after RT must be considered an important goal. Methods and materials Sixty-one patients with histologically proven locally advanced disease (LAPD) were analyzed. The therapeutic strategy consisted of induction chemotherapy (ChT) followed by concurrent chemoradiotherapy (CRT). In 39 out of 61 patients the target volume was based on a four-dimensional CT (4D-CT) procedure. Delivered dose was 44.25 Gy in 15 fractions to PTV2, which consisted of pancreatic tumor and regional lymph nodes considered radiologically involved; 23 out of 61 patients received a simultaneous integrated boost (SIB) to a tumor sub-volume infiltrating the great abdominal vessels (PTV1) with dose in the range of 48-58 Gy. RT was delivered with Helical Tomotherapy. Dose-volume histograms (DVHs) of target volumes and organs at risk (OARs) were collected for analysis. The predictive value of clinical/dosimetric parameters was tested by univariate/multivariate analyses. Results The crude incidence of acute gastrointestinal (GI) grade 2 toxicity was 33%. The 12-month actuarial rate of "anatomical" (gastro-duodenal mucosa damage) toxicity was 13% (95% CI: 4-22%). On univariate analysis, several stomach and duodenum DVH endpoints are predictive of toxicity after moderately hypofractionated radiotherapy. Multivariate analysis confirmed that baseline performance status and the stomach V20[%] were strong independent predictors of acute GI grade ≥2 toxicity. The high-dose region of duodenum DVH (V45[%]; V 40[%]) was strongly correlated with grade ≥2 " anatomical" toxicity; the best V40[%] and V45[%] cut-off values were 16% and 2.6% respectively. Conclusion Regarding dosimetric indices, stomach V20[%] correlates with a higher rate of acute toxicity; more severe acute and late anatomical toxicities are related to the high dose region of duodenum DVH.

Original languageEnglish
Pages (from-to)66-71
Number of pages6
JournalRadiotherapy and Oncology
Volume108
Issue number1
DOIs
Publication statusPublished - Jul 2013

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Adenocarcinoma
Radiotherapy
Four-Dimensional Computed Tomography
Duodenum
Drug Therapy
Stomach
Multivariate Analysis
Organs at Risk
Intensity-Modulated Radiotherapy
Induction Chemotherapy
Chemoradiotherapy
Tumor Burden
Mucous Membrane
Lymph Nodes
Incidence
Neoplasms
Therapeutics

Keywords

  • Dosimetric predictors
  • Pancreatic cancer
  • Radiotherapy
  • Tomotherapy
  • Toxicity
  • Unresectable disease

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Hematology

Cite this

Dosimetric and clinical predictors of toxicity following combined chemotherapy and moderately hypofractionated rotational radiotherapy of locally advanced pancreatic adenocarcinoma. / Cattaneo, Giovanni M.; Passoni, Paolo; Longobardi, Barbara; Slim, Najla; Reni, Michele; Cereda, Stefano; Di Muzio, Nadia; Calandrino, Riccardo.

In: Radiotherapy and Oncology, Vol. 108, No. 1, 07.2013, p. 66-71.

Research output: Contribution to journalArticle

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abstract = "Background and purpose Hypofractionated radiotherapy (RT) of pancreatic adenocarcinoma is limited by the tolerance of adjacent normal tissues. A better understanding of the influence of dosimetric variables on the rate of toxicity after RT must be considered an important goal. Methods and materials Sixty-one patients with histologically proven locally advanced disease (LAPD) were analyzed. The therapeutic strategy consisted of induction chemotherapy (ChT) followed by concurrent chemoradiotherapy (CRT). In 39 out of 61 patients the target volume was based on a four-dimensional CT (4D-CT) procedure. Delivered dose was 44.25 Gy in 15 fractions to PTV2, which consisted of pancreatic tumor and regional lymph nodes considered radiologically involved; 23 out of 61 patients received a simultaneous integrated boost (SIB) to a tumor sub-volume infiltrating the great abdominal vessels (PTV1) with dose in the range of 48-58 Gy. RT was delivered with Helical Tomotherapy. Dose-volume histograms (DVHs) of target volumes and organs at risk (OARs) were collected for analysis. The predictive value of clinical/dosimetric parameters was tested by univariate/multivariate analyses. Results The crude incidence of acute gastrointestinal (GI) grade 2 toxicity was 33{\%}. The 12-month actuarial rate of {"}anatomical{"} (gastro-duodenal mucosa damage) toxicity was 13{\%} (95{\%} CI: 4-22{\%}). On univariate analysis, several stomach and duodenum DVH endpoints are predictive of toxicity after moderately hypofractionated radiotherapy. Multivariate analysis confirmed that baseline performance status and the stomach V20[{\%}] were strong independent predictors of acute GI grade ≥2 toxicity. The high-dose region of duodenum DVH (V45[{\%}]; V 40[{\%}]) was strongly correlated with grade ≥2 {"} anatomical{"} toxicity; the best V40[{\%}] and V45[{\%}] cut-off values were 16{\%} and 2.6{\%} respectively. Conclusion Regarding dosimetric indices, stomach V20[{\%}] correlates with a higher rate of acute toxicity; more severe acute and late anatomical toxicities are related to the high dose region of duodenum DVH.",
keywords = "Dosimetric predictors, Pancreatic cancer, Radiotherapy, Tomotherapy, Toxicity, Unresectable disease",
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T1 - Dosimetric and clinical predictors of toxicity following combined chemotherapy and moderately hypofractionated rotational radiotherapy of locally advanced pancreatic adenocarcinoma

AU - Cattaneo, Giovanni M.

AU - Passoni, Paolo

AU - Longobardi, Barbara

AU - Slim, Najla

AU - Reni, Michele

AU - Cereda, Stefano

AU - Di Muzio, Nadia

AU - Calandrino, Riccardo

PY - 2013/7

Y1 - 2013/7

N2 - Background and purpose Hypofractionated radiotherapy (RT) of pancreatic adenocarcinoma is limited by the tolerance of adjacent normal tissues. A better understanding of the influence of dosimetric variables on the rate of toxicity after RT must be considered an important goal. Methods and materials Sixty-one patients with histologically proven locally advanced disease (LAPD) were analyzed. The therapeutic strategy consisted of induction chemotherapy (ChT) followed by concurrent chemoradiotherapy (CRT). In 39 out of 61 patients the target volume was based on a four-dimensional CT (4D-CT) procedure. Delivered dose was 44.25 Gy in 15 fractions to PTV2, which consisted of pancreatic tumor and regional lymph nodes considered radiologically involved; 23 out of 61 patients received a simultaneous integrated boost (SIB) to a tumor sub-volume infiltrating the great abdominal vessels (PTV1) with dose in the range of 48-58 Gy. RT was delivered with Helical Tomotherapy. Dose-volume histograms (DVHs) of target volumes and organs at risk (OARs) were collected for analysis. The predictive value of clinical/dosimetric parameters was tested by univariate/multivariate analyses. Results The crude incidence of acute gastrointestinal (GI) grade 2 toxicity was 33%. The 12-month actuarial rate of "anatomical" (gastro-duodenal mucosa damage) toxicity was 13% (95% CI: 4-22%). On univariate analysis, several stomach and duodenum DVH endpoints are predictive of toxicity after moderately hypofractionated radiotherapy. Multivariate analysis confirmed that baseline performance status and the stomach V20[%] were strong independent predictors of acute GI grade ≥2 toxicity. The high-dose region of duodenum DVH (V45[%]; V 40[%]) was strongly correlated with grade ≥2 " anatomical" toxicity; the best V40[%] and V45[%] cut-off values were 16% and 2.6% respectively. Conclusion Regarding dosimetric indices, stomach V20[%] correlates with a higher rate of acute toxicity; more severe acute and late anatomical toxicities are related to the high dose region of duodenum DVH.

AB - Background and purpose Hypofractionated radiotherapy (RT) of pancreatic adenocarcinoma is limited by the tolerance of adjacent normal tissues. A better understanding of the influence of dosimetric variables on the rate of toxicity after RT must be considered an important goal. Methods and materials Sixty-one patients with histologically proven locally advanced disease (LAPD) were analyzed. The therapeutic strategy consisted of induction chemotherapy (ChT) followed by concurrent chemoradiotherapy (CRT). In 39 out of 61 patients the target volume was based on a four-dimensional CT (4D-CT) procedure. Delivered dose was 44.25 Gy in 15 fractions to PTV2, which consisted of pancreatic tumor and regional lymph nodes considered radiologically involved; 23 out of 61 patients received a simultaneous integrated boost (SIB) to a tumor sub-volume infiltrating the great abdominal vessels (PTV1) with dose in the range of 48-58 Gy. RT was delivered with Helical Tomotherapy. Dose-volume histograms (DVHs) of target volumes and organs at risk (OARs) were collected for analysis. The predictive value of clinical/dosimetric parameters was tested by univariate/multivariate analyses. Results The crude incidence of acute gastrointestinal (GI) grade 2 toxicity was 33%. The 12-month actuarial rate of "anatomical" (gastro-duodenal mucosa damage) toxicity was 13% (95% CI: 4-22%). On univariate analysis, several stomach and duodenum DVH endpoints are predictive of toxicity after moderately hypofractionated radiotherapy. Multivariate analysis confirmed that baseline performance status and the stomach V20[%] were strong independent predictors of acute GI grade ≥2 toxicity. The high-dose region of duodenum DVH (V45[%]; V 40[%]) was strongly correlated with grade ≥2 " anatomical" toxicity; the best V40[%] and V45[%] cut-off values were 16% and 2.6% respectively. Conclusion Regarding dosimetric indices, stomach V20[%] correlates with a higher rate of acute toxicity; more severe acute and late anatomical toxicities are related to the high dose region of duodenum DVH.

KW - Dosimetric predictors

KW - Pancreatic cancer

KW - Radiotherapy

KW - Tomotherapy

KW - Toxicity

KW - Unresectable disease

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