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 language | English |
|---|---|
| Pages (from-to) | 66-71 |
| Number of pages | 6 |
| Journal | Radiotherapy and Oncology |
| Volume | 108 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Jul 2013 |
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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 journal › Article
}
TY - JOUR
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
UR - http://www.scopus.com/inward/record.url?scp=84883142820&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84883142820&partnerID=8YFLogxK
U2 - 10.1016/j.radonc.2013.05.011
DO - 10.1016/j.radonc.2013.05.011
M3 - Article
C2 - 23726116
AN - SCOPUS:84883142820
VL - 108
SP - 66
EP - 71
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
SN - 0167-8140
IS - 1
ER -