Dose-Painted Intensity Modulated Radiation Therapy Improves Local Control for Locally Advanced Pancreas Cancer

Background. To evaluate the outcomes, adverse events, and therapeutic role of Dose-Painted Intensity-Modulated Radiation Therapy (DP-IMRT) for locally advanced pancreas cancer (LAPC). Methods. Patients with LAPC were treated with induction chemotherapy (n = 25) and those without metastasis (n = 20)...

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Main Authors:	Tunceroglu, Ahmet, Park, Joo Han, Balasubramanian, Sairam, Poppe, Matthew, Anker, Christopher J., Poplin, Elizabeth, Moss, Rebecca A., Yue, Ning J., Carpizo, Darren, Gannon, Christopher J., Haffty, Bruce G., Jabbour, Salma K.
Format:	Online
Language:	English
Published:	International Scholarly Research Network 2012
Online Access:	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3483817/

id	pubmed-3483817
recordtype	oai_dc
spelling	pubmed-34838172012-11-01 Dose-Painted Intensity Modulated Radiation Therapy Improves Local Control for Locally Advanced Pancreas Cancer Tunceroglu, Ahmet Park, Joo Han Balasubramanian, Sairam Poppe, Matthew Anker, Christopher J. Poplin, Elizabeth Moss, Rebecca A. Yue, Ning J. Carpizo, Darren Gannon, Christopher J. Haffty, Bruce G. Jabbour, Salma K. Research Article Background. To evaluate the outcomes, adverse events, and therapeutic role of Dose-Painted Intensity-Modulated Radiation Therapy (DP-IMRT) for locally advanced pancreas cancer (LAPC). Methods. Patients with LAPC were treated with induction chemotherapy (n = 25) and those without metastasis (n = 20) received DP-IMRT consisting of 45 Gy to Planning Treatment Volume 1 (PTV1) including regional lymph nodes with a concomitant boost to the PTV2 (gross tumor volume + 0.5 cm) to either 50.4 Gy (n = 9) or 54 Gy (n = 11) in 25 fractions. DP-IMRT cases were compared to three-dimensional conformal radiation therapy (3D-CRT) plans to assess the potential relationship of radiation dose to adverse events. Kaplan-Meier and Cox regression analyses were used to calculate survival probabilities. The Fisher exact test and t-test were utilized to investigate potential prognostic factors of toxicity and survival. Results. Median overall and progression-free survivals were 11.6 and 5.9 months, respectively. Local control was 90%. Post-RT CA-19-9 levels following RT were predictive of survival (P = 0.02). Grade 2 and ≥grade 3 GI toxicity were 60% and 20%, respectively. In comparison to 3D-CRT, DP-IMRT plans demonstrated significantly lower V45 values of small bowel (P = 0.0002), stomach (P = 0.007), and mean liver doses (P = 0.001). Conclusions. Dose-escalated DP-IMRT offers improved local control in patients treated with induction chemotherapy for LAPC. Radiation-related morbidity appears reduced with DP-IMRT compared to 3D-CRT techniques, likely due to reduction in RT doses to organs at risk. International Scholarly Research Network 2012-10-18 /pmc/articles/PMC3483817/ /pubmed/23119186 http://dx.doi.org/10.5402/2012/572342 Text en Copyright © 2012 Ahmet Tunceroglu et al. https://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
repository_type	Open Access Journal
institution_category	Foreign Institution
institution	US National Center for Biotechnology Information
building	NCBI PubMed
collection	Online Access
language	English
format	Online
author	Tunceroglu, Ahmet Park, Joo Han Balasubramanian, Sairam Poppe, Matthew Anker, Christopher J. Poplin, Elizabeth Moss, Rebecca A. Yue, Ning J. Carpizo, Darren Gannon, Christopher J. Haffty, Bruce G. Jabbour, Salma K.
spellingShingle	Tunceroglu, Ahmet Park, Joo Han Balasubramanian, Sairam Poppe, Matthew Anker, Christopher J. Poplin, Elizabeth Moss, Rebecca A. Yue, Ning J. Carpizo, Darren Gannon, Christopher J. Haffty, Bruce G. Jabbour, Salma K. Dose-Painted Intensity Modulated Radiation Therapy Improves Local Control for Locally Advanced Pancreas Cancer
author_facet	Tunceroglu, Ahmet Park, Joo Han Balasubramanian, Sairam Poppe, Matthew Anker, Christopher J. Poplin, Elizabeth Moss, Rebecca A. Yue, Ning J. Carpizo, Darren Gannon, Christopher J. Haffty, Bruce G. Jabbour, Salma K.
author_sort	Tunceroglu, Ahmet
title	Dose-Painted Intensity Modulated Radiation Therapy Improves Local Control for Locally Advanced Pancreas Cancer
title_short	Dose-Painted Intensity Modulated Radiation Therapy Improves Local Control for Locally Advanced Pancreas Cancer
title_full	Dose-Painted Intensity Modulated Radiation Therapy Improves Local Control for Locally Advanced Pancreas Cancer
title_fullStr	Dose-Painted Intensity Modulated Radiation Therapy Improves Local Control for Locally Advanced Pancreas Cancer
title_full_unstemmed	Dose-Painted Intensity Modulated Radiation Therapy Improves Local Control for Locally Advanced Pancreas Cancer
title_sort	dose-painted intensity modulated radiation therapy improves local control for locally advanced pancreas cancer
description	Background. To evaluate the outcomes, adverse events, and therapeutic role of Dose-Painted Intensity-Modulated Radiation Therapy (DP-IMRT) for locally advanced pancreas cancer (LAPC). Methods. Patients with LAPC were treated with induction chemotherapy (n = 25) and those without metastasis (n = 20) received DP-IMRT consisting of 45 Gy to Planning Treatment Volume 1 (PTV1) including regional lymph nodes with a concomitant boost to the PTV2 (gross tumor volume + 0.5 cm) to either 50.4 Gy (n = 9) or 54 Gy (n = 11) in 25 fractions. DP-IMRT cases were compared to three-dimensional conformal radiation therapy (3D-CRT) plans to assess the potential relationship of radiation dose to adverse events. Kaplan-Meier and Cox regression analyses were used to calculate survival probabilities. The Fisher exact test and t-test were utilized to investigate potential prognostic factors of toxicity and survival. Results. Median overall and progression-free survivals were 11.6 and 5.9 months, respectively. Local control was 90%. Post-RT CA-19-9 levels following RT were predictive of survival (P = 0.02). Grade 2 and ≥grade 3 GI toxicity were 60% and 20%, respectively. In comparison to 3D-CRT, DP-IMRT plans demonstrated significantly lower V45 values of small bowel (P = 0.0002), stomach (P = 0.007), and mean liver doses (P = 0.001). Conclusions. Dose-escalated DP-IMRT offers improved local control in patients treated with induction chemotherapy for LAPC. Radiation-related morbidity appears reduced with DP-IMRT compared to 3D-CRT techniques, likely due to reduction in RT doses to organs at risk.
publisher	International Scholarly Research Network
publishDate	2012
url	https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3483817/
_version_	1611919814204325888

Dose-Painted Intensity Modulated Radiation Therapy Improves Local Control for Locally Advanced Pancreas Cancer

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