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

الملخص EN

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.