Sharing Mono-Institutional Experience of Treating Pancreatic Cancer with Stereotactic Body Radiation Therapy (SBRT)
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Data Collection
2.2. SBRT Details
2.3. CT Simulation
2.4. Target Volumes
2.5. Follow Up
2.6. Statistical Methods
3. Results
3.1. Patient and Treatment Characteristics
3.2. Dosimetric Features
3.3. Overall Survival and Progression-Free Survival
3.4. Comparison of Treatment Time with Abdominal Compression versus Breath-Hold Technique
3.5. Toxicity
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Organs at Risk | Dose Volume Constraints |
---|---|
Duodenum | V33Gy < 0.5 cc |
V20Gy < 3 cc | |
V15Gy < 9 cc | |
Liver | V10Gy < 70% |
Kidneys | Mean < 10 Gy |
Spinal Cord | Dmax < 18 Gy |
V8Gy < 1 cc | |
Small Bowel | V33Gy < 0.5 cc |
V20Gy < 3 cc | |
V15Gy < 9 cc | |
Large Bowel | V35Gy < 0.5 cc |
Stomach | V33Gy < 0.5 cc |
V20Gy < 3 cc | |
V15Gy < 9 cc |
Total Patients Number | 17 |
Mean Age | 9 (47–85) |
Gender | |
(M:F) | 14:3 |
Smoking Status | |
Nonsmokers | 10 (58.8%) |
Smokers | 7 (41.2%) |
Pathology | |
Adenocarcinoma | 15(88.2%) |
Other | 2 (11.8%) |
TNM stage | |
IA | 2(11.8%) |
IB | 4(23.5%) |
IIB | 3(17.7%) |
III | 8(47.1%) |
Site of Pancreatic Cancer | |
Head | 10 (58.8%) |
Neck | 3(17.6%) |
Body | 2 (11.8%) |
Tail | 1(5.9%) |
Periampullary | 1 (5.9%) |
Fiducial insertion | |
Yes | 13(76.5%) |
No | 4 (23.5%) |
Mean Dose | 35 Gy (23–50) |
Motion Management Technique | |
Abdominal Compression | 10 (58.8%) |
Exhale Breath-Hold | 7 (41.2%) |
Prior Therapy | |
Chemotherapy | 11 (64.7%) |
Surgery | 1 (5.9%) |
Radiation therapy | 3 (17.6%) |
Immunotherapy | 2 (11.8%) |
Organ | Parameter | Mean ± SD | Range |
---|---|---|---|
GTV | Vol (cc) | 47.61 ± 46.97 | [4.9; 145.8] |
Mean (Gy) | 39.13 ± 5.94 | [25.8; 49.5] | |
Min (Gy) | 27.35 ± 5.41 | [16.6; 34.50] | |
Max (Gy) | 45.71 ± 7.79 | [29.8; 58.8] | |
ITV | Vol (cc) | 48.43 ± 52.06 | [5.0; 149.7] |
Mean (Gy) | 36.71 ± 5.59 | [25.64; 44.52] | |
Min (Gy) | 26.02 ± 5.98 | [16.55; 34.41] | |
Max (Gy) | 42.46 ± 6.99 | [29.81; 52.40] | |
PTV | Vol (cc) | 97.87 ± 79.33 | [19.9; 255.3] |
Mean (Gy) | 35.91 ± 4.62 | [25.12; 42.23] | |
Min (Gy) | 18.93 ± 7.55 | [8.34; 30.46] | |
Max (Gy) | 45.17± 7.93 | [29.81; 58.87] |
Organ | Parameter | Objective | Mean ± SD | Range |
---|---|---|---|---|
Left Kidney | Vol (cc) | 169.9 ± 41.06 | [90.7; 249.5] | |
Mean (Gy) | 2.71 ± 1.41 | [0.79; 5.76] | ||
Min (Gy) | 0.17 ± 0.11 | [0.04; 0.5] | ||
Max (Gy) | 10.32 ± 5.13 | [3.46; 21.95] | ||
V15Gy (%) | 0.14 ± 0.38 | [0; 1.19] | ||
D1cc (Gy) | 8.84 ± 4.31 | [2.9; 17.2] | ||
Right Kidney | Vol (cc) | 160.5 ± 44.44 | [90.5; 246.5] | |
Mean (Gy) | 4.05 ± 2.74 | [1.36; 9.92] | ||
Min (Gy) | 0.29 ± 0.44 | [0.07; 1.90] | ||
Max (Gy) | 13.39 ± 5.70 | [4.77;25.79] | ||
V15Gy (%) | 1.20 ± 3.24 | [0; 12.85] | ||
D1cc (Gy) | 11.29 ± 4.77 | [4.3; 21.7] | ||
Small Bowel | Vol (cc) | 744.2 ± 505.3 | [120.6; 1762.1] | |
Mean (Gy) | 3.45 ± 2.29 | [0.75; 7.82] | ||
Min (Gy) | 0.18 ± 0.19 | [0.01;0.78] | ||
Max (Gy) | 26.92± 28.04 | [12.47; 36.87] | ||
D3cc (Gy) | 19.23 ± 6.77 | [7.2; 28.4] | ||
V33Gy (cc) | V33Gy < 0.5 cc | 0.02 ± 0.06 | [0; 0.19] | |
V20Gy (cc) | V20Gy < 3 cc | 6.09 ± 10.04 | [0; 40.07] | |
V15Gy (cc) | V15Gy < 9 cc | 17.84 ± 29.58 | [0; 122.7] | |
Large Bowel | Vol (cc) | 728.5 ± 399.5 | [78.8; 1514.7] | |
Mean (Gy) | 3.95 ± 1.91 | [0.69; 8.49] | ||
Min (Gy) | 0.09 ± 0.07 | [0.01; 0.28] | ||
Max (Gy) | 24.85 ± 10.35 | [7.17; 46.35] | ||
D3cc (Gy) | 18.27 ± 7.27 | [5.6; 32.5] | ||
V35Gy (cc) | V35Gy < 0.5 cc | 0.09 ± 0.39 | [0; 1.61] | |
Liver | Vol (cc) | 1516.8 ± 523.5 | [176.9; 2255.2] | |
Mean (Gy) | 1.86 ± 1.57 | [0.23; 5.42] | ||
Min (Gy) | 0.07 ± 0.05 | [0.02; 0.2] | ||
Max (Gy) | 22.18 ± 12.51 | [6.67; 43.62] | ||
V21Gy (cc) | 6.78 ± 16.36 | [0; 61.82] | ||
Vspare (Vtot-V21Gy) (cc) | 1510 ± 527.2 | [176.89; 2255.2] | ||
V10Gy (%) | V10Gy < 70% | 3.85 ± 5.75 | [0; 19.16] | |
Stomach | Vol (cc) | 274.4 ± 157.9 | [22.3; 698] | |
Mean (Gy) | 1.97 ± 2.46 | [0.19; 7.66] | ||
Min (Gy) | 0.16 ± 0.10 | [0.04; 0.44] | ||
Max (Gy) | 12.30 ± 12.34 | [0.46; 30.99] | ||
D3cc (Gy) | 8.29 ± 9.24 | [0.4; 25.2] | ||
V33Gy (cc) | V33Gy < 0.5 cc | 0 ± 0 | [0; 0] | |
V20Gy (cc) | V20Gy < 3 cc | 1.16 ± 2.76 | [0; 10.87] | |
V15Gy (cc) | V15Gy < 9 cc | 5.43 ± 10.29 | [0; 37.86] | |
Duodenum | Vol (cc) | 5.15 ± 49.66 | [17.3; 196.5] | |
Mean (Gy) | 8.22 ± 4.89 | [2.12; 19.87] | ||
Min (Gy) | 0.89 ± 1.09 | [0.1; 4.08] | ||
Max (Gy) | 30.39± 8.12 | [7.51; 42.22] | ||
D1cc (Gy) | 23.84 ± 8.4 | [5.5; 31.3] | ||
V33Gy (cc) | V33Gy < 0.5 cc | 0.07 ± 0.14 | [0; 0.55] | |
V20Gy (cc) | V20Gy < 3 cc | 9.72 ± 14.04 | [0; 39.46] | |
V15Gy (cc) | V15Gy < 9 cc | 15.42 ± 18.25 | [0; 55.45] | |
Spinal Cord | Vol (cc) | 32.68 ± 13.29 | [15.1; 71.6] | |
Mean (Gy) | 2.06 ± 1.27 | [0.58; 5.19] | ||
Min (Gy) | 0.08 ± 0.09 | [0; 0.37] | ||
Max (Gy) | <18 Gy | 8.03 ± 3.38 | [2.39; 16.02] | |
D1cc (Gy) | 6.58 ± 2.73 | [2.0; 13.7] | ||
V8Gy (cc) | V8Gy < 1 cc | 6.79 ± 4.44 | [0; 14.64] | |
Both Kidneys | Vol (cc) | 330.5 ± 81.05 | [181.2; 496] | |
Mean (Gy) | <10 Gy | 3.32 ± 1.77 | [1.06; 7.11] | |
Min (Gy) | 0.15 ± 0.10 | [0.04; 0.49] | ||
Max (Gy) | 15.21 ± 5.12 | [7.48; 25.79] |
Abdominal Compression | End-Exhale Breath-Hold | ||||||||
---|---|---|---|---|---|---|---|---|---|
Time (min) | Delivery | Total | PTV | Time (min) | Delivery | Total | PTV | ||
Median | 4.60 | 17.67 | Volume (cc) | 52 | Median | 8.78 | 20.28 | Volume (cc) | 49 |
Mean | 4.75 | 15.89 | Mean dose (Gy) | 20.3 | Mean | 9.47 | 23.17 | Mean dose (Gy) | 16.9 |
Min | 2.53 | 8.03 | Min dose (Gy) | 10.8 | Min | 4.32 | 11.40 | Min dose (Gy) | 8.8 |
Max | 10.68 | 29.38 | Max dose (Gy) | 24.9 | Max | 22.1 | 59.50 | Max dose (Gy) | 21.8 |
Reference | Design | No. of Patients | Median Dose (Gy) | Fractions | Median FU (Months) | Local Control (%) | Median OS (Months) |
---|---|---|---|---|---|---|---|
Schellenberg [21] | Prospective | 20 | 25 | 1 | 30 | 94 | 11.8 |
Polistina [22] | Prospective | 23 | 30 | 3 | 9 | 57 | 10.6 |
Chang [23] | Retrospective | 77 | 25 | 1 | 6 | 84 | 11.4 |
Mahadevan [24] | Retrospective | 39 | 24–36 | 3 | 21 | 85 | 20 |
Didolkar [25] | Prospective | 85 | 15–30 | 3 | 8 | 91.7 | 18.6 |
Koong [26] | Prospective | 15 | 15–25 | 1 | - | 77 | 11 |
Rwigema [27] | Retrospective | 71 | 18–25 | 1 | 12.7 | 64.8 | 10.3 |
Tozzi [28] | Prospective | 30 | 36–45 | 6 | 11 | 96 | 19.5 |
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Share and Cite
Waheed, A.; Murland, S.; Yip, E.; Heikal, A.; Ghosh, S.; Abraham, A.; Paulson, K.; Tankel, K.; Usmani, N.; Severin, D.; et al. Sharing Mono-Institutional Experience of Treating Pancreatic Cancer with Stereotactic Body Radiation Therapy (SBRT). Curr. Oncol. 2024, 31, 5974-5986. https://doi.org/10.3390/curroncol31100446
Waheed A, Murland S, Yip E, Heikal A, Ghosh S, Abraham A, Paulson K, Tankel K, Usmani N, Severin D, et al. Sharing Mono-Institutional Experience of Treating Pancreatic Cancer with Stereotactic Body Radiation Therapy (SBRT). Current Oncology. 2024; 31(10):5974-5986. https://doi.org/10.3390/curroncol31100446
Chicago/Turabian StyleWaheed, Asmara, Shannah Murland, Eugene Yip, Amr Heikal, Sunita Ghosh, Aswin Abraham, Kim Paulson, Keith Tankel, Nawaid Usmani, Diane Severin, and et al. 2024. "Sharing Mono-Institutional Experience of Treating Pancreatic Cancer with Stereotactic Body Radiation Therapy (SBRT)" Current Oncology 31, no. 10: 5974-5986. https://doi.org/10.3390/curroncol31100446
APA StyleWaheed, A., Murland, S., Yip, E., Heikal, A., Ghosh, S., Abraham, A., Paulson, K., Tankel, K., Usmani, N., Severin, D., Wong, C., & Joseph, K. (2024). Sharing Mono-Institutional Experience of Treating Pancreatic Cancer with Stereotactic Body Radiation Therapy (SBRT). Current Oncology, 31(10), 5974-5986. https://doi.org/10.3390/curroncol31100446