Chemoradiotherapy for locally advanced pancreatic cancer: a radiotherapy dose escalation and organ motion study.

2.50
Hdl Handle:
http://hdl.handle.net/10541/68699
Title:
Chemoradiotherapy for locally advanced pancreatic cancer: a radiotherapy dose escalation and organ motion study.
Authors:
Henry, Ann M; Ryder, W David J; Moore, Christopher J; Sherlock, David J; Geh, J I; Dunn, P; Price, Patricia M
Abstract:
AIMS: To determine the efficacy of radiation dose escalation and to examine organ motion during conformal radiotherapy for locally advanced pancreatic cancer. MATERIALS AND METHODS: Thirty-nine patients who were consecutively treated with chemoradiotherapy were studied. Fifteen patients, treated from 1993 to 1997, received 50 Gy in 20 fractions (group I). Twenty-four patients, treated from 1997 to 2003, received an escalated dose of 55 Gy in 25 fractions (group II). Intra-fraction pancreatic tumour motion was assessed in three patients using megavoltage movies during radiation delivery to track implanted radio-opaque markers. RESULTS: Improved survival rates were seen in latterly treated group II patients (P=0.083), who received escalated radiotherapy to smaller treatment volumes due to advances in verification. Worse toxicity effects (World Health Organization grade 3-4) were reported by some patients (<10%), but treatment compliance was similar in both groups, indicating equivalent tolerance. Substantial intra-fraction tumour displacement due to respiratory motion was observed: this was greatest in the superior/inferior (mean=6.6 mm) and anterior/posterior (mean=4.75 mm) directions. Lateral displacements were small (<2 mm). CONCLUSIONS: Dose escalation is feasible in pancreatic cancer, particularly when combined with a reduction in irradiated volume, and enhanced efficacy is indicated. Large, globally applied margins to compensate for pancreatic tumour motion during radiotherapy may be inappropriate. Strategies to reduce respiratory motion, and/or the application of image-guided techniques that incorporate individual patients' respiratory motion into radiotherapy planning and delivery, will probably improve pancreatic radiotherapy.
Affiliation:
Academic Department of Radiation Oncology, The University of Manchester, Department of Medical Statistics, Christie Hospital NHS Trust, Manchester, UK.
Citation:
Chemoradiotherapy for locally advanced pancreatic cancer: a radiotherapy dose escalation and organ motion study. 2008, 20 (7):541-7 Clin Oncol
Journal:
Clinical Oncology
Issue Date:
Sep-2008
URI:
http://hdl.handle.net/10541/68699
DOI:
10.1016/j.clon.2008.03.004
PubMed ID:
18562186
Type:
Article
Language:
en
ISSN:
0936-6555
Appears in Collections:
All Christie Publications ; Christie Medical Physics and Engineering Research; Academic Department of Radiation Oncology - ADRO

Full metadata record

DC FieldValue Language
dc.contributor.authorHenry, Ann M-
dc.contributor.authorRyder, W David J-
dc.contributor.authorMoore, Christopher J-
dc.contributor.authorSherlock, David J-
dc.contributor.authorGeh, J I-
dc.contributor.authorDunn, P-
dc.contributor.authorPrice, Patricia M-
dc.date.accessioned2009-05-21T16:30:06Z-
dc.date.available2009-05-21T16:30:06Z-
dc.date.issued2008-09-
dc.identifier.citationChemoradiotherapy for locally advanced pancreatic cancer: a radiotherapy dose escalation and organ motion study. 2008, 20 (7):541-7 Clin Oncolen
dc.identifier.issn0936-6555-
dc.identifier.pmid18562186-
dc.identifier.doi10.1016/j.clon.2008.03.004-
dc.identifier.urihttp://hdl.handle.net/10541/68699-
dc.description.abstractAIMS: To determine the efficacy of radiation dose escalation and to examine organ motion during conformal radiotherapy for locally advanced pancreatic cancer. MATERIALS AND METHODS: Thirty-nine patients who were consecutively treated with chemoradiotherapy were studied. Fifteen patients, treated from 1993 to 1997, received 50 Gy in 20 fractions (group I). Twenty-four patients, treated from 1997 to 2003, received an escalated dose of 55 Gy in 25 fractions (group II). Intra-fraction pancreatic tumour motion was assessed in three patients using megavoltage movies during radiation delivery to track implanted radio-opaque markers. RESULTS: Improved survival rates were seen in latterly treated group II patients (P=0.083), who received escalated radiotherapy to smaller treatment volumes due to advances in verification. Worse toxicity effects (World Health Organization grade 3-4) were reported by some patients (<10%), but treatment compliance was similar in both groups, indicating equivalent tolerance. Substantial intra-fraction tumour displacement due to respiratory motion was observed: this was greatest in the superior/inferior (mean=6.6 mm) and anterior/posterior (mean=4.75 mm) directions. Lateral displacements were small (<2 mm). CONCLUSIONS: Dose escalation is feasible in pancreatic cancer, particularly when combined with a reduction in irradiated volume, and enhanced efficacy is indicated. Large, globally applied margins to compensate for pancreatic tumour motion during radiotherapy may be inappropriate. Strategies to reduce respiratory motion, and/or the application of image-guided techniques that incorporate individual patients' respiratory motion into radiotherapy planning and delivery, will probably improve pancreatic radiotherapy.en
dc.language.isoenen
dc.subjectDose Escalationen
dc.subjectImagingen
dc.subjectMotionen
dc.subjectPancreatic Canceren
dc.subjectRadiotherapyen
dc.subject.meshAdult-
dc.subject.meshAged-
dc.subject.meshAged, 80 and over-
dc.subject.meshAntineoplastic Agents-
dc.subject.meshCombined Modality Therapy-
dc.subject.meshDose-Response Relationship, Radiation-
dc.subject.meshFemale-
dc.subject.meshHumans-
dc.subject.meshKaplan-Meiers Estimate-
dc.subject.meshMale-
dc.subject.meshMiddle Aged-
dc.subject.meshPancreatic Neoplasms-
dc.subject.meshRadiation Injuries-
dc.subject.meshRetrospective Studies-
dc.titleChemoradiotherapy for locally advanced pancreatic cancer: a radiotherapy dose escalation and organ motion study.en
dc.typeArticleen
dc.contributor.departmentAcademic Department of Radiation Oncology, The University of Manchester, Department of Medical Statistics, Christie Hospital NHS Trust, Manchester, UK.en
dc.identifier.journalClinical Oncologyen

Related articles on PubMed

All Items in Christie are protected by copyright, with all rights reserved, unless otherwise indicated.