Individually optimized stereotactic radiotherapy for pancreatic head tumors: A planning feasibility study

Milly Buwenge; Savino Cilla; Alessandra Guido; Lucia Giaccherini; Gabriella Macchia; Francesco Deodato; Silvia Cammelli; Francesco Cellini; Gian C Mattiucci; Vincenzo Valentini; Markus Stock; Alessio G Morganti

doi:10.1016/j.rpor.2016.09.003

Individually optimized stereotactic radiotherapy for pancreatic head tumors: A planning feasibility study

Milly Buwenge, Savino Cilla, Alessandra Guido, Lucia Giaccherini, Gabriella Macchia, Francesco Deodato, Silvia Cammelli, Francesco Cellini, Gian C Mattiucci, Vincenzo Valentini, Markus Stock, Alessio G Morganti

Research output: Journal article (peer-reviewed) › Journal article

10 Citations (Scopus)

Abstract

AIM: Aim of this study was to perform a planning feasibility analysis of a 3-level dose prescription using an IMRT-SIB technique.

BACKGROUND: Radiation therapy of locally advanced pancreatic cancer should administer a minimum dose to the duodenum and a very high dose to the vascular infiltration areas to improve the possibility of a radical resection.

MATERIALS AND METHODS: Fifteen patients with pancreatic head adenocarcinoma and vascular involvement were included. The duodenal PTV (PTVd) was defined as the GTV overlapping the duodenal PRV. Vascular CTV (CTVv) was defined as the surface of contact or infiltration between the tumor and vessel plus a 5 mm margin. Vascular PTV (PTVv) was considered as the CTVv plus an anisotropic margin. The tumor PTV (PTVt) was defined as the GTV plus a margin including the PTVv and excluding the PTVd. The following doses were prescribed: 30 Gy (6 Gy/fraction) to PTVd, 37.5 Gy (7.5 Gy/fraction) to PTVt, and 45 Gy (9 Gy/fraction) to PTVv, respectively. Treatment was planned with an IMRT technique.

RESULTS: The primary end-point (PTVv Dmean > 90%) was achieved in all patients. PTVv D98% > 90% was achieved in 6 patients (40%). OARs constraints were achieved in all patients.

CONCLUSIONS: Although the PTVv D95% > 95% objective was achieved only in 40% of patients, the study showed that in 100% of patients it was possible to administer a strongly differentiated mean/median dose. Prospective trials based on clinical application of this strategy seem to be justified in selected patients without overlap between PTVd and PTVv.

Original language	English
Pages (from-to)	548-554
Number of pages	7
Journal	Reports of Practical Oncology and Radiotherapy
Volume	21
Issue number	6
DOIs	https://doi.org/10.1016/j.rpor.2016.09.003
Publication status	Published - 01 Nov 2016
Externally published	Yes

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10.1016/j.rpor.2016.09.003

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Buwenge, M., Cilla, S., Guido, A., Giaccherini, L., Macchia, G., Deodato, F., Cammelli, S., Cellini, F., Mattiucci, G. C., Valentini, V., Stock, M., & Morganti, A. G. (2016). Individually optimized stereotactic radiotherapy for pancreatic head tumors: A planning feasibility study. Reports of Practical Oncology and Radiotherapy, 21(6), 548-554. https://doi.org/10.1016/j.rpor.2016.09.003

@article{6302686a508d4b5a88df96c27a9b4816,

title = "Individually optimized stereotactic radiotherapy for pancreatic head tumors: A planning feasibility study",

abstract = "AIM: Aim of this study was to perform a planning feasibility analysis of a 3-level dose prescription using an IMRT-SIB technique.BACKGROUND: Radiation therapy of locally advanced pancreatic cancer should administer a minimum dose to the duodenum and a very high dose to the vascular infiltration areas to improve the possibility of a radical resection.MATERIALS AND METHODS: Fifteen patients with pancreatic head adenocarcinoma and vascular involvement were included. The duodenal PTV (PTVd) was defined as the GTV overlapping the duodenal PRV. Vascular CTV (CTVv) was defined as the surface of contact or infiltration between the tumor and vessel plus a 5 mm margin. Vascular PTV (PTVv) was considered as the CTVv plus an anisotropic margin. The tumor PTV (PTVt) was defined as the GTV plus a margin including the PTVv and excluding the PTVd. The following doses were prescribed: 30 Gy (6 Gy/fraction) to PTVd, 37.5 Gy (7.5 Gy/fraction) to PTVt, and 45 Gy (9 Gy/fraction) to PTVv, respectively. Treatment was planned with an IMRT technique.RESULTS: The primary end-point (PTVv Dmean > 90%) was achieved in all patients. PTVv D98% > 90% was achieved in 6 patients (40%). OARs constraints were achieved in all patients.CONCLUSIONS: Although the PTVv D95% > 95% objective was achieved only in 40% of patients, the study showed that in 100% of patients it was possible to administer a strongly differentiated mean/median dose. Prospective trials based on clinical application of this strategy seem to be justified in selected patients without overlap between PTVd and PTVv.",

author = "Milly Buwenge and Savino Cilla and Alessandra Guido and Lucia Giaccherini and Gabriella Macchia and Francesco Deodato and Silvia Cammelli and Francesco Cellini and Mattiucci, {Gian C} and Vincenzo Valentini and Markus Stock and Morganti, {Alessio G}",

note = "Publisher Copyright: {\textcopyright} 2016 Greater Poland Cancer Centre",

year = "2016",

month = nov,

day = "1",

doi = "10.1016/j.rpor.2016.09.003",

language = "English",

volume = "21",

pages = "548--554",

journal = "Reports of Practical Oncology and Radiotherapy",

issn = "1507-1367",

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number = "6",

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Buwenge, M, Cilla, S, Guido, A, Giaccherini, L, Macchia, G, Deodato, F, Cammelli, S, Cellini, F, Mattiucci, GC, Valentini, V, Stock, M & Morganti, AG 2016, 'Individually optimized stereotactic radiotherapy for pancreatic head tumors: A planning feasibility study', Reports of Practical Oncology and Radiotherapy, vol. 21, no. 6, pp. 548-554. https://doi.org/10.1016/j.rpor.2016.09.003

TY - JOUR

T1 - Individually optimized stereotactic radiotherapy for pancreatic head tumors

T2 - A planning feasibility study

AU - Buwenge, Milly

AU - Cilla, Savino

AU - Guido, Alessandra

AU - Giaccherini, Lucia

AU - Macchia, Gabriella

AU - Deodato, Francesco

AU - Cammelli, Silvia

AU - Cellini, Francesco

AU - Mattiucci, Gian C

AU - Valentini, Vincenzo

AU - Stock, Markus

AU - Morganti, Alessio G

PY - 2016/11/1

Y1 - 2016/11/1

N2 - AIM: Aim of this study was to perform a planning feasibility analysis of a 3-level dose prescription using an IMRT-SIB technique.BACKGROUND: Radiation therapy of locally advanced pancreatic cancer should administer a minimum dose to the duodenum and a very high dose to the vascular infiltration areas to improve the possibility of a radical resection.MATERIALS AND METHODS: Fifteen patients with pancreatic head adenocarcinoma and vascular involvement were included. The duodenal PTV (PTVd) was defined as the GTV overlapping the duodenal PRV. Vascular CTV (CTVv) was defined as the surface of contact or infiltration between the tumor and vessel plus a 5 mm margin. Vascular PTV (PTVv) was considered as the CTVv plus an anisotropic margin. The tumor PTV (PTVt) was defined as the GTV plus a margin including the PTVv and excluding the PTVd. The following doses were prescribed: 30 Gy (6 Gy/fraction) to PTVd, 37.5 Gy (7.5 Gy/fraction) to PTVt, and 45 Gy (9 Gy/fraction) to PTVv, respectively. Treatment was planned with an IMRT technique.RESULTS: The primary end-point (PTVv Dmean > 90%) was achieved in all patients. PTVv D98% > 90% was achieved in 6 patients (40%). OARs constraints were achieved in all patients.CONCLUSIONS: Although the PTVv D95% > 95% objective was achieved only in 40% of patients, the study showed that in 100% of patients it was possible to administer a strongly differentiated mean/median dose. Prospective trials based on clinical application of this strategy seem to be justified in selected patients without overlap between PTVd and PTVv.

AB - AIM: Aim of this study was to perform a planning feasibility analysis of a 3-level dose prescription using an IMRT-SIB technique.BACKGROUND: Radiation therapy of locally advanced pancreatic cancer should administer a minimum dose to the duodenum and a very high dose to the vascular infiltration areas to improve the possibility of a radical resection.MATERIALS AND METHODS: Fifteen patients with pancreatic head adenocarcinoma and vascular involvement were included. The duodenal PTV (PTVd) was defined as the GTV overlapping the duodenal PRV. Vascular CTV (CTVv) was defined as the surface of contact or infiltration between the tumor and vessel plus a 5 mm margin. Vascular PTV (PTVv) was considered as the CTVv plus an anisotropic margin. The tumor PTV (PTVt) was defined as the GTV plus a margin including the PTVv and excluding the PTVd. The following doses were prescribed: 30 Gy (6 Gy/fraction) to PTVd, 37.5 Gy (7.5 Gy/fraction) to PTVt, and 45 Gy (9 Gy/fraction) to PTVv, respectively. Treatment was planned with an IMRT technique.RESULTS: The primary end-point (PTVv Dmean > 90%) was achieved in all patients. PTVv D98% > 90% was achieved in 6 patients (40%). OARs constraints were achieved in all patients.CONCLUSIONS: Although the PTVv D95% > 95% objective was achieved only in 40% of patients, the study showed that in 100% of patients it was possible to administer a strongly differentiated mean/median dose. Prospective trials based on clinical application of this strategy seem to be justified in selected patients without overlap between PTVd and PTVv.

UR - http://www.scopus.com/inward/record.url?scp=84988700572&partnerID=8YFLogxK

U2 - 10.1016/j.rpor.2016.09.003

DO - 10.1016/j.rpor.2016.09.003

M3 - Journal article

C2 - 27708554

SN - 1507-1367

VL - 21

SP - 548

EP - 554

JO - Reports of Practical Oncology and Radiotherapy

JF - Reports of Practical Oncology and Radiotherapy

IS - 6

ER -

Individually optimized stereotactic radiotherapy for pancreatic head tumors: A planning feasibility study

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