PURPOSE: In chemoradiation for pancreatic carcinoma three-dimensional target volume definitions could maximize tolerability and therapeutic effect at the same time because toxicity correlates with treatment volume. We aimed to define guidelines for elective treatment of nodal areas based on pathologic nodal involvement to optimize treatment volume for this tumor. METHODS AND MATERIALS: Pathologic patterns of regional nodal spread in 175 patients who underwent primary pancreatoduodenectomy with > or =10 assessed nodes and literature data on para-aortic spread were the base of the definition of the target volume. Significant correlations between spread to lymphatic areas and tumor characteristics were determined using Fisher's exact test. Computed tomography scans and a Pinnacle3 (Philips, Best, The Netherlands) system were used for treatment planning. RESULTS: Among 175 resected tumors without pretreatment, 76% had regional nodal metastasis and 22% had spread to distant nodes. High-risk lymphatic areas were identified and selected for elective treatment. A standardized planning procedure was derived and tested under treatment conditions. CONCLUSIONS: Histopathologic data allowed us to develop recommendations for standardized treatment planning for ductal carcinoma of the pancreatic head. These are proposed for quality assurance in multicenter studies and routine use.
PURPOSE: In chemoradiation for pancreatic carcinoma three-dimensional target volume definitions could maximize tolerability and therapeutic effect at the same time because toxicity correlates with treatment volume. We aimed to define guidelines for elective treatment of nodal areas based on pathologic nodal involvement to optimize treatment volume for this tumor. METHODS AND MATERIALS: Pathologic patterns of regional nodal spread in 175 patients who underwent primary pancreatoduodenectomy with > or =10 assessed nodes and literature data on para-aortic spread were the base of the definition of the target volume. Significant correlations between spread to lymphatic areas and tumor characteristics were determined using Fisher's exact test. Computed tomography scans and a Pinnacle3 (Philips, Best, The Netherlands) system were used for treatment planning. RESULTS: Among 175 resected tumors without pretreatment, 76% had regional nodal metastasis and 22% had spread to distant nodes. High-risk lymphatic areas were identified and selected for elective treatment. A standardized planning procedure was derived and tested under treatment conditions. CONCLUSIONS: Histopathologic data allowed us to develop recommendations for standardized treatment planning for ductal carcinoma of the pancreatic head. These are proposed for quality assurance in multicenter studies and routine use.
Authors: Karyn A Goodman; William F Regine; Laura A Dawson; Edgar Ben-Josef; Karin Haustermans; Walter R Bosch; Julius Turian; Ross A Abrams Journal: Int J Radiat Oncol Biol Phys Date: 2012-04-05 Impact factor: 7.038
Authors: Dominik Tinkl; Gerhard G Grabenbauer; Henriette Golcher; Thomas Meyer; Thomas Papadopoulos; Werner Hohenberger; Rolf Sauer; Thomas B Brunner Journal: Strahlenther Onkol Date: 2009-09-12 Impact factor: 3.621
Authors: E Fokas; C Eccles; N Patel; K-Y Chu; S Warren; W Gillies McKenna; T B Brunner Journal: Strahlenther Onkol Date: 2013-04-05 Impact factor: 3.621
Authors: Nikhil Yegya-Raman; Mihir M Shah; Miral S Grandhi; Elizabeth Poplin; David A August; Timothy J Kennedy; Usha Malhotra; Kristen R Spencer; Darren R Carpizo; Salma K Jabbour Journal: Ann Pancreat Cancer Date: 2018-08-06