Jennifer Y Wo1, Harvey J Mamon2, Cristina R Ferrone3, David P Ryan4, Lawrence S Blaszkowsky4, Eunice L Kwak4, Yolanda D Tseng5, Brian N Napolitano6, Marek Ancukiewicz6, Richard S Swanson7, Keith D Lillemoe3, Carlos Fernandez-del Castillo3, Theodore S Hong6. 1. Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, United States. Electronic address: jwo@partners.org. 2. Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, United States. 3. Department of General Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, United States. 4. Department of Medical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, United States. 5. Harvard Radiation Oncology Program, Boston, United States. 6. Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, United States. 7. Department of General Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, United States.
Abstract
PURPOSE: In this phase I study, we sought to determine the feasibility and tolerability of neoadjuvant short course radiotherapy (SC-CRT) delivered with photon RT with concurrent capecitabine for resectable pancreatic adenocarcinoma. MATERIALS AND METHODS: Ten patients with localized, resectable pancreatic adenocarcinoma were enrolled from December 2009 to August 2011. In dose level I, patients received 3 Gy × 10. In dose level 2, patients received 5 Gy × 5 (every other day). In dose level 3, patients received 5 Gy × 5 (consecutive days). Capecitabine was given during weeks 1 and 2. Surgery was performed 1-3 weeks after completion of chemotherapy. RESULTS: With an intended accrual of 12 patients, the study was closed early due to unexpected intraoperative complications. Compared to the companion phase I proton study, patients treated with photons had increased intraoperative RT fibrosis reported by surgeons (27% vs. 63%). Among those undergoing a Whipple resection, increased RT fibrosis translated to an increased mean OR time of 69 min. Dosimetric comparison revealed significantly increased low dose exposure to organs at risk for patients treated with photon RT. CONCLUSIONS: This phase I experience evaluating the tolerability of neoadjuvant SC-CRT with photon RT closed early due to unexpected intraoperative complications.
PURPOSE: In this phase I study, we sought to determine the feasibility and tolerability of neoadjuvant short course radiotherapy (SC-CRT) delivered with photon RT with concurrent capecitabine for resectable pancreatic adenocarcinoma. MATERIALS AND METHODS: Ten patients with localized, resectable pancreatic adenocarcinoma were enrolled from December 2009 to August 2011. In dose level I, patients received 3 Gy × 10. In dose level 2, patients received 5 Gy × 5 (every other day). In dose level 3, patients received 5 Gy × 5 (consecutive days). Capecitabine was given during weeks 1 and 2. Surgery was performed 1-3 weeks after completion of chemotherapy. RESULTS: With an intended accrual of 12 patients, the study was closed early due to unexpected intraoperative complications. Compared to the companion phase I proton study, patients treated with photons had increased intraoperative RT fibrosis reported by surgeons (27% vs. 63%). Among those undergoing a Whipple resection, increased RT fibrosis translated to an increased mean OR time of 69 min. Dosimetric comparison revealed significantly increased low dose exposure to organs at risk for patients treated with photon RT. CONCLUSIONS: This phase I experience evaluating the tolerability of neoadjuvant SC-CRT with photon RT closed early due to unexpected intraoperative complications.
Authors: Theodore S Hong; David P Ryan; Darrell R Borger; Lawrence S Blaszkowsky; Beow Y Yeap; Marek Ancukiewicz; Vikram Deshpande; Shweta Shinagare; Jennifer Y Wo; Yves Boucher; Raymond C Wadlow; Eunice L Kwak; Jill N Allen; Jeffrey W Clark; Andrew X Zhu; Cristina R Ferrone; Harvey J Mamon; Judith Adams; Barbara Winrich; Tarin Grillo; Rakesh K Jain; Thomas F DeLaney; Carlos Fernandez-del Castillo; Dan G Duda Journal: Int J Radiat Oncol Biol Phys Date: 2014-05-24 Impact factor: 7.038
Authors: Janet E Murphy; Jennifer Y Wo; David P Ryan; Jeffrey W Clark; Wenqing Jiang; Beow Y Yeap; Lorraine C Drapek; Leilana Ly; Christian V Baglini; Lawrence S Blaszkowsky; Cristina R Ferrone; Aparna R Parikh; Colin D Weekes; Ryan D Nipp; Eunice L Kwak; Jill N Allen; Ryan B Corcoran; David T Ting; Jason E Faris; Andrew X Zhu; Lipika Goyal; David L Berger; Motaz Qadan; Keith D Lillemoe; Nilesh Talele; Rakesh K Jain; Thomas F DeLaney; Dan G Duda; Yves Boucher; Carlos Fernández-Del Castillo; Theodore S Hong Journal: JAMA Oncol Date: 2019-07-01 Impact factor: 31.777
Authors: Mashaal Dhir; Gautam K Malhotra; Davendra P S Sohal; Nicholas A Hein; Lynette M Smith; Eileen M O'Reilly; Nathan Bahary; Chandrakanth Are Journal: World J Surg Oncol Date: 2017-10-10 Impact factor: 2.754
Authors: Sarah Stefanowicz; Waldemar Wlodarczyk; Susanne Frosch; Sebastian Zschaeck; Esther G C Troost Journal: Clin Transl Radiat Oncol Date: 2020-12-09