PURPOSE: We assessed the feasibility and theoretical dosimetric advantages of an injectable hydrogel to increase the space between the head of the pancreas (HOP) and duodenum in a human cadaveric model. METHODS AND MATERIALS: Using 3 human cadaveric specimens, an absorbable radiopaque hydrogel was injected between the HOP and duodenum by way of open laparotomy in 1 case and endoscopic ultrasound (EUS) guidance in 2 cases. The cadavers were subsequently imaged using computed tomography and dissected for histologic confirmation of hydrogel placement. The duodenal dose reduction and planning target volume (PTV) coverage were characterized using pre- and postspacer injection stereotactic body radiation therapy (SBRT) plans for the 2 cadavers with EUS-guided placement, the delivery method that appeared the most clinically desirable. Modeling studies were performed using 60 SBRT plans consisting of 10 previously treated patients with unresectable pancreatic cancer, each with 6 different HOP-duodenum separation distances. The duodenal volume receiving 15 Gy (V15), 20 Gy (V20), and 33 Gy (V33) was assessed for each iteration. RESULTS: In the 3 cadaveric studies, an average of 0.9 cm, 1.1 cm, and 0.9 cm HOP-duodenum separation was achieved. In the 2 EUS cases, the V20 decreased from 3.86 cm3 to 0.36 cm3 and 3.75 cm3 to 1.08 cm3 (treatment constraint <3 cm3), and the V15 decreased from 7.07 cm3 to 2.02 cm3 and 9.12 cm3 to 3.91 cm3 (treatment constraint <9 cm3). The PTV coverage improved or was comparable between the pre- and postinjection studies. Modeling studies demonstrated that a separation of 8 mm was sufficient to consistently reduce the V15, V20, and V33 to acceptable clinical constraints. CONCLUSIONS: Currently, dose escalation has been limited owing to radiosensitive structures adjacent to the pancreas. We demonstrated the feasibility of hydrogel separation of the HOP and duodenum. Future studies will evaluate the safety and efficacy of this technique with the potential for more effective dose escalation using SBRT or intensity-modulated radiation therapy to improve the outcomes in patients with unresectable pancreatic cancer.
PURPOSE: We assessed the feasibility and theoretical dosimetric advantages of an injectable hydrogel to increase the space between the head of the pancreas (HOP) and duodenum in a human cadaveric model. METHODS AND MATERIALS: Using 3 human cadaveric specimens, an absorbable radiopaque hydrogel was injected between the HOP and duodenum by way of open laparotomy in 1 case and endoscopic ultrasound (EUS) guidance in 2 cases. The cadavers were subsequently imaged using computed tomography and dissected for histologic confirmation of hydrogel placement. The duodenal dose reduction and planning target volume (PTV) coverage were characterized using pre- and postspacer injection stereotactic body radiation therapy (SBRT) plans for the 2 cadavers with EUS-guided placement, the delivery method that appeared the most clinically desirable. Modeling studies were performed using 60 SBRT plans consisting of 10 previously treated patients with unresectable pancreatic cancer, each with 6 different HOP-duodenum separation distances. The duodenal volume receiving 15 Gy (V15), 20 Gy (V20), and 33 Gy (V33) was assessed for each iteration. RESULTS: In the 3 cadaveric studies, an average of 0.9 cm, 1.1 cm, and 0.9 cm HOP-duodenum separation was achieved. In the 2 EUS cases, the V20 decreased from 3.86 cm3 to 0.36 cm3 and 3.75 cm3 to 1.08 cm3 (treatment constraint <3 cm3), and the V15 decreased from 7.07 cm3 to 2.02 cm3 and 9.12 cm3 to 3.91 cm3 (treatment constraint <9 cm3). The PTV coverage improved or was comparable between the pre- and postinjection studies. Modeling studies demonstrated that a separation of 8 mm was sufficient to consistently reduce the V15, V20, and V33 to acceptable clinical constraints. CONCLUSIONS: Currently, dose escalation has been limited owing to radiosensitive structures adjacent to the pancreas. We demonstrated the feasibility of hydrogel separation of the HOP and duodenum. Future studies will evaluate the safety and efficacy of this technique with the potential for more effective dose escalation using SBRT or intensity-modulated radiation therapy to improve the outcomes in patients with unresectable pancreatic cancer.
Authors: Edgar Ben-Josef; Mathew Schipper; Isaac R Francis; Scott Hadley; Randall Ten-Haken; Theodore Lawrence; Daniel Normolle; Diane M Simeone; Christopher Sonnenday; Ross Abrams; William Leslie; Gazala Khan; Mark M Zalupski Journal: Int J Radiat Oncol Biol Phys Date: 2012-04-27 Impact factor: 7.038
Authors: Gencay Hatiboglu; Michael Pinkawa; Jean-Paul Vallée; Boris Hadaschik; Markus Hohenfellner Journal: BJU Int Date: 2012-07-12 Impact factor: 5.588
Authors: Edgar Ben-Josef; Anthony F Shields; Ulka Vaishampayan; Vainutis Vaitkevicius; Basil F El-Rayes; Patrick McDermott; Jay Burmeister; Todd Bossenberger; Philip A Philip Journal: Int J Radiat Oncol Biol Phys Date: 2004-06-01 Impact factor: 7.038
Authors: H N Ismael; J Denbo; S Cox; C H Crane; P Das; S Krishnan; R T Schroff; M Javle; C Conrad; J Vauthey; T Aloia Journal: Eur J Surg Oncol Date: 2016-06-02 Impact factor: 4.424
Authors: Joseph M Herman; Daniel T Chang; Karyn A Goodman; Avani S Dholakia; Siva P Raman; Amy Hacker-Prietz; Christine A Iacobuzio-Donahue; Mary E Griffith; Timothy M Pawlik; Jonathan S Pai; Eileen O'Reilly; George A Fisher; Aaron T Wild; Lauren M Rosati; Lei Zheng; Christopher L Wolfgang; Daniel A Laheru; Laurie A Columbo; Elizabeth A Sugar; Albert C Koong Journal: Cancer Date: 2014-12-23 Impact factor: 6.860
Authors: Colin S Hill; Lauren Rosati; Hao Wang; Hua-Ling Tsai; Jin He; Amy Hacker-Prietz; Daniel A Laheru; Lei Zheng; Shuchi Sehgal; Vincent Bernard; Dung T Le; Timothy M Pawlik; Matthew J Weiss; Amol K Narang; Joseph M Herman Journal: Pract Radiat Oncol Date: 2022-03-17
Authors: Ziwei Feng; Avani D Rao; Zhi Cheng; Eun Ji Shin; Joseph Moore; Lin Su; Seong-Hun Kim; John Wong; Amol Narang; Joseph M Herman; Todd McNutt; Dengwang Li; Kai Ding Journal: Int J Radiat Oncol Biol Phys Date: 2018-07-19 Impact factor: 7.038
Authors: Avani Dholakia Rao; Eun Ji Shin; Jeffrey Meyer; Elizabeth L Thompson; Wei Fu; Chen Hu; Elliot K Fishman; Matthew Weiss; Christopher Wolfgang; Richard Burkhart; Jin He; Tossapol Kerdsirichairat; Joseph M Herman; Kai Ding; Amol Narang Journal: Pract Radiat Oncol Date: 2020-03-07
Authors: Avani D Rao; Eun Ji Shin; Sarah E Beck; Caroline Garrett; Seong-Hun Kim; Nam Ju Lee; Eleni Liapi; John Wong; Joseph Herman; Amol Narang; Kai Ding Journal: Int J Radiat Oncol Biol Phys Date: 2018-03-02 Impact factor: 7.038
Authors: Lianna D Di Maso; Jessie Huang; Michael F Bassetti; Larry A DeWerd; Jessica R Miller Journal: J Appl Clin Med Phys Date: 2018-08-17 Impact factor: 2.102
Authors: Eugene J Koay; Alexander N Hanania; William A Hall; Cullen M Taniguchi; Neal Rebueno; Sten Myrehaug; Katharine L Aitken; Laura A Dawson; Christopher H Crane; Joseph M Herman; Beth Erickson Journal: Pract Radiat Oncol Date: 2020-02-13