PURPOSE: Radiation therapy dose escalation using stereotactic body radiation therapy may significantly improve both local control (LC) and overall survival (OS) for patients with inoperable pancreas cancer. However, ablative dose cannot be routinely offered because of the risk of causing severe injury to adjacent normal organs. Stereotactic magnetic resonance (MR)-guided adaptive radiation therapy (SMART) represents a novel technique that may achieve safe delivery of ablative dose and improve long-term outcomes. METHODS AND MATERIALS: We performed a single institution retrospective analysis of 35 consecutive pancreatic cancer patients treated with SMART in mid-inspiration breath hold on an MR-linear accelerator. Most had locally advanced disease (80%) and received induction chemotherapy (91.4%) for a median 3.9 months before stereotactic body radiation therapy. All were prescribed 5 fractions delivered in consecutive days to a median total dose of 50 Gy (BED10 100 Gy10), typically with a 120% to 130% hotspot. Elective nodal irradiation was delivered to 20 (57.1%) patients. No patient had fiducial markers placed and all were treated with continuous intrafraction MR visualization and automatic beam triggering. RESULTS: With median follow-up of 10.3 months from SMART, acute (2.9%) and late (2.9%) grade 3 toxicities were uncommon. One-year LC, distant metastasis-free survival, progression-free survival, cause-specific survival, and OS were 87.8%, 63.1%, 52.4%, 77.6%, and 58.9%, respectively. CONCLUSIONS: To our knowledge, this is the first report of 5-fraction pancreas SMART delivered on an MR-linear accelerator. We observed minimal severe treatment-related toxicity and encouraging early LC. Prospective confirmation of feasibility and long-term clinical outcomes of dose intensified SMART is warranted.
PURPOSE: Radiation therapy dose escalation using stereotactic body radiation therapy may significantly improve both local control (LC) and overall survival (OS) for patients with inoperable pancreas cancer. However, ablative dose cannot be routinely offered because of the risk of causing severe injury to adjacent normal organs. Stereotactic magnetic resonance (MR)-guided adaptive radiation therapy (SMART) represents a novel technique that may achieve safe delivery of ablative dose and improve long-term outcomes. METHODS AND MATERIALS: We performed a single institution retrospective analysis of 35 consecutive pancreatic cancerpatients treated with SMART in mid-inspiration breath hold on an MR-linear accelerator. Most had locally advanced disease (80%) and received induction chemotherapy (91.4%) for a median 3.9 months before stereotactic body radiation therapy. All were prescribed 5 fractions delivered in consecutive days to a median total dose of 50 Gy (BED10 100 Gy10), typically with a 120% to 130% hotspot. Elective nodal irradiation was delivered to 20 (57.1%) patients. No patient had fiducial markers placed and all were treated with continuous intrafraction MR visualization and automatic beam triggering. RESULTS: With median follow-up of 10.3 months from SMART, acute (2.9%) and late (2.9%) grade 3 toxicities were uncommon. One-year LC, distant metastasis-free survival, progression-free survival, cause-specific survival, and OS were 87.8%, 63.1%, 52.4%, 77.6%, and 58.9%, respectively. CONCLUSIONS: To our knowledge, this is the first report of 5-fraction pancreas SMART delivered on an MR-linear accelerator. We observed minimal severe treatment-related toxicity and encouraging early LC. Prospective confirmation of feasibility and long-term clinical outcomes of dose intensified SMART is warranted.
Authors: William A Hall; Eric Paulson; X Allen Li; Beth Erickson; Christopher Schultz; Alison Tree; Musaddiq Awan; Daniel A Low; Brigid A McDonald; Travis Salzillo; Carri K Glide-Hurst; Amar U Kishan; Clifton D Fuller Journal: CA Cancer J Clin Date: 2021-11-18 Impact factor: 508.702
Authors: Abhinav V Reddy; Colin S Hill; Shuchi Sehgal; Jin He; Lei Zheng; Joseph M Herman; Jeffrey Meyer; Amol K Narang Journal: J Gastrointest Oncol Date: 2022-06
Authors: Tugce Kutuk; Robert Herrera; Teuta Z Mustafayev; Gorkem Gungor; Gamze Ugurluer; Banu Atalar; Rupesh Kotecha; Matthew D Hall; Muni Rubens; Kathryn E Mittauer; Jessika A Contreras; James McCulloch; Noah S Kalman; Diane Alvarez; Tino Romaguera; Alonso N Gutierrez; Jacklyn Garcia; Adeel Kaiser; Minesh P Mehta; Enis Ozyar; Michael D Chuong Journal: Adv Radiat Oncol Date: 2022-04-25
Authors: Michael D Chuong; Roberto Herrera; Adeel Kaiser; Muni Rubens; Tino Romaguera; Diane Alvarez; Rupesh Kotecha; Matthew D Hall; James McCulloch; Antonio Ucar; Fernando DeZarraga; Santiago Aparo; Sarah Joseph; Horacio Asbun; Ramon Jimenez; Govindarajan Narayanan; Alonso N Gutierrez; Kathryn E Mittauer Journal: Front Oncol Date: 2022-06-23 Impact factor: 5.738
Authors: Robert Hawranko; James J Sohn; Keith Neiderer; Ed Bump; Timothy Harris; Emma C Fields; Elisabeth Weiss; William Y Song Journal: J Clin Med Date: 2022-05-05 Impact factor: 4.241
Authors: William A Hall; Christina Small; Eric Paulson; Eugene J Koay; Christopher Crane; Martijn Intven; Lois A Daamen; Gert J Meijer; Hanne D Heerkens; Michael Bassetti; Stephen A Rosenberg; Katharine Aitken; Sten Myrehaug; Laura A Dawson; Percy Lee; Cihan Gani; Michael David Chuong; Parag J Parikh; Beth A Erickson Journal: Front Oncol Date: 2021-05-11 Impact factor: 5.738
Authors: Neelam Tyagi; Jiayi Liang; Sarah Burleson; Ergys Subashi; Paola Godoy Scripes; Kathryn R Tringale; Paul B Romesser; Marsha Reyngold; Christopher H Crane Journal: Phys Imaging Radiat Oncol Date: 2021-07-12