Anand Mahadevan1, Shalini Moningi2, Jimm Grimm3, X Allen Li4, Kenneth M Forster3, Manisha Palta5, Phillip Prior4, Karyn A Goodman6, Amol Narang7, Dwight E Heron8, Simon S Lo9, James Urbanic10, Joseph M Herman11. 1. Department of Radiation Oncology, Geisinger Cancer Institute, Danville, Pennsylvania. Electronic address: amahadevan@geisinger.edu. 2. Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts. 3. Department of Radiation Oncology, Geisinger Cancer Institute, Danville, Pennsylvania. 4. Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin. 5. Department of Radiation Oncology, Duke University, Durham, North Carolina. 6. Department of Radiation Oncology, Mount Sinai Hospital, New York, New York. 7. Department of Radiation Oncology, Johns Hopkins Hospital, Baltimore, Maryland. 8. Department of Radiation Oncology, Bon Secours Mercy Health System, Youngstown, Ohio. 9. Department of Radiation Oncology, Washington University, Seattle, Washington. 10. Department of Radiation Oncology, University of California, San Diego, California. 11. Department of Radiation Oncology, Northwell Health, New York, New York.
Abstract
PURPOSE: Stereotactic body radiation therapy (SBRT) and stereotactic ablative body radiation therapy is being increasingly used for pancreatic cancer (PCa), particularly in patients with locally advanced and borderline resectable disease. A wide variety of dose fractionation schemes have been reported in the literature. This HyTEC review uses tumor control probability models to evaluate the comparative effectiveness of the various SBRT treatment regimens used in the treatment of patients with localized PCa. METHODS AND MATERIALS: A PubMed search was performed to review the published literature on the use of hypofractionated SBRT (usually in 1-5 fractions) for PCa in various clinical scenarios (eg, preoperative [neoadjuvant], borderline resectable, and locally advanced PCa). The linear quadratic model with α/β= 10 Gy was used to address differences in fractionation. Logistic tumor control probability models were generated using maximum likelihood parameter fitting. RESULTS: After converting to 3-fraction equivalent doses, the pooled reported data and associated models suggests that 1-year local control (LC) without surgery is ≈79% to 86% after the equivalent of 30 to 36 Gy in 3 fractions, showing a dose response in the range of 25 to 36 Gy, and decreasing to less than 70% 1-year LC at doses below 24 Gy in 3 fractions. The 33 Gy in 5 fraction regimen (Alliance A021501) corresponds to 28.2 Gy in 3 fractions, for which the HyTEC pooled model had 77% 1-year LC without surgery. Above an equivalent dose of 28 Gy in 3 fractions, with margin-negative resection the 1-year LC exceeded 90%. CONCLUSIONS: Pooled analyses of reported tumor control probabilities for commonly used SBRT dose-fractionation schedules for PCa suggests a dose response. These findings should be viewed with caution given the challenges and limitations of this review. Additional data are needed to better understand the dose or fractionation-response of SBRT for PCa.
PURPOSE: Stereotactic body radiation therapy (SBRT) and stereotactic ablative body radiation therapy is being increasingly used for pancreatic cancer (PCa), particularly in patients with locally advanced and borderline resectable disease. A wide variety of dose fractionation schemes have been reported in the literature. This HyTEC review uses tumor control probability models to evaluate the comparative effectiveness of the various SBRT treatment regimens used in the treatment of patients with localized PCa. METHODS AND MATERIALS: A PubMed search was performed to review the published literature on the use of hypofractionated SBRT (usually in 1-5 fractions) for PCa in various clinical scenarios (eg, preoperative [neoadjuvant], borderline resectable, and locally advanced PCa). The linear quadratic model with α/β= 10 Gy was used to address differences in fractionation. Logistic tumor control probability models were generated using maximum likelihood parameter fitting. RESULTS: After converting to 3-fraction equivalent doses, the pooled reported data and associated models suggests that 1-year local control (LC) without surgery is ≈79% to 86% after the equivalent of 30 to 36 Gy in 3 fractions, showing a dose response in the range of 25 to 36 Gy, and decreasing to less than 70% 1-year LC at doses below 24 Gy in 3 fractions. The 33 Gy in 5 fraction regimen (Alliance A021501) corresponds to 28.2 Gy in 3 fractions, for which the HyTEC pooled model had 77% 1-year LC without surgery. Above an equivalent dose of 28 Gy in 3 fractions, with margin-negative resection the 1-year LC exceeded 90%. CONCLUSIONS: Pooled analyses of reported tumor control probabilities for commonly used SBRT dose-fractionation schedules for PCa suggests a dose response. These findings should be viewed with caution given the challenges and limitations of this review. Additional data are needed to better understand the dose or fractionation-response of SBRT for PCa.
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: Morgan Michalet; Karl Bordeau; Marie Cantaloube; Simon Valdenaire; Pierre Debuire; Sebastien Simeon; Fabienne Portales; Roxana Draghici; Marc Ychou; Eric Assenat; Marie Dupuy; Sophie Gourgou; Pierre-Emmanuel Colombo; Sebastien Carrere; François-Regis Souche; Norbert Aillères; Pascal Fenoglietto; David Azria; Olivier Riou Journal: Front Oncol Date: 2022-03-09 Impact factor: 6.244