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Pancreatic cancer planning: Complex conformal vs modulated therapies.
Chapman, Katherine L; Witek, Matthew E; Chen, Hongyu; Showalter, Timothy N; Bar-Ad, Voichita; Harrison, Amy S.
Afiliação
  • Chapman KL; Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, PA.
  • Witek ME; Department of Radiation Oncology, University of Wisconsin School of Medicine School of Medicine and Public Health, Madison, WI.
  • Chen H; Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, PA.
  • Showalter TN; Department of Radiation Oncology, University of Virginia, Charlottesville, VA.
  • Bar-Ad V; Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, PA.
  • Harrison AS; Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, PA. Electronic address: amy.harrison@jefferson.edu.
Med Dosim ; 41(2): 100-4, 2016.
Article em En | MEDLINE | ID: mdl-26831922
To compare the roles of intensity-modulated radiation therapy (IMRT) and volumetric- modulated arc therapy (VMAT) therapy as compared to simple and complex 3-dimensional chemoradiotherpy (3DCRT) planning for resectable and borderline resectable pancreatic cancer. In all, 12 patients who received postoperative radiotherapy (8) or neoadjuvant concurrent chemoradiotherapy (4) were evaluated retrospectively. Radiotherapy planning was performed for 4 treatment techniques: simple 4-field box, complex 5-field 3DCRT, 5 to 6-field IMRT, and single-arc VMAT. All volumes were approved by a single observer in accordance with Radiation Therapy Oncology Group (RTOG) Pancreas Contouring Atlas. Plans included tumor/tumor bed and regional lymph nodes to 45Gy; with tumor/tumor bed boosted to 50.4Gy, at least 95% of planning target volume (PTV) received the prescription dose. Dose-volume histograms (DVH) for multiple end points, treatment planning, and delivery time were assessed. Complex 3DCRT, IMRT, and VMAT plans significantly (p < 0.05) decreased mean kidney dose, mean liver dose, liver (V30, V35), stomach (D10%), stomach (V45), mean right kidney dose, and right kidney (V15) as compared with the simple 4-field plans that are most commonly reported in the literature. IMRT plans resulted in decreased mean liver dose, liver (V35), and left kidney (V15, V18, V20). VMAT plans decreased small bowel (D10%, D15%), small bowel (V35, V45), stomach (D10%, D15%), stomach (V35, V45), mean liver dose, liver (V35), left kidney (V15, V18, V20), and right kidney (V18, V20). VMAT plans significantly decreased small bowel (D10%, D15%), left kidney (V20), and stomach (V45) as compared with IMRT plans. Treatment planning and delivery times were most efficient for simple 4-field box and VMAT. Excluding patient setup and imaging, average treatment delivery was within 10minutes for simple and complex 3DCRT, IMRT, and VMAT treatments. This article shows significant improvements in 3D plan performance with complex planning over the more frequently compared 3- or 4-field simple 3D planning techniques. VMAT plans continue to demonstrate potential for the most organ sparing. However, further studies are required to identify if dosimetric benefits associated with inverse optimized planning can be translated into clinical benefits and if these treatment techniques are value-added therapies for this group of patients with cancer.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias Pancreáticas / Planejamento da Radioterapia Assistida por Computador / Radioterapia Conformacional / Radioterapia de Intensidade Modulada Tipo de estudo: Etiology_studies / Observational_studies / Risk_factors_studies Limite: Humans Idioma: En Revista: Med Dosim Assunto da revista: RADIOTERAPIA Ano de publicação: 2016 Tipo de documento: Article País de publicação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Neoplasias Pancreáticas / Planejamento da Radioterapia Assistida por Computador / Radioterapia Conformacional / Radioterapia de Intensidade Modulada Tipo de estudo: Etiology_studies / Observational_studies / Risk_factors_studies Limite: Humans Idioma: En Revista: Med Dosim Assunto da revista: RADIOTERAPIA Ano de publicação: 2016 Tipo de documento: Article País de publicação: Estados Unidos