Dose escalation with an IMRT technique in 15 to 28 fractions is better tolerated than standard doses of 3DCRT for LAPC
Purpose: To review acute and late toxicities after chemoradiation for locally advanced pancreatic ductal adenocarcinoma in patients who were treated with escalated dose radiation (EDR). Methods and materials: Maximum Common Terminology Criteria for Adverse Events Version 4.0 acute toxicities (AT) du...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2017-07-01
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| Series: | Advances in Radiation Oncology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2452109417300350 |
| _version_ | 1818934144580714496 |
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| author | Lauren E. Colbert, MD, MSCR Shalini Moningi, MD Awalpreet Chadha, MD Ahmed Amer, MD Yeonju Lee, PhD Robert A. Wolff, MD Gauri Varadhachary, MD Jason Fleming, MD Matthew Katz, MD Prajnan Das, MD, MPH Sunil Krishnan, MD Eugene J. Koay, MD, PhD Peter Park, PhD Christopher H. Crane, MD Cullen M. Taniguchi, MD, PhD |
| author_facet | Lauren E. Colbert, MD, MSCR Shalini Moningi, MD Awalpreet Chadha, MD Ahmed Amer, MD Yeonju Lee, PhD Robert A. Wolff, MD Gauri Varadhachary, MD Jason Fleming, MD Matthew Katz, MD Prajnan Das, MD, MPH Sunil Krishnan, MD Eugene J. Koay, MD, PhD Peter Park, PhD Christopher H. Crane, MD Cullen M. Taniguchi, MD, PhD |
| author_sort | Lauren E. Colbert, MD, MSCR |
| collection | DOAJ |
| description | Purpose: To review acute and late toxicities after chemoradiation for locally advanced pancreatic ductal adenocarcinoma in patients who were treated with escalated dose radiation (EDR).
Methods and materials: Maximum Common Terminology Criteria for Adverse Events Version 4.0 acute toxicities (AT) during radiation and within 60 days after radiation were recorded for both acute gastrointestinal toxicity and overall toxicity (OT). Late toxicities were also recorded. EDR was generally delivered with daily image guidance and breath-hold techniques using intensity modulated radiation therapy (IMRT) planning. These were compared with patients who received standard dose radiation (SDR) delivered as 50.4 Gy in 28 fractions using 3-dimensional chemoradiation therapy planning.
Results: A total of 59 of 154 patients (39%) received EDR with biologically equivalent doses >70 Gy. The most frequent schedules were 63 Gy in 28 fractions (19 of 154 patients), 67.5 Gy in 15 fractions (10 of 154 patients), and 70 Gy in 28 fractions (15 of 154 patients). No grade 4 or grade 5 OT or late toxicities were reported. Rates of grade 3 acute gastrointestinal toxicity were significantly lower in patients who received EDR compared with SDR (1% vs 14%; P < .001). Similarly, rates of grade 3 OT were also lower for EDR compared with SDR (4% vs 16%; P = .004). The proportion of patients who experienced no AT was higher in the EDR group than the SDR group (36% vs 15%; P = .001). For EDR patients treated with IMRT, a lower risk of AT was associated with a later treatment year (P = .007), nonpancreatic head tumor location (P = .01), breath-hold (P = .002), 4-dimensional computed tomography (P = .003), computed tomography on rails (P = .002), and lower stomach V40 (P = .03). With a median time of 12 months (range, 1-79 months) from the start of radiation therapy to the last known follow-up in the EDR group, 51 of 59 patients (86%) had no late toxicity. Six of 59 EDR patients (10%) had either strictures or gastrointestinal bleeding that required intervention. No significant predictors of late toxicity were identified.
Conclusion: Overall acute and late toxicity rates were low with EDR using an IMRT technique with image guidance and respiratory gating. |
| first_indexed | 2024-12-20T04:59:36Z |
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| id | doaj.art-e19f9542adfc45d68c84f6d2b8c147f0 |
| institution | Directory Open Access Journal |
| issn | 2452-1094 |
| language | English |
| last_indexed | 2024-12-20T04:59:36Z |
| publishDate | 2017-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Advances in Radiation Oncology |
| spelling | doaj.art-e19f9542adfc45d68c84f6d2b8c147f02022-12-21T19:52:37ZengElsevierAdvances in Radiation Oncology2452-10942017-07-012340341510.1016/j.adro.2017.02.004Dose escalation with an IMRT technique in 15 to 28 fractions is better tolerated than standard doses of 3DCRT for LAPCLauren E. Colbert, MD, MSCR0Shalini Moningi, MD1Awalpreet Chadha, MD2Ahmed Amer, MD3Yeonju Lee, PhD4Robert A. Wolff, MD5Gauri Varadhachary, MD6Jason Fleming, MD7Matthew Katz, MD8Prajnan Das, MD, MPH9Sunil Krishnan, MD10Eugene J. Koay, MD, PhD11Peter Park, PhD12Christopher H. Crane, MD13Cullen M. Taniguchi, MD, PhD14Department of Radiation Oncology, UT MD Anderson Cancer Center, Houston, TexasDepartment of Radiation Oncology, UT MD Anderson Cancer Center, Houston, TexasDepartment of Radiation Oncology, UT MD Anderson Cancer Center, Houston, TexasDepartment of Radiation Oncology, UT MD Anderson Cancer Center, Houston, TexasDepartment of Radiation Oncology, UT MD Anderson Cancer Center, Houston, TexasDepartment of Medical Oncology, UT MD Anderson Cancer Center, Houston, TexasDepartment of Medical Oncology, UT MD Anderson Cancer Center, Houston, TexasDepartment of Surgical Oncology, UT MD Anderson Cancer Center, Houston, TexasDepartment of Surgical Oncology, UT MD Anderson Cancer Center, Houston, TexasDepartment of Radiation Oncology, UT MD Anderson Cancer Center, Houston, TexasDepartment of Radiation Oncology, UT MD Anderson Cancer Center, Houston, TexasDepartment of Radiation Oncology, UT MD Anderson Cancer Center, Houston, TexasDepartment of Radiation Oncology, UT MD Anderson Cancer Center, Houston, TexasDepartment of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New YorkDepartment of Radiation Oncology, UT MD Anderson Cancer Center, Houston, TexasPurpose: To review acute and late toxicities after chemoradiation for locally advanced pancreatic ductal adenocarcinoma in patients who were treated with escalated dose radiation (EDR). Methods and materials: Maximum Common Terminology Criteria for Adverse Events Version 4.0 acute toxicities (AT) during radiation and within 60 days after radiation were recorded for both acute gastrointestinal toxicity and overall toxicity (OT). Late toxicities were also recorded. EDR was generally delivered with daily image guidance and breath-hold techniques using intensity modulated radiation therapy (IMRT) planning. These were compared with patients who received standard dose radiation (SDR) delivered as 50.4 Gy in 28 fractions using 3-dimensional chemoradiation therapy planning. Results: A total of 59 of 154 patients (39%) received EDR with biologically equivalent doses >70 Gy. The most frequent schedules were 63 Gy in 28 fractions (19 of 154 patients), 67.5 Gy in 15 fractions (10 of 154 patients), and 70 Gy in 28 fractions (15 of 154 patients). No grade 4 or grade 5 OT or late toxicities were reported. Rates of grade 3 acute gastrointestinal toxicity were significantly lower in patients who received EDR compared with SDR (1% vs 14%; P < .001). Similarly, rates of grade 3 OT were also lower for EDR compared with SDR (4% vs 16%; P = .004). The proportion of patients who experienced no AT was higher in the EDR group than the SDR group (36% vs 15%; P = .001). For EDR patients treated with IMRT, a lower risk of AT was associated with a later treatment year (P = .007), nonpancreatic head tumor location (P = .01), breath-hold (P = .002), 4-dimensional computed tomography (P = .003), computed tomography on rails (P = .002), and lower stomach V40 (P = .03). With a median time of 12 months (range, 1-79 months) from the start of radiation therapy to the last known follow-up in the EDR group, 51 of 59 patients (86%) had no late toxicity. Six of 59 EDR patients (10%) had either strictures or gastrointestinal bleeding that required intervention. No significant predictors of late toxicity were identified. Conclusion: Overall acute and late toxicity rates were low with EDR using an IMRT technique with image guidance and respiratory gating.http://www.sciencedirect.com/science/article/pii/S2452109417300350 |
| spellingShingle | Lauren E. Colbert, MD, MSCR Shalini Moningi, MD Awalpreet Chadha, MD Ahmed Amer, MD Yeonju Lee, PhD Robert A. Wolff, MD Gauri Varadhachary, MD Jason Fleming, MD Matthew Katz, MD Prajnan Das, MD, MPH Sunil Krishnan, MD Eugene J. Koay, MD, PhD Peter Park, PhD Christopher H. Crane, MD Cullen M. Taniguchi, MD, PhD Dose escalation with an IMRT technique in 15 to 28 fractions is better tolerated than standard doses of 3DCRT for LAPC Advances in Radiation Oncology |
| title | Dose escalation with an IMRT technique in 15 to 28 fractions is better tolerated than standard doses of 3DCRT for LAPC |
| title_full | Dose escalation with an IMRT technique in 15 to 28 fractions is better tolerated than standard doses of 3DCRT for LAPC |
| title_fullStr | Dose escalation with an IMRT technique in 15 to 28 fractions is better tolerated than standard doses of 3DCRT for LAPC |
| title_full_unstemmed | Dose escalation with an IMRT technique in 15 to 28 fractions is better tolerated than standard doses of 3DCRT for LAPC |
| title_short | Dose escalation with an IMRT technique in 15 to 28 fractions is better tolerated than standard doses of 3DCRT for LAPC |
| title_sort | dose escalation with an imrt technique in 15 to 28 fractions is better tolerated than standard doses of 3dcrt for lapc |
| url | http://www.sciencedirect.com/science/article/pii/S2452109417300350 |
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