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Clinical Outcomes of Whole Body Gamma Knife Therapy for Local Pancreatic Carcinoma
I. J. Radiation Oncology d Biology d Physics
S284
Volume 75, Number 3, Supplement, 2009
Conclusions: External beam RT for HCCs with higher SUV ratios resulted in higher response rates. This study failed to show a significant correlation between treatment response and patient survival; similar rates of intrahepatic and distant metastases in both SUV groups might have been implicated. The results suggest that SUV ratios obtained from the pre-treatment FDG-PET can be beneficial in selecting patients who are likely to respond to localized external beam RT for unresectable HCC. Author Disclosure: J. Kim, None; J. Seong, None; M. Yun, None; W. Koom, None; H. Yoon, None; H. Cho, None; K. Han, None.
2230
Hypofractionated Tomotherapy with Concomitant Chemotherapy in Pancreatic Adenocarcinoma: Preliminary Results of a Phase I Study
N. Slim1, S. Cereda2, P. Passoni1, M. Reni2, M. Cattaneo3, F. Alongi1, G. Sangalli3, V. Bettinardi4, P. Mancosu4, N. Di Muzio1 Radiation Oncology, Scientific Institute San Raffaele, Milan, Italy, 2Medical Oncology, Scientific Institute San Raffaele, Milan, Italy, 3Medical Physics, Scientific Institute San Raffaele, Milan, Italy, 4Nuclear Medicine, Scientific Institute San Raffaele, Milan, Italy 1
Purpose/Objective(s): To evaluate the feasibility of hypofractionated Tomotherapy for the tumor with simultaneous integrated boost (SIB) at escalating dose to a tumor sub-volume infiltrating vessels, concomitant to 5-FU continuous infusion (c.i.) or capecitabine in patients with pancreatic adenocarcinoma. Materials/Methods: From 5/2005 to 11/2008, 29 patients (pts) with histologically proven pancreatic adenocarcinoma, were enrolled. Characteristics of pts. Median age: 60 years; median KPS: 90; stage III: 23 pts; stage IV: 3 pts; local relapse: 3 pts. All pts had been previously treated with chemotherapy. All pts underwent simulation contrast-enhanced four-dimensional computed tomography (4D-CT). GTVs were defined on each 4D-CT series: GTV2 (the tumor) and GTV1 (a tumor sub-volume 1 cm around the infiltrated vessels). The contours were convoluted to generate ITV2 and ITV1. The PTVs were created by adding a further margin of 5-7 mm to the ITVs. Radiation therapy was delivered with Tomotherapy. Results: Toxicity : 28/29 evaluable pts (1 lost). G1-G2: diarrhoea 6 (21%), N/V 13 (46%), abdominal pain 7 (25%), anorexia 4 (14%), neutropenia 2 (7%). Hepatotoxicity G1: 4 (14%). Two pts (7%) had early G3 toxicity: gastric ulcer (1pt at 2nd dose level) and gastro-duodenitis (1 pt at 4th dose level). No late toxicity occurred. Responses. SIB group: 15/16 evaluable pts (1 lost), 4 PR (27%), 8 SD (53%), 3 PD (20%). Group without SIB: 13/13 evaluable pts, 1CR (7%), 4 PR (31%), 4 SD (31%), 4 PD (31%). Median-TTP, median-TTLP and median survival for all patients was 11.6, 14.9 and 18.2 months, respectively. Conclusions: A dose of 44.25 Gy in 15 fractions on PTV2 concomitant to 5-FU c.i. or oral capecitabine is feasible and seems to provide a promising response rate. The concomitant boost to infiltrated vessels does not seem to improve the response rate; however, once the maximum tolerated dose is reached, its efficacy will be tested on potentially operable disease. Author Disclosure: N. Slim, None; S. Cereda, None; P. Passoni, None; M. Reni, None; M. Cattaneo, None; F. Alongi, None; G. Sangalli, None; V. Bettinardi, None; P. Mancosu, None; N. Di Muzio, None.
2231
Clinical Outcomes of Whole Body Gamma Knife Therapy for Local Pancreatic Carcinoma
D. Chang, T. Y. Xia, P. Li, Q. X. Sun, Y. J. Wang, H. Q. Li, N. B. Fan, W. Z. Wu Air Force General Hospital Beijing, Beijing, China Purpose/Objective(s): To evaluate the efficacy and radiation reaction of whole body g-knife in patients with pancreatic carcinoma. Materials/Methods: 41 patients with pancreatic carcinoma were treated with the Stereotactic Gamma Ray Whole-Body Therapeutic System (Whole Body g-knife). Low-speed computed tomography simulation was conducted. The patients who was supine or prostrate were fixed by a stereotactic body frame and vacuum bag. GTV, CTV and PTV were defined on the contrast CT scans. It was required that 50% isodose line covered 100% of PTV and 70% isodose line covered more than 80% of GTV. The 50% isodose line was prescription dose. For patients with pancreatic head carcinoma, they were irradiated 3-4Gy per fraction, 5 fractions per week. For patients with pancreas cauda cancer, they were irradiated 4-5Gy per fraction, 5 fractions per week. Total dose of 4051Gy at PTV margin and 60-70Gy at GTV margin were delivered. The treatment generally last 2 3 weeks and the follow-up period was every 3 6 months. Results: The complete response rate (CR) and the partial response rate (PR) in the primary tumors were 39.0% and 34.1%, steady 17.1%,and the overall response rate was 90.2%. The single factor and Cox regression analysis showed that stage and diameter of the tumor before radiotherapy were the significant factors of survival. The 1-, 2-, 3-,4- and 5- year overall survival rates were 64.7%,29.4%,23.5%,23.5% and 23.5%, respectively, for patients with stage I/II. The median follow-up duration was 16 months. The 1-, 2- and 3- year overall survival rates were 26.1%, 8.7% and 8.7%, respectively, for patients with III stage. The median follow-up duration was 8 months. The 1-, 2-, 3-,4- and 5- year overall survival rates were 52.6%,31.6%,25.3%,25.3% and 25.3%, respectively, when the diameter of tumor was \5 centimeter. The 1-, 2-,3- and 4- year overall survival rates were 33.4%,4.8%,4.8% and 4.8%, respectively, when the diameter of tumor was$5 centimeter. The acute side effects were nausea,vomiting,diarrhoea, and occurring rates were 75.6% in RTOG grade I-II and 2.4% in RTOG grade III. The whole process was tolerant for all patients after allopathy. Conclusions: When therapeutic mode was 3-5Gy per fraction, 5 fractions per week and 40-51Gy as total dose of PTV, the results demonstrated the safety and efficacy of whole body g-knife treatment for pancreatic carcinoma. It could improve the local control rate and survival rate of the patients with early pancreatic carcinoma. Author Disclosure: D. Chang, None; T.Y. Xia, None; P. Li, None; Q.X. Sun, None; Y.J. Wang, None; H.Q. Li, None; N.B. Fan, None; W.Z. Wu, None.
S284
Volume 75, Number 3, Supplement, 2009
Conclusions: External beam RT for HCCs with higher SUV ratios resulted in higher response rates. This study failed to show a significant correlation between treatment response and patient survival; similar rates of intrahepatic and distant metastases in both SUV groups might have been implicated. The results suggest that SUV ratios obtained from the pre-treatment FDG-PET can be beneficial in selecting patients who are likely to respond to localized external beam RT for unresectable HCC. Author Disclosure: J. Kim, None; J. Seong, None; M. Yun, None; W. Koom, None; H. Yoon, None; H. Cho, None; K. Han, None.
2230
Hypofractionated Tomotherapy with Concomitant Chemotherapy in Pancreatic Adenocarcinoma: Preliminary Results of a Phase I Study
N. Slim1, S. Cereda2, P. Passoni1, M. Reni2, M. Cattaneo3, F. Alongi1, G. Sangalli3, V. Bettinardi4, P. Mancosu4, N. Di Muzio1 Radiation Oncology, Scientific Institute San Raffaele, Milan, Italy, 2Medical Oncology, Scientific Institute San Raffaele, Milan, Italy, 3Medical Physics, Scientific Institute San Raffaele, Milan, Italy, 4Nuclear Medicine, Scientific Institute San Raffaele, Milan, Italy 1
Purpose/Objective(s): To evaluate the feasibility of hypofractionated Tomotherapy for the tumor with simultaneous integrated boost (SIB) at escalating dose to a tumor sub-volume infiltrating vessels, concomitant to 5-FU continuous infusion (c.i.) or capecitabine in patients with pancreatic adenocarcinoma. Materials/Methods: From 5/2005 to 11/2008, 29 patients (pts) with histologically proven pancreatic adenocarcinoma, were enrolled. Characteristics of pts. Median age: 60 years; median KPS: 90; stage III: 23 pts; stage IV: 3 pts; local relapse: 3 pts. All pts had been previously treated with chemotherapy. All pts underwent simulation contrast-enhanced four-dimensional computed tomography (4D-CT). GTVs were defined on each 4D-CT series: GTV2 (the tumor) and GTV1 (a tumor sub-volume 1 cm around the infiltrated vessels). The contours were convoluted to generate ITV2 and ITV1. The PTVs were created by adding a further margin of 5-7 mm to the ITVs. Radiation therapy was delivered with Tomotherapy. Results: Toxicity : 28/29 evaluable pts (1 lost). G1-G2: diarrhoea 6 (21%), N/V 13 (46%), abdominal pain 7 (25%), anorexia 4 (14%), neutropenia 2 (7%). Hepatotoxicity G1: 4 (14%). Two pts (7%) had early G3 toxicity: gastric ulcer (1pt at 2nd dose level) and gastro-duodenitis (1 pt at 4th dose level). No late toxicity occurred. Responses. SIB group: 15/16 evaluable pts (1 lost), 4 PR (27%), 8 SD (53%), 3 PD (20%). Group without SIB: 13/13 evaluable pts, 1CR (7%), 4 PR (31%), 4 SD (31%), 4 PD (31%). Median-TTP, median-TTLP and median survival for all patients was 11.6, 14.9 and 18.2 months, respectively. Conclusions: A dose of 44.25 Gy in 15 fractions on PTV2 concomitant to 5-FU c.i. or oral capecitabine is feasible and seems to provide a promising response rate. The concomitant boost to infiltrated vessels does not seem to improve the response rate; however, once the maximum tolerated dose is reached, its efficacy will be tested on potentially operable disease. Author Disclosure: N. Slim, None; S. Cereda, None; P. Passoni, None; M. Reni, None; M. Cattaneo, None; F. Alongi, None; G. Sangalli, None; V. Bettinardi, None; P. Mancosu, None; N. Di Muzio, None.
2231
Clinical Outcomes of Whole Body Gamma Knife Therapy for Local Pancreatic Carcinoma
D. Chang, T. Y. Xia, P. Li, Q. X. Sun, Y. J. Wang, H. Q. Li, N. B. Fan, W. Z. Wu Air Force General Hospital Beijing, Beijing, China Purpose/Objective(s): To evaluate the efficacy and radiation reaction of whole body g-knife in patients with pancreatic carcinoma. Materials/Methods: 41 patients with pancreatic carcinoma were treated with the Stereotactic Gamma Ray Whole-Body Therapeutic System (Whole Body g-knife). Low-speed computed tomography simulation was conducted. The patients who was supine or prostrate were fixed by a stereotactic body frame and vacuum bag. GTV, CTV and PTV were defined on the contrast CT scans. It was required that 50% isodose line covered 100% of PTV and 70% isodose line covered more than 80% of GTV. The 50% isodose line was prescription dose. For patients with pancreatic head carcinoma, they were irradiated 3-4Gy per fraction, 5 fractions per week. For patients with pancreas cauda cancer, they were irradiated 4-5Gy per fraction, 5 fractions per week. Total dose of 4051Gy at PTV margin and 60-70Gy at GTV margin were delivered. The treatment generally last 2 3 weeks and the follow-up period was every 3 6 months. Results: The complete response rate (CR) and the partial response rate (PR) in the primary tumors were 39.0% and 34.1%, steady 17.1%,and the overall response rate was 90.2%. The single factor and Cox regression analysis showed that stage and diameter of the tumor before radiotherapy were the significant factors of survival. The 1-, 2-, 3-,4- and 5- year overall survival rates were 64.7%,29.4%,23.5%,23.5% and 23.5%, respectively, for patients with stage I/II. The median follow-up duration was 16 months. The 1-, 2- and 3- year overall survival rates were 26.1%, 8.7% and 8.7%, respectively, for patients with III stage. The median follow-up duration was 8 months. The 1-, 2-, 3-,4- and 5- year overall survival rates were 52.6%,31.6%,25.3%,25.3% and 25.3%, respectively, when the diameter of tumor was \5 centimeter. The 1-, 2-,3- and 4- year overall survival rates were 33.4%,4.8%,4.8% and 4.8%, respectively, when the diameter of tumor was$5 centimeter. The acute side effects were nausea,vomiting,diarrhoea, and occurring rates were 75.6% in RTOG grade I-II and 2.4% in RTOG grade III. The whole process was tolerant for all patients after allopathy. Conclusions: When therapeutic mode was 3-5Gy per fraction, 5 fractions per week and 40-51Gy as total dose of PTV, the results demonstrated the safety and efficacy of whole body g-knife treatment for pancreatic carcinoma. It could improve the local control rate and survival rate of the patients with early pancreatic carcinoma. Author Disclosure: D. Chang, None; T.Y. Xia, None; P. Li, None; Q.X. Sun, None; Y.J. Wang, None; H.Q. Li, None; N.B. Fan, None; W.Z. Wu, None.