Stereotactic ablative radiation for pancreatic cancer on a 1.5 Telsa magnetic resonance-linac system
•Ablative radiation therapy (A-RT) is effective for locally advanced pancreas cancer.•30 patients received A-RT using diagnostic quality MR-adaptive treatment delivery.•Cumulative incidences of 1-year local and distant progression were 19.3% and 47.4%•Overall and progression-free survival 1-year fro...
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| Vydáno v: | Physics and imaging in radiation oncology Ročník 24; s. 88 - 94 |
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| Hlavní autoři: | , , , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
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Netherlands
Elsevier B.V
01.10.2022
Elsevier |
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| ISSN: | 2405-6316, 2405-6316 |
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| Abstract | •Ablative radiation therapy (A-RT) is effective for locally advanced pancreas cancer.•30 patients received A-RT using diagnostic quality MR-adaptive treatment delivery.•Cumulative incidences of 1-year local and distant progression were 19.3% and 47.4%•Overall and progression-free survival 1-year from A-RT was 80.0% and 39.7%•50 Gray in 5 fractions led to promising 1-year local control and survival.•Most local failures were marginal at the tumor-organ-at-risk (OAR) interface.•No grade 3 or higher toxicities were observed despite adjacent sensitive OARs.
Ablative radiation therapy (A-RT) appears to improve outcomes in locally advanced pancreatic cancer (LAPC) yet requires solutions for respiratory and digestive motion. We report outcomes of A-RT for pancreatic cancer using 1.5 T MR-adaptive treatment delivery.
Between March 2020 and July 2021, we treated 30 patients with pancreatic cancer with 50 Gy in 5 fractions (biologically effective dose [BED10] = 100 Gy10) using a novel compression belt workflow and remote planning on the Unity 1.5 T MR linac system. Cumulative incidence of progression was computed from A-RT initiation with death as a competing risk. Overall (OS) and progression-free survival (PFS) were calculated using Kaplan Meier methods.
Of 30 patients, most (73 %) were locally advanced, 4 (13 %) were metastatic, 2 (7 %) were medically inoperable, and 2 (7 %) were locally recurrent. Most (73 %) received FOLFIRINOX prior to A-RT. Median follow-up times from diagnosis and A-RT were 17.6 (IQR 15.8–23.1) and 11.5 months (IQR 9.7–16.1), respectively. Cumulative incidences at 1-year of local and distant progression were 19.3 % (95 %CI 6.7–36.8 %) and 47.4 % (95 %CI 26.7–65.6 %), respectively. Median OS from diagnosis and A-RT were not reached. One-year OS from diagnosis and A-RT were 96.4 % (95 %CI 77.2–99.5 %) and 80.0 % (95 %CI 57.3–91.4 %), respectively. Median and 1-year PFS were 10.1 months (95 %CI 4.4–14.4) and 39.7 % (95 %CI 20.3–58.5 %), respectively. No grade 3 + toxicities were observed.
A-RT using the 1.5 T Unity MR Linac resulted in promising LC and OS with no severe toxicity in patients with LAPC despite radiosensitive organs adjacent to the target volumes. Longer follow-up is needed to assess long-term outcomes. |
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| AbstractList | •
Ablative radiation therapy (A-RT) is effective for locally advanced pancreas cancer.
•
30 patients received A-RT using diagnostic quality MR-adaptive treatment delivery.
•
Cumulative incidences of 1-year local and distant progression were 19.3% and 47.4%
•
Overall and progression-free survival 1-year from A-RT was 80.0% and 39.7%
•
50 Gray in 5 fractions led to promising 1-year local control and survival.
•
Most local failures were marginal at the tumor-organ-at-risk (OAR) interface.
•
No grade 3 or higher toxicities were observed despite adjacent sensitive OARs. •Ablative radiation therapy (A-RT) is effective for locally advanced pancreas cancer.•30 patients received A-RT using diagnostic quality MR-adaptive treatment delivery.•Cumulative incidences of 1-year local and distant progression were 19.3% and 47.4%•Overall and progression-free survival 1-year from A-RT was 80.0% and 39.7%•50 Gray in 5 fractions led to promising 1-year local control and survival.•Most local failures were marginal at the tumor-organ-at-risk (OAR) interface.•No grade 3 or higher toxicities were observed despite adjacent sensitive OARs. Ablative radiation therapy (A-RT) appears to improve outcomes in locally advanced pancreatic cancer (LAPC) yet requires solutions for respiratory and digestive motion. We report outcomes of A-RT for pancreatic cancer using 1.5 T MR-adaptive treatment delivery. Between March 2020 and July 2021, we treated 30 patients with pancreatic cancer with 50 Gy in 5 fractions (biologically effective dose [BED10] = 100 Gy10) using a novel compression belt workflow and remote planning on the Unity 1.5 T MR linac system. Cumulative incidence of progression was computed from A-RT initiation with death as a competing risk. Overall (OS) and progression-free survival (PFS) were calculated using Kaplan Meier methods. Of 30 patients, most (73 %) were locally advanced, 4 (13 %) were metastatic, 2 (7 %) were medically inoperable, and 2 (7 %) were locally recurrent. Most (73 %) received FOLFIRINOX prior to A-RT. Median follow-up times from diagnosis and A-RT were 17.6 (IQR 15.8–23.1) and 11.5 months (IQR 9.7–16.1), respectively. Cumulative incidences at 1-year of local and distant progression were 19.3 % (95 %CI 6.7–36.8 %) and 47.4 % (95 %CI 26.7–65.6 %), respectively. Median OS from diagnosis and A-RT were not reached. One-year OS from diagnosis and A-RT were 96.4 % (95 %CI 77.2–99.5 %) and 80.0 % (95 %CI 57.3–91.4 %), respectively. Median and 1-year PFS were 10.1 months (95 %CI 4.4–14.4) and 39.7 % (95 %CI 20.3–58.5 %), respectively. No grade 3 + toxicities were observed. A-RT using the 1.5 T Unity MR Linac resulted in promising LC and OS with no severe toxicity in patients with LAPC despite radiosensitive organs adjacent to the target volumes. Longer follow-up is needed to assess long-term outcomes. Purpose: Ablative radiation therapy (A-RT) appears to improve outcomes in locally advanced pancreatic cancer (LAPC) yet requires solutions for respiratory and digestive motion. We report outcomes of A-RT for pancreatic cancer using 1.5 T MR-adaptive treatment delivery. Methods: Between March 2020 and July 2021, we treated 30 patients with pancreatic cancer with 50 Gy in 5 fractions (biologically effective dose [BED10] = 100 Gy10) using a novel compression belt workflow and remote planning on the Unity 1.5 T MR linac system. Cumulative incidence of progression was computed from A-RT initiation with death as a competing risk. Overall (OS) and progression-free survival (PFS) were calculated using Kaplan Meier methods. Results: Of 30 patients, most (73 %) were locally advanced, 4 (13 %) were metastatic, 2 (7 %) were medically inoperable, and 2 (7 %) were locally recurrent. Most (73 %) received FOLFIRINOX prior to A-RT. Median follow-up times from diagnosis and A-RT were 17.6 (IQR 15.8–23.1) and 11.5 months (IQR 9.7–16.1), respectively. Cumulative incidences at 1-year of local and distant progression were 19.3 % (95 %CI 6.7–36.8 %) and 47.4 % (95 %CI 26.7–65.6 %), respectively. Median OS from diagnosis and A-RT were not reached. One-year OS from diagnosis and A-RT were 96.4 % (95 %CI 77.2–99.5 %) and 80.0 % (95 %CI 57.3–91.4 %), respectively. Median and 1-year PFS were 10.1 months (95 %CI 4.4–14.4) and 39.7 % (95 %CI 20.3–58.5 %), respectively. No grade 3 + toxicities were observed. Conclusions: A-RT using the 1.5 T Unity MR Linac resulted in promising LC and OS with no severe toxicity in patients with LAPC despite radiosensitive organs adjacent to the target volumes. Longer follow-up is needed to assess long-term outcomes. Ablative radiation therapy (A-RT) appears to improve outcomes in locally advanced pancreatic cancer (LAPC) yet requires solutions for respiratory and digestive motion. We report outcomes of A-RT for pancreatic cancer using 1.5 T MR-adaptive treatment delivery.PurposeAblative radiation therapy (A-RT) appears to improve outcomes in locally advanced pancreatic cancer (LAPC) yet requires solutions for respiratory and digestive motion. We report outcomes of A-RT for pancreatic cancer using 1.5 T MR-adaptive treatment delivery.Between March 2020 and July 2021, we treated 30 patients with pancreatic cancer with 50 Gy in 5 fractions (biologically effective dose [BED10] = 100 Gy10) using a novel compression belt workflow and remote planning on the Unity 1.5 T MR linac system. Cumulative incidence of progression was computed from A-RT initiation with death as a competing risk. Overall (OS) and progression-free survival (PFS) were calculated using Kaplan Meier methods.MethodsBetween March 2020 and July 2021, we treated 30 patients with pancreatic cancer with 50 Gy in 5 fractions (biologically effective dose [BED10] = 100 Gy10) using a novel compression belt workflow and remote planning on the Unity 1.5 T MR linac system. Cumulative incidence of progression was computed from A-RT initiation with death as a competing risk. Overall (OS) and progression-free survival (PFS) were calculated using Kaplan Meier methods.Of 30 patients, most (73 %) were locally advanced, 4 (13 %) were metastatic, 2 (7 %) were medically inoperable, and 2 (7 %) were locally recurrent. Most (73 %) received FOLFIRINOX prior to A-RT. Median follow-up times from diagnosis and A-RT were 17.6 (IQR 15.8-23.1) and 11.5 months (IQR 9.7-16.1), respectively. Cumulative incidences at 1-year of local and distant progression were 19.3 % (95 %CI 6.7-36.8 %) and 47.4 % (95 %CI 26.7-65.6 %), respectively. Median OS from diagnosis and A-RT were not reached. One-year OS from diagnosis and A-RT were 96.4 % (95 %CI 77.2-99.5 %) and 80.0 % (95 %CI 57.3-91.4 %), respectively. Median and 1-year PFS were 10.1 months (95 %CI 4.4-14.4) and 39.7 % (95 %CI 20.3-58.5 %), respectively. No grade 3 + toxicities were observed.ResultsOf 30 patients, most (73 %) were locally advanced, 4 (13 %) were metastatic, 2 (7 %) were medically inoperable, and 2 (7 %) were locally recurrent. Most (73 %) received FOLFIRINOX prior to A-RT. Median follow-up times from diagnosis and A-RT were 17.6 (IQR 15.8-23.1) and 11.5 months (IQR 9.7-16.1), respectively. Cumulative incidences at 1-year of local and distant progression were 19.3 % (95 %CI 6.7-36.8 %) and 47.4 % (95 %CI 26.7-65.6 %), respectively. Median OS from diagnosis and A-RT were not reached. One-year OS from diagnosis and A-RT were 96.4 % (95 %CI 77.2-99.5 %) and 80.0 % (95 %CI 57.3-91.4 %), respectively. Median and 1-year PFS were 10.1 months (95 %CI 4.4-14.4) and 39.7 % (95 %CI 20.3-58.5 %), respectively. No grade 3 + toxicities were observed.A-RT using the 1.5 T Unity MR Linac resulted in promising LC and OS with no severe toxicity in patients with LAPC despite radiosensitive organs adjacent to the target volumes. Longer follow-up is needed to assess long-term outcomes.ConclusionsA-RT using the 1.5 T Unity MR Linac resulted in promising LC and OS with no severe toxicity in patients with LAPC despite radiosensitive organs adjacent to the target volumes. Longer follow-up is needed to assess long-term outcomes. Ablative radiation therapy (A-RT) appears to improve outcomes in locally advanced pancreatic cancer (LAPC) yet requires solutions for respiratory and digestive motion. We report outcomes of A-RT for pancreatic cancer using 1.5 T MR-adaptive treatment delivery. Between March 2020 and July 2021, we treated 30 patients with pancreatic cancer with 50 Gy in 5 fractions (biologically effective dose [BED10] = 100 Gy10) using a novel compression belt workflow and remote planning on the Unity 1.5 T MR linac system. Cumulative incidence of progression was computed from A-RT initiation with death as a competing risk. Overall (OS) and progression-free survival (PFS) were calculated using Kaplan Meier methods. Of 30 patients, most (73 %) were locally advanced, 4 (13 %) were metastatic, 2 (7 %) were medically inoperable, and 2 (7 %) were locally recurrent. Most (73 %) received FOLFIRINOX prior to A-RT. Median follow-up times from diagnosis and A-RT were 17.6 (IQR 15.8-23.1) and 11.5 months (IQR 9.7-16.1), respectively. Cumulative incidences at 1-year of local and distant progression were 19.3 % (95 %CI 6.7-36.8 %) and 47.4 % (95 %CI 26.7-65.6 %), respectively. Median OS from diagnosis and A-RT were not reached. One-year OS from diagnosis and A-RT were 96.4 % (95 %CI 77.2-99.5 %) and 80.0 % (95 %CI 57.3-91.4 %), respectively. Median and 1-year PFS were 10.1 months (95 %CI 4.4-14.4) and 39.7 % (95 %CI 20.3-58.5 %), respectively. No grade 3 + toxicities were observed. A-RT using the 1.5 T Unity MR Linac resulted in promising LC and OS with no severe toxicity in patients with LAPC despite radiosensitive organs adjacent to the target volumes. Longer follow-up is needed to assess long-term outcomes. |
| Author | Tringale, Kathryn R. Tyagi, Neelam Wu, Abraham Marsha Reyngold Varghese, Anna M. Yu, Kenneth Khalil, Danny N. O'Reilly, Eileen M. Park, Wungki Romesser, Paul B. Godoy Scripes, Paola Crane, Christopher H. |
| Author_xml | – sequence: 1 givenname: Kathryn R. surname: Tringale fullname: Tringale, Kathryn R. email: tringalk@mskcc.org organization: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, United States – sequence: 2 givenname: Neelam surname: Tyagi fullname: Tyagi, Neelam organization: Department of Medical Physics, Memorial Sloan Kettering Cancer Center, United States – sequence: 3 surname: Marsha Reyngold fullname: Marsha Reyngold organization: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, United States – sequence: 4 givenname: Paul B. surname: Romesser fullname: Romesser, Paul B. organization: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, United States – sequence: 5 givenname: Abraham surname: Wu fullname: Wu, Abraham organization: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, United States – sequence: 6 givenname: Eileen M. surname: O'Reilly fullname: O'Reilly, Eileen M. organization: Department of Medicine, Memorial Sloan Kettering Cancer Center, United States – sequence: 7 givenname: Anna M. surname: Varghese fullname: Varghese, Anna M. organization: Department of Medicine, Memorial Sloan Kettering Cancer Center, United States – sequence: 8 givenname: Paola surname: Godoy Scripes fullname: Godoy Scripes, Paola organization: Department of Medical Physics, Memorial Sloan Kettering Cancer Center, United States – sequence: 9 givenname: Danny N. surname: Khalil fullname: Khalil, Danny N. organization: Department of Medicine, Memorial Sloan Kettering Cancer Center, United States – sequence: 10 givenname: Wungki surname: Park fullname: Park, Wungki organization: Department of Medicine, Memorial Sloan Kettering Cancer Center, United States – sequence: 11 givenname: Kenneth surname: Yu fullname: Yu, Kenneth organization: Department of Medicine, Memorial Sloan Kettering Cancer Center, United States – sequence: 12 givenname: Christopher H. surname: Crane fullname: Crane, Christopher H. email: cranec1@mskcc.org organization: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, United States |
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| Keywords | Ablative radiation therapy MRI Pancreas cancer MR linac |
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| Snippet | •Ablative radiation therapy (A-RT) is effective for locally advanced pancreas cancer.•30 patients received A-RT using diagnostic quality MR-adaptive treatment... Ablative radiation therapy (A-RT) appears to improve outcomes in locally advanced pancreatic cancer (LAPC) yet requires solutions for respiratory and digestive... • Ablative radiation therapy (A-RT) is effective for locally advanced pancreas cancer. • 30 patients received A-RT using diagnostic quality MR-adaptive... Purpose: Ablative radiation therapy (A-RT) appears to improve outcomes in locally advanced pancreatic cancer (LAPC) yet requires solutions for respiratory and... |
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| Title | Stereotactic ablative radiation for pancreatic cancer on a 1.5 Telsa magnetic resonance-linac system |
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