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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Veröffentlicht in:Physics and imaging in radiation oncology Jg. 24; S. 88 - 94
Hauptverfasser: Tringale, Kathryn R., Tyagi, Neelam, Marsha Reyngold, Romesser, Paul B., Wu, Abraham, O'Reilly, Eileen M., Varghese, Anna M., Godoy Scripes, Paola, Khalil, Danny N., Park, Wungki, Yu, Kenneth, Crane, Christopher H.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: Netherlands Elsevier B.V 01.10.2022
Elsevier
Schlagworte:
Ablative radiation therapy
MR linac
MRI
Original
Pancreas cancer
Ablative radiation therapy
MRI
Pancreas cancer
MR linac
ISSN:2405-6316, 2405-6316
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Zusammenfassung:•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.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:2405-6316
2405-6316
DOI:10.1016/j.phro.2022.10.003