Stereotactic ablative radiation for pancreatic cancer on a 1.5 Telsa magnetic resonance-linac system Journal Article
| Authors: | Tringale, K. R.; Tyagi, N.; Reyngold, M.; Romesser, P. B.; Wu, A.; O'Reilly, E. M.; Varghese, A. M.; Godoy Scripes, P.; Khalil, D. N.; Park, W.; Yu, K.; Crane, C. H. |
| Article Title: | Stereotactic ablative radiation for pancreatic cancer on a 1.5 Telsa magnetic resonance-linac system |
| Abstract: | 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. © 2022 The Authors |
| Keywords: | adult; cancer survival; clinical article; controlled study; aged; overall survival; fatigue; cancer recurrence; advanced cancer; cancer combination chemotherapy; diarrhea; treatment planning; gemcitabine; paclitaxel; pancreas cancer; follow up; anorexia; metastasis; progression free survival; computer assisted tomography; nausea; vomiting; lorazepam; retrospective study; abdominal pain; simulation; dosimetry; loperamide; inoperable cancer; acute toxicity; stereotactic body radiation therapy; mri; gross tumor volume; cumulative incidence; immune checkpoint inhibitor; human; male; female; article; mr linac; ablative radiation therapy; t2 weighted imaging |
| Journal Title: | Physics and Imaging in Radiation Oncology |
| Volume: | 24 |
| ISSN: | 2405-6316 |
| Publisher: | Elsevier B.V. |
| Date Published: | 2022-10-01 |
| Start Page: | 88 |
| End Page: | 94 |
| Language: | English |
| DOI: | 10.1016/j.phro.2022.10.003 |
| PROVIDER: | scopus |
| PMCID: | PMC9640311 |
| PUBMED: | 36386447 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 December 2022 -- Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
Related MSK Work