Clinical results of dynamic tumor tracking intensity-modulated radiotherapy with real-time monitoring for pancreatic cancers using a gimbal mounted linac
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Yoko Goto1, Ryo Ashida1, Akira Nakamura1, Satoshi Itasaka1, Keiko Shibuya2, Mami Akimoto1, Nobutaka Mukumoto1, Shigemi Matsumoto3, Masashi Kanai3, Hiroyoshi Isoda4, Toshihiko Masui5, Yuzo Kodama6, Mitsuhiro Nakamura1, Kyoichi Takaori5, Takashi Mizowaki1 and Masahiro Hiraoka1,7
1Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
2Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, Japan
3Department of Clinical Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
4Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
5Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
6Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
7Department of Radiation Oncology, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
Yoko Goto, email: [email protected]
Keywords: dynamic tumor tracking (DTT); intensity-modulated radiotherapy (IMRT); chemoradiotherapy; locally advanced pancreatic cancer; prognosis
Received: January 05, 2018 Accepted: April 14, 2018 Published: May 04, 2018
Objectives: We performed dynamic tumor-tracking IMRT (DTT-IMRT) in locally advanced pancreatic cancer (LAPC) patients using a gimbaled linac of Vero4DRT. The purpose of this study is to report the first clinical results.
Methods: From June 2013 to June 2015, eleven LAPC patients enrolled in this study and DTT-IMRT was successfully performed. The locoregional progression free survival (LRPFS), distant metastasis free survival (DMFS), overall survival (OS), hematologic and gastrointestinal (GI) toxicities were evaluated. Oncologic outcomes were estimated using Kaplan-Meier analysis, and toxicities using CTCAE v4.0.
Results: The median radiation dose was 48 Gy (range, 45-51) in 15 fractions. Concurrent chemoradiotherapy (CCRT) was performed using gemcitabine in 9 patients and S-1 in one, while one patient refused. With a median follow-up of 22.9 months, 1-year LRPFS, DMFS, and OS rates were 90.9%, 70.7%, and 100%, respectively. Median survival time was 23.6 months. Grade-3 leucopenia and neutropenia were observed in two (18%) and one patient (9%), respectively. Grade-2 acute GI toxicity occurred in 2 patients (18%) and late grade-3 in 1 patient (9%).
Conclusions: Preliminarily application of DTT-IMRT using a gimbaled linac on CCRT in LAPC patients resulted in excellent locoregional control and OS without severe toxicity.
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