| Workplace | Study Concept | Number of Patients | Volume
(chemotherapy) |
Doses | Output Parameters | Toxicity |
| Hyogo Ion Beam Medical Center22) | Inoperable | 50 | CTV* + ENI
(gemcitabine weekly x3) |
50GyE/25 fractions
67,5 GyE/25 fractions 70,2 GyE/26 fractions |
1 annual local check-up 81.7%
1 year survival 76.8% |
GI 3.st 10% |
| Hyogo Ion Beam Medical Center33) | Inoperable | 91 | CTV + ENI
(gemcitabine weekly x3) |
67,5 GyE/25 fractions
|
Median follow-up 10 months | GI st. I
GI 4. St. 1,1%, 5. st. 2,2%. (3x duodenal ulcer, 2x fatal)
|
| National Cancer Center Goyang Korea34) | Inoperable | 37 | CTV without ENI
(capecitabine or infused 5-FU) After induction CHT FolFirinOx or gemcitabine + erlotinib |
45 GyE resp. 30 GyE/10 fractions – SIB | Median follow-up 16.7 months
Median survival 19.3 months |
Without acute and chronic toxicity st. > 2 |
| Mayo clinic35) | Inoperable | 13 | CTV + ENI
(capecitabine or infused 5-FU) |
50 GyE resp. 45 GyE/25 fractions SIB | Median follow-up 16 months
1-year and 2-year survival 62 resp. 40% |
Without acute and chronic toxicity st. > 2 |
| Nagoya36) | Inoperable | 13 | CTV without ENI
(S1) |
60 GyE resp. 40 GyE/ 20 fractions SIB | Median follow-up 12 months | Acute toxicity 3. St. 30.7%
Without chronic toxicity st. > 2 |
| UPEN Philadelphia32) | Post-operative | 38 | Bed + lymphatics
(capecitabine or infused 5-FU) |
54 GyE/27 fractions
|
Median follow-up 20 months | Acute GI toxicity st. > 3 3% |
| Massahusets General Hospital37) | Preoperative
(primarily operable) |
48 | CTV + ENI
(capecitabine) |
25 GyE/5 fractions | Radical resection 81%
Median follow-up 38 months, median survival 17 months |
Acute toxicity st. > 3 4.1% |
| Chiba21) | Preoperative
(primarily operable) |
26 | CTV + ENI | 30-36,8 GyE/8 fractions | R0 resection 73%
Median survival 18.6 months. (not absorbed after R0 resection) |
Acute resp. chronic toxicity st. > 3 3.8% resp. 3.8% |
References
1. www.svod.cz
2. Neoptolemos JP, Palmer DH, Ghaneh P, et al.
Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial.
Lancet 2017;389:1011-24
3. Groot VP, Rezaee N, Wu W, et al.
Patterns, Timing, and Predictors of Recurrence Following Pancreatectomy for Pancreatic Ductal Adenocarcinoma.
Ann Surg 2018;267:936-45
4. Hammel P, Huguet F, van Laethem JL, et al.
Effect of Chemoradiotherapy vs. Chemotherapy on Survival in Patients With Locally Advanced Pancreatic Cancer Controlled After 4 Months of Gemcitabine With or Without Erlotinib: The LAP07 Randomized Clinical Trial.
JAMA 2016;315:1844-53
5. Oettle H, Post S, Neuhaus P, et al.
Adjuvant chemotherapy with gemcitabine vs. observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial.
JAMA 2007;297:267-77
6. Regine WF, Winter KA, Abrams RA, et al.
luorouracil vs. gemcitabine chemotherapy before and after fluorouracil-based chemoradiation following resection of pancreatic adenocarcinoma: a randomized controlled trial.
JAMA 2008;299:1019-26
7. Tienhoven GV, Versteiine E, Suker M, et al.
Preoperative chemoradiotherapy versus immediate surgery for resectable borderline resectable pancreatic cancer (PREOPANC-1): A randomized, controlled, multicenter phase III trial.
J Clin Oncol 2018;36:LBA4002
8. Murphy JD, Adusumilli S, Griffith KA, Ray ME et al.
Full-dose gemcitabine and concurrent radiotherapy for unresectable pancreatic cancer
Int J Radiat Oncol Biol Phys 2007; 68: 801–808.
9. McGinn CJ, Zalupski MM, Shureiqi I, Robertson JM
Phase I trial of radiation dose escalation with concurrent weekly full-dose gemcitabine in patients with advanced pancreatic cancer
J Clin Oncol 2001; 19: 4202–4208
10. Brunner TB, Merkel S, Grabenbauer GG, Meyer T, et al.
Definition of elective lymphatic target volume in ductal carcinoma of the pancreatic head based on histopathologic analysis
Int J Radiat Oncol Biol Phys 2005; 62: 1021–1029
11. Turrini O, Viret F, Moureau-Zabotto L, Guiramand J. et al.
Neoadjuvant 5 fluorouracil-cisplatin chemoradiation effect on survival in patients with resectable pancreatic head adenocarcinoma: a ten-year single institution experience
Oncology 2009; 76: 413–419
12. Loehrer PJ, Sr., Feng Y, Cardenes H, et al. Gemcitabine alone
versus gemcitabine plus radiotherapy in patients with locally
advanced pancreatic cancer: an Eastern Cooperative Oncology
Group trial. J Clin Oncol. 2011;29(31):4105-4112
13. Mukherjee S, Hurt CN, Bridgewater J, et al.
Gemcitabine-based or capecitabine-based chemoradiotherapy for locally advanced
pancreatic cancer (SCALOP): a multicentre, randomised, phase
2 trial.
Lancet Oncol. 2013;14(4):317-326
14. Huguet F, Goodman KA, Azria D, Racadot S.
Radiotherapy technical considerations in the management of locally advanced pancreatic cancer: American-French consensus recommendations
Int J Radiat Oncol Biol Phys 2012; 83: 1355–1364
15. Fokas E, Eccles C, Patel N, Chu K-Y et al.
Comparison of four target volume definitions for pancreatic cancer. Guidelines for treatment of the lymphatics and the primary tumor.
Strahlenther. Onko. 2013; 189:407-416
16. Ling TC, Slater JM, Mifflin R, Nookala P et al.
Evaluation of normal tissue exposure in patients receiving radiotherapy for pancreatic cancer based on RTOG 0848
Journal of Gastrointestinal Oncology 2015; 6: 108–114
17. Thompson RF, Mayekar SU, Zhai H, Both S. et al.
A dosimetric comparison of proton and photon therapy in unresectable cancers of the head of pancreas
Medical physics 2014; 41: 081711-1–10
18. Abrams RA, Regine WF, Goodman KA, Dawson LA et al.
Consensus panel contouring atlas for the delineation of the clinical target volume in the postoperative treatment of pancreatic cancer
http://www.rtog.org/CoreLab/ContouringAtlases/PancreasAtlas.aspx
19. Caravatta L, Sallustio G, Pacelli F, Padulla GDA et al.
Clinical target volume delinetation uncluding elective nodal irradiation in preoperative and definitive radiotherapy of pancreatic cancer.
Radiation Oncology 2012; 7:86
20. Morganti AT, Trodella L, Valentin V, Barbi S et al.
Pain relief with short-term irradiation in locally advanced carcinoma of the pancreas.
J. Palliat. Care 2003; 19:258-262
21. Shinoto M, Yamada S, Yasuda S, Imada H et al.
Phase 1 trial of preoperative, short-course carbon-ion radiotherapy for patients with resectable pancreatic cancer
Cancer 2013; 119:45-51
22. Terashima K, Demizu Y, Hashimoto N, Jin D et al.
A phase I/II study of gemcitabine-concurrent proton radiotherapy for locally advanced pancreatic cancer without distant metastasis
Radiother. Oncol. 2012; 103:25-31
23. Nichols RC Jr, George TJ, Zaiden RA Jr, Awad ZT
Proton therapy with concomitant capecitabine for pancreatic and ampullary cancers is associated with a low incidence of gastrointestinal toxicity
Acta Oncol. 2013; 52:498-505
24. Zurlo A, Lomax A, Hoess A et al.
The role of proton therapy in the treatment of large irradiation volumes: a comparative planning study of pancreatic and biliary tumors.
Int J Radiat Oncol Biol Phys 2000;48:277-88
25. Chuong M, Badiyan SN, Yam M, et al.
Pencil beam scanning versus passively scattered proton therapy for unresectable pancreatic cancer.
J Gastrointest Oncol 2018;9:687-93.
26. Nichols RC Jr, Huh SN, Prado KL, et al.
Protons offer reduced normal-tissue exposure for patients receiving postoperative radiotherapy for resected pancreatic head cancer
Int J Radiat Oncol Biol Phys 2012;83:158-63.
27. Nichols RC, Huh S, Li Z, Rutenberg M
Proton therapy for pancreatic cancer
World J. Gastrointestinal Oncol. 2015; 7:141-147
28. Verma J, Sulman P, Jhingran A et al.
Dosimetric Predictors of Duodenal Toxicity After Intensity Modulated Radiation Therapy for Treatment of the Para-aortic Nodes in Gynecologic Cancer
Int. J. Radiat. Oncol. Biol. Phys. 2014; 88:357-362
29. https://www.nccn.org/professionals/physician_gls/pdf/pancreatic_blocks.pdf
30. Patrick Kelly P, Das P, Pinnix CC, Beddar S et al.
Duodenal Toxicity After Fractionated Chemoradiation for Unresectable Pancreatic Cancer
Int. J. Radiat. Oncol. Biol. Phys. 2013; 85:e143-e149
31. Ling TC, Slater JM, Mifflin R, Nookala P et al.
Evaluation of normal tissue exposure in patients receiving
radiotherapy for pancreatic cancer based on RTOG 0848
J. Gastrointestinal Oncol. 2015; 6:108-114
32. Woodhouse KD, Elrakhawy, Jain A, et al.
Acute toxicity of proton versus photon adjuvant chemoradiation in the treatment of pancreatic cancer: A cohort study. Int J Radiat Oncol Biol Phys 2016;96:E208-9.
33. Takatori K, Terashima K, Yoshida R, et al.
Upper gastrointestinal complications associated with gemcitabine-concurrent proton radiotherapy for inoperable pancreatic cancer.
J Gastroenterol 2014;49:1074-80..
34. Kim TH, Lee WJ, Woo SM, et al.
Effectiveness and Safety of Simultaneous Integrated Boost-Proton Beam Therapy for Localized Pancreatic Cancer.
Technol Cancer Res Treat 2018;17:1533033818783879.
35. Jethwa KR, Tryggestad EJ, Whitaker TJ et al.
Initial experience with intensity modulated proton therapy for intact, clinically localized pancreas cancer: Clinical implementation, dosimetric analysis, acute treatment-related adverse events, and patient-reported outcomes.
Adv Radiat Oncol 2018;3:314-21.
36. Hattori Y, Hirano A, Iwata H, et al.
Image-Guided Hypofractionated Proton Therapy and Concurrent Chemotherapy for Inoperable Locally Advanced Pancreatic Cancer: Toxicities and Preliminary Outcomes.
Int J Radiat Oncol Biol Phys 2017;99:E153.
37. Hong TS, Ryan DP, Borger DR, et al.
A phase 1/2 and biomarker study of preoperative short course chemoradiation with proton beam therapy and capecitabine followed by early surgery for resectable pancreatic ductal adenocarcinoma. Int J Radiat Oncol Biol Phys 2014;89:830-8.
38. Le Scodan RL, F. Mornex F, Girard N, Mercier C et al.
Preoperative chemoradiation in potentially resectable pancreatic adenocarcinoma: feasibility, treatment
effect evaluation and prognostic factors, analysis of the SFRO-FFCD 9704 trial and literature review
Ann. Oncol. 2009; 20:1387-1396
39. Murphy JE, Wo JY, Ryan DP, Jiang W et al.
Total Neoadjuvant Therapy With FOLFIRINOX Followed by Individualized Chemoradiotherapy for Borderline Resectable Pancreatic Adenocarcinoma
JAMA Oncol. 2018 Jul; 4(7): 963–969
40. Michael S. Rutenberg, Romaine C. Nichols
Proton beam radiotherapy for pancreas cancer
J. Gastrointestinal Oncol. 2020; 11:165-175
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