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Study on the analysis of gastrointestinal positional variations and the efficacy of online adaptive radiation therapy for improving the treatment outcomes of locally advanced pancreatic cancer

Ogawa, Ayaka 京都大学 DOI:10.14989/doctor.k24884

2023.09.25

概要

Background This study examined the differences in late gastrointestinal (GI) toxicities in moderately
hypofractionated intensity-modulated radiation therapy (IMRT) for locally advanced pancreatic ductal
adenocarcinoma (LA-PDAC) by changing the planning organs at risk volume (PRV) margin and the target matching
method and assessed the causes of adverse events.
Methods We examined 37 patients with LA-PDAC who underwent moderately hypofractionated IMRT between
2016 and 2020 at our institution; 23 patients were treated with wide PRV margins and soft tissue matching (Protocol
A) and 14 with narrow PRV margins and fiducial marker matching (Protocol B). The GI toxicities, local control (LC) rate,
and overall survival (OS) were assessed for each protocol. The initially planned and daily doses to the gross tumor
volume (GTV), stomach, and duodenum, reproduced from cone-beam computed tomography, were evaluated.
Results The late GI toxicity rate of grades 3–4 was higher in Protocol B (42.9%) than in Protocol A (4.3%). Although
the 2-year LC rates were significantly higher in Protocol B (90.0%) than in Protocol A (33.3%), no significant difference
was observed in OS rates. In the initial plan, no deviations were found for the stomach and duodenum from the dose
constraints in either protocol. In contrast, daily dose evaluation for the stomach to duodenal bulb revealed that the
frequency of deviation of V3 Gy per session was 44.8% in Protocol B, which was significantly higher than the 24.3% in
Protocol A.
Conclusions Reducing PRV margins with fiducial marker matching increased GI toxicities in exchange for improved
LC. Daily dose analysis indicated the trade-off between the GTV dose coverage and the irradiated doses to the GI. This
study showed that even with strict matching methods, the PRV margin could not be reduced safely because of GI
inter-fractional error, which is expected to be resolved with online adaptive radiotherapy. ...

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