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The technical feasibility of an image-guided intensity-modulated radiotherapy (IG-IMRT) to perform a hypofractionated schedule in terms of toxicity and local control for patients with locally advanced or recurrent pancreatic cancer

Seok Hyun Son1, Jin Ho Song1, Byung Ock Choi1, Young-nam Kang1, Myung Ah Lee2, Ki Mun Kang3 and Hong Seok Jang1*

Author Affiliations

1 Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Seoul, Korea

2 Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea

3 Department of Radiation Oncology, College of Medicine, Gyeongsang National University, Jinju, Korea

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Radiation Oncology 2012, 7:203  doi:10.1186/1748-717X-7-203

Published: 5 December 2012

Abstract

Background

The purpose of this study was to evaluate the technical feasibility of an image-guided intensity modulated radiotherapy (IG-IMRT) using involved-field technique to perform a hypofractionated schedule for patients with locally advanced or recurrent pancreatic cancer.

Methods

From May 2009 to November 2011, 12 patients with locally advanced or locally recurrent pancreatic cancer received hypofractionated CCRT using TomoTherapy Hi-Art with concurrent and sequential chemotherapy at Seoul St. Mary’s Hospital, the Catholic University of Korea. The total dose delivered was 45 Gy in 15 fractions or 50 Gy in 20 fractions. The target volume did not include the uninvolved regional lymph nodes. Treatment planning and delivery were performed using the IG-IMRT technique. The follow-up duration was a median of 31.1 months (range: 5.7-36.3 months).

Results

Grade 2 or worse acute toxicities developed in 7 patients (58%). Grade 3 or worse gastrointestinal and hematologic toxicity occurred in 0% and 17% of patients, respectively. In the response evaluation, the rates of partial response and stable disease were 58% and 42%, respectively. The rate of local failure was 8% and no regional failure was observed. Distant failure was the main cause of treatment failure. The progression-free survival and overall survival durations were 7.6 and 12.1 months, respectively.

Conclusion

The involved-field technique and IG-IMRT delivered via a hypofractionated schedule are feasible for patients with locally advanced or recurrent pancreatic cancer.

Keywords:
Unresectable pancreatic cancer; Hypofractionated radiotherapy; Image-guided; Intensity-modulated radiotherapy