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Helical tomotherapy with concurrent capecitabine for the treatment of inoperable pancreatic cancer.

Ji JS, Han CW, Jang JW, Lee BI, Kim BW, Choi H, Kim JY, Kang YN, Kay CS, Choi IB - Radiat Oncol (2010)

Bottom Line: None of the lesions showed in-field progression.Treatment was well tolerated with only minor toxicities such as grade 1 nausea (one patient), grade 1 hand-foot syndrome (one patient) and grade 1/2 fatigue (three patients).Helical tomotherapy with concurrent capecitabine is a feasible option without significant toxicities in patients with advanced pancreatic cancer.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, The Catholic University of Korea, St Mary's Hospital, 62, Youidodong, Youngdeoungpogu, Seoul, 150-713, Republic of Korea.

ABSTRACT

Background: Helical tomotherapy, an advanced intensity-modulated radiation therapy with integrated CT imaging, permits highly conformal irradiation with sparing of normal tissue. Capecitabine, a pro-drug of 5-FU that induces thymidine phosphorylase can achieve higher levels of intracellular 5-FU when administered concurrently with radiation. We evaluated the feasibility as well as the clinical outcome of concurrent administration of capecitabine with tomotherapy in patients with advanced pancreatic cancer.

Methods: Nineteen patients with advanced pancreatic cancer including primarily unresectable disease and recurrence after curative surgery were included in the study. Two planning target volumes (PTV) were entered: PTV1 is gross tumor volume; and PTV2, the volume of the draining lymph nodes. The total doses to target 1 and target 2 were 55 and 50 Gy, respectively. Capecitabine at 1600 mg/m2/day was administered on each day of irradiation.

Results: Twenty six measurable lesions were evaluated. Overall in-field response rate was 42.3%; partial responses were achieved in 53.3% of the pancreatic masses, 28.6% of distant metastatic lesions and 25.0% of regional lymph nodes. The median duration of follow-up after tomotherapy was 6.5 months. None of the lesions showed in-field progression. Treatment was well tolerated with only minor toxicities such as grade 1 nausea (one patient), grade 1 hand-foot syndrome (one patient) and grade 1/2 fatigue (three patients).

Conclusions: Helical tomotherapy with concurrent capecitabine is a feasible option without significant toxicities in patients with advanced pancreatic cancer. We achieved excellent conformal distribution of radiation doses and minimal treatment-related toxicities with promising target volume responses.

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Related in: MedlinePlus

Average dose-volume histogram for GTV and organs at risk. Patients were prescribed doses of 55 Gy to PTV1 and 50 Gy to PTV2. GTV = gross tumor volume, PTV = planning target volume.
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Figure 2: Average dose-volume histogram for GTV and organs at risk. Patients were prescribed doses of 55 Gy to PTV1 and 50 Gy to PTV2. GTV = gross tumor volume, PTV = planning target volume.

Mentions: Radiotherapy was provided by helical tomotherapy (Tomotherapy Incorporated, Madison, WI, USA). Two planning target volumes (PTV) were entered for each patient [3]. PTV1 consisted of the gross tumor volume (GTV) as determined by CT scan, or the tumor bed (in post-surgical cases). PTV2 consisted of the draining lymph nodes, comprising the nodes in the porta hepatis, celiac axis, superior mesenteric and retroperitoneal areas. PTV2 extended 2 cm below the target volume and did not have to include the inferior mesenteric nodes. Both targets were treated simultaneously in 25 daily fractions, 5 days a week. Helical tomotherapy delivered 55 Gy to PTV1 and 50 Gy to PTV2. In some patients with distant metastases (liver or lung), the metastatic lesions were also targeted as another PTV. The distribution of isodoses in the helical tomotherpy treatment planning is shown in Figure 1. The dose and volume constraints for the normal structures are listed in Table 1. Figure 2 is an average delivered dose-volume histogram for GTV and organ at risk. Capecitabine (Xeloda; Roche Pharmaceuticals, Nutley, NJ) was given at 1600 mg/m2/day in two doses on each day of radiation and continued for the duration of the radiation therapy [3].


Helical tomotherapy with concurrent capecitabine for the treatment of inoperable pancreatic cancer.

Ji JS, Han CW, Jang JW, Lee BI, Kim BW, Choi H, Kim JY, Kang YN, Kay CS, Choi IB - Radiat Oncol (2010)

Average dose-volume histogram for GTV and organs at risk. Patients were prescribed doses of 55 Gy to PTV1 and 50 Gy to PTV2. GTV = gross tumor volume, PTV = planning target volume.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2903902&req=5

Figure 2: Average dose-volume histogram for GTV and organs at risk. Patients were prescribed doses of 55 Gy to PTV1 and 50 Gy to PTV2. GTV = gross tumor volume, PTV = planning target volume.
Mentions: Radiotherapy was provided by helical tomotherapy (Tomotherapy Incorporated, Madison, WI, USA). Two planning target volumes (PTV) were entered for each patient [3]. PTV1 consisted of the gross tumor volume (GTV) as determined by CT scan, or the tumor bed (in post-surgical cases). PTV2 consisted of the draining lymph nodes, comprising the nodes in the porta hepatis, celiac axis, superior mesenteric and retroperitoneal areas. PTV2 extended 2 cm below the target volume and did not have to include the inferior mesenteric nodes. Both targets were treated simultaneously in 25 daily fractions, 5 days a week. Helical tomotherapy delivered 55 Gy to PTV1 and 50 Gy to PTV2. In some patients with distant metastases (liver or lung), the metastatic lesions were also targeted as another PTV. The distribution of isodoses in the helical tomotherpy treatment planning is shown in Figure 1. The dose and volume constraints for the normal structures are listed in Table 1. Figure 2 is an average delivered dose-volume histogram for GTV and organ at risk. Capecitabine (Xeloda; Roche Pharmaceuticals, Nutley, NJ) was given at 1600 mg/m2/day in two doses on each day of radiation and continued for the duration of the radiation therapy [3].

Bottom Line: None of the lesions showed in-field progression.Treatment was well tolerated with only minor toxicities such as grade 1 nausea (one patient), grade 1 hand-foot syndrome (one patient) and grade 1/2 fatigue (three patients).Helical tomotherapy with concurrent capecitabine is a feasible option without significant toxicities in patients with advanced pancreatic cancer.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine, The Catholic University of Korea, St Mary's Hospital, 62, Youidodong, Youngdeoungpogu, Seoul, 150-713, Republic of Korea.

ABSTRACT

Background: Helical tomotherapy, an advanced intensity-modulated radiation therapy with integrated CT imaging, permits highly conformal irradiation with sparing of normal tissue. Capecitabine, a pro-drug of 5-FU that induces thymidine phosphorylase can achieve higher levels of intracellular 5-FU when administered concurrently with radiation. We evaluated the feasibility as well as the clinical outcome of concurrent administration of capecitabine with tomotherapy in patients with advanced pancreatic cancer.

Methods: Nineteen patients with advanced pancreatic cancer including primarily unresectable disease and recurrence after curative surgery were included in the study. Two planning target volumes (PTV) were entered: PTV1 is gross tumor volume; and PTV2, the volume of the draining lymph nodes. The total doses to target 1 and target 2 were 55 and 50 Gy, respectively. Capecitabine at 1600 mg/m2/day was administered on each day of irradiation.

Results: Twenty six measurable lesions were evaluated. Overall in-field response rate was 42.3%; partial responses were achieved in 53.3% of the pancreatic masses, 28.6% of distant metastatic lesions and 25.0% of regional lymph nodes. The median duration of follow-up after tomotherapy was 6.5 months. None of the lesions showed in-field progression. Treatment was well tolerated with only minor toxicities such as grade 1 nausea (one patient), grade 1 hand-foot syndrome (one patient) and grade 1/2 fatigue (three patients).

Conclusions: Helical tomotherapy with concurrent capecitabine is a feasible option without significant toxicities in patients with advanced pancreatic cancer. We achieved excellent conformal distribution of radiation doses and minimal treatment-related toxicities with promising target volume responses.

Show MeSH
Related in: MedlinePlus