Individually optimized stereotactic radiotherapy for pancreatic head tumors: A planning feasibility study.

AIM

Aim of this study was to perform a planning feasibility analysis of a 3-level dose prescription using an IMRT-SIB technique.

BACKGROUND

Radiation therapy of locally advanced pancreatic cancer should administer a minimum dose to the duodenum and a very high dose to the vascular infiltration areas to improve the possibility of a radical resection.

MATERIALS AND METHODS

Fifteen patients with pancreatic head adenocarcinoma and vascular involvement were included. The duodenal PTV (PTVd) was defined as the GTV overlapping the duodenal PRV. Vascular CTV (CTVv) was defined as the surface of contact or infiltration between the tumor and vessel plus a 5 mm margin. Vascular PTV (PTVv) was considered as the CTVv plus an anisotropic margin. The tumor PTV (PTVt) was defined as the GTV plus a margin including the PTVv and excluding the PTVd. The following doses were prescribed: 30 Gy (6 Gy/fraction) to PTVd, 37.5 Gy (7.5 Gy/fraction) to PTVt, and 45 Gy (9 Gy/fraction) to PTVv, respectively. Treatment was planned with an IMRT technique.

RESULTS

The primary end-point (PTVv  > 90%) was achieved in all patients. PTVv  > 90% was achieved in 6 patients (40%). OARs constraints were achieved in all patients.

CONCLUSIONS

Although the PTVv  > 95% objective was achieved only in 40% of patients, the study showed that in 100% of patients it was possible to administer a strongly differentiated mean/median dose. Prospective trials based on clinical application of this strategy seem to be justified in selected patients without overlap between PTVd and PTVv.