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Palliative two-dimensional radiotherapy of pancreatic carcinoma: a feasibility study

Abstract

Aims and background. The aim of the study was to analyze the dose to be administered with two-dimensional involved-field palliative radiotherapy in advanced pancreatic carcinoma with respect to current dose-volume constraints (QUANTEC).
Methods and study design. The following standard regimens were evaluated: 30 Gy at 3 Gy/fraction (regimen A), 36 Gy at 2.4 Gy/fraction (regimen B), 45 Gy at 1.8 Gy/fraction (regimen C), and 50 Gy at 2 Gy /fraction (regimen D). The following constraints were considered: spinal cord Dmax >50 Gy, duodenum Dmax >55 Gy, liver Dmean >30 Gy, kidneys Dmean >15 Gy. For dose/fraction different from 1.8-2 Gy, the correction of constraints using a value of alpha/beta = 3 for late effects was considered. The calculation of dose/volume constraints was repeated for three different radiation beams: cobalt unit, 6 MV photons, and 15 MV photons. Standard field sizes were used and adapted according to the different beam types, using the parameters of our previous study. Respect of dose-volume constraints was assessed for each type of beam and treatment (dose per fractionation) in all patients. Treatments were considered acceptable in case of: 1) respect of the constraints for spinal cord and duodenum in all patients; 2) respect in >10/15 patients of constraints for kidneys and liver. Therefore, minor violations (>10%) of the constraints for these organs were accepted (in less than 5/15 patients), in consideration of the palliative aim of treatment.
Results. In regimen A (30 Gy, 3 Gy/fraction), evaluated constraints were respected in all patients, regardless of the type of energy. In regimen B (36 Gy, 2.4 Gy/fraction), constraints were met in all patients undergoing irradiation with 6 and 15 MV photons. However, using the cobalt unit, kidney constraint was respected only in 5 of 15 patients. In regimens C and D (45 Gy, 1.8 Gy/fraction and 50 Gy, 2 Gy/fraction, respectively), the constraint for the kidney was respected only in 2-5 patients, depending on the energy used. Furthermore, using 50 Gy, the spinal cord constraint was not respected in 2-3 patients, depending on the beam used. Therefore, only the following treatments were considered acceptable: 1) 30 Gy, 3 Gy/fraction, regardless of the energy used; 2) 36 Gy, 2.4 Gy/fraction, only for treatments performed with linear accelerator (6-15 MV).
Conclusions. The clinical benefits of radiotherapy in pancreatic tumors should not be withheld from patients treated in centers only with two-dimensional technology. Prospective trials, particularly in developing countries, would be useful to evaluate the efficacy in this setting of involved-field two-dimensional treatments using the dose and fractionation defined in this analysis.

Tumori 2013; 99(4): 488 - 492

Article Type: ORIGINAL RESEARCH ARTICLE

DOI:10.1700/1361.15099

Authors

Alessio G Morganti, Alfonso Marinelli, Milly Buwenge, Gabriella Macchia, Francesco Deodato, Mariangela Massaccesi, Joseph Kigula-Mugambe, Tigeneh Wondemagegnhu, David Dawotola, Luciana Caravatta, Giuseppina Sallustio, Angelo Piermattei, Vincenzo Valentini, Savino Cilla

Article History

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Authors

  • Morganti, Alessio G [PubMed] [Google Scholar]
    Radiotherapy Unit, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Campobasso, Italy
  • Marinelli, Alfonso [PubMed] [Google Scholar]
    Radiotherapy Unit, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Campobasso, Italy
  • Buwenge, Milly [PubMed] [Google Scholar]
    Department of Radiotherapy, Mulago Hospital, Kampala, Uganda, Italy
  • Macchia, Gabriella [PubMed] [Google Scholar]
    Radiotherapy Unit, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Campobasso, Italy
  • Deodato, Francesco [PubMed] [Google Scholar]
    Radiotherapy Unit, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Campobasso, Italy
  • Massaccesi, Mariangela [PubMed] [Google Scholar]
    Radiotherapy Unit, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Campobasso, Italy
  • Kigula-Mugambe, Joseph [PubMed] [Google Scholar]
    Department of Radiotherapy, Mulago Hospital, Kampala, Uganda, Italy
  • Wondemagegnhu, Tigeneh [PubMed] [Google Scholar]
    Department of Radiotherapy, Black Lion Hospital, Addis-Ababa, Ethiopia, Italy
  • Dawotola, David [PubMed] [Google Scholar]
    Department of Radiotherapy, Radiotherapy and Oncology Centre, Abuth, Zaria, Nigeria, Italy
  • Caravatta, Luciana [PubMed] [Google Scholar]
    Radiotherapy Unit, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Campobasso, Italy
  • Sallustio, Giuseppina [PubMed] [Google Scholar]
    Radiology Unit, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Campobasso, Italy
  • Piermattei, Angelo [PubMed] [Google Scholar]
    Medical Physics Unit, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Campobasso, Italy
  • Valentini, Vincenzo [PubMed] [Google Scholar]
    Department of Radiotherapy, Policlinico Universitario “A Gemelli”, Università Cattolica del Sacro Cuore, Rome, Italy
  • Cilla, Savino [PubMed] [Google Scholar]
    Medical Physics Unit, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Campobasso, Italy

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