Table of Contents
ISRN Oncology
Volume 2012, Article ID 572342, 7 pages
http://dx.doi.org/10.5402/2012/572342
Research Article

Dose-Painted Intensity Modulated Radiation Therapy Improves Local Control for Locally Advanced Pancreas Cancer

1Department of Radiation Oncology, The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, G2N45, 195 Little Albany Street, New Brunswick, NJ 08903, USA
2Department of Radiation Oncology, University of Utah School of Medicine, Huntsman Cancer Hospital, 1950 Circle of Hope, Room 1570, Salt Lake City, UT 84112, USA
3Division of Medical Oncology, Department of Medicine, The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08903, USA
4Department of Surgery, The Cancer Institute of New Jersey, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, 195 Little Albany Street, New Brunswick, NJ 08903, USA
5Advanced Surgical Associates of New Jersey, Two Capital Way, Suite 356, Pennington, NJ 08534, USA

Received 9 August 2012; Accepted 13 September 2012

Academic Editors: R. A. Abrams and V. Lorusso

Copyright © 2012 Ahmet Tunceroglu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. To evaluate the outcomes, adverse events, and therapeutic role of Dose-Painted Intensity-Modulated Radiation Therapy (DP-IMRT) for locally advanced pancreas cancer (LAPC). Methods. Patients with LAPC were treated with induction chemotherapy ( ) and those without metastasis ( ) received DP-IMRT consisting of 45 Gy to Planning Treatment Volume 1 (PTV1) including regional lymph nodes with a concomitant boost to the PTV2 (gross tumor volume  cm) to either 50.4 Gy ( ) or 54 Gy ( ) in 25 fractions. DP-IMRT cases were compared to three-dimensional conformal radiation therapy (3D-CRT) plans to assess the potential relationship of radiation dose to adverse events. Kaplan-Meier and Cox regression analyses were used to calculate survival probabilities. The Fisher exact test and t-test were utilized to investigate potential prognostic factors of toxicity and survival. Results. Median overall and progression-free survivals were 11.6 and 5.9 months, respectively. Local control was 90%. Post-RT CA-19-9 levels following RT were predictive of survival ( ). Grade 2 and ≥grade 3 GI toxicity were 60% and 20%, respectively. In comparison to 3D-CRT, DP-IMRT plans demonstrated significantly lower V45 values of small bowel ( ), stomach ( ), and mean liver doses ( ). Conclusions. Dose-escalated DP-IMRT offers improved local control in patients treated with induction chemotherapy for LAPC. Radiation-related morbidity appears reduced with DP-IMRT compared to 3D-CRT techniques, likely due to reduction in RT doses to organs at risk.