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For: Teng F, Meng L, Zhu F, Ren G. Dosimetric feasibility on hypofractionated intensity-modulated radiotherapy and simultaneous integrated boost for locally advanced unresectable pancreatic cancer with helical tomotherapy. J Gastrointest Oncol 2021;12:496-506. [PMID: 34012643 DOI: 10.21037/jgo-21-160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open

For:	Teng F, Meng L, Zhu F, Ren G. Dosimetric feasibility on hypofractionated intensity-modulated radiotherapy and simultaneous integrated boost for locally advanced unresectable pancreatic cancer with helical tomotherapy. J Gastrointest Oncol 2021;12:496-506. [PMID: 34012643 DOI: 10.21037/jgo-21-160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open

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Cited by Other Article(s)

Meldolesi E, Chiloiro G, Giannini R, Menghi R, Persiani R, Corvari B, Coco C, Manfrida S, Ratto C, De Luca V, Sofo L, Reina S, Crucitti A, Masiello V, Dinapoli N, Valentini V, Gambacorta MA. The Role of Simultaneous Integrated Boost in Locally Advanced Rectal Cancer Patients with Positive Lateral Pelvic Lymph Nodes. Cancers (Basel) 2022;14:cancers14071643. [PMID: 35406415 PMCID: PMC8996944 DOI: 10.3390/cancers14071643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/04/2022] [Accepted: 03/15/2022] [Indexed: 11/30/2022] Open

Abstract

Aims: Between 11 to 14% of patients with locally advanced rectal cancer (LARC) have positive lateral pelvic lymph nodes (LPLN) at diagnosis, related to a worse prognosis with a 5-year survival rate between 30 to 40%. The best treatment choice for this group of patients is still a challenge. The optimal radiotherapy (RT) dose for LPLN patients has been investigated. Methods: We retrospectively collected data from LARC patients with LPLN at the primary staging MRI, treated in our center from March 2003 to December 2020. Patients underwent a neoadjuvant concomitant chemo-radiotherapy (CRT) treatment on the primary tumor (T), mesorectum, and pelvic nodes, associated with a fluoride-based chemotherapy. The total reached dose was 45 Gy at 1.8 Gy/fr on the elective sites and 55 Gy at 2.2 Gy/fr on the disease and mesorectum. Patients were divided in two groups based on whether they received a simultaneous integrated RT boost on the LPLN or not. Overall Survival (OS), Disease Free Survival (DFS), Metastasis Free Survival (MFS), and Local Control (LC) were evaluated in the whole group and then compared between the two groups. Results: A total of 176 patients were evaluated: 82 were included in the RT boost group and 94 in the non-RT boost group. The median follow-up period was 57.8 months. All the clinical endpoint (OS, DFS, MFS, LC), resulted were affected by the simultaneous integrated boost on LPLN with a survival rate of 84.7%, 79.5%, 84.1%, and 92%, respectively, in the entire population. From the comparison of the two groups, there was a statistical significance towards the RT boost group with a p < 0.006, 0.030, 0.042, 0.026, respectively. Conclusions: Concomitant radiotherapy boost on positive LPLN has shown to be beneficial on the survival outcomes (OS, DFS, MFR, and LC) in patients with LARC and LPLN. This analysis demonstrates that a higher dose of radiotherapy on positive pelvic lymph nodes led not only to a higher local control but also to a better survival rate. These results, if validated by future prospective studies, can bring a valid alternative to the surgery dissection without the important side effects and permanent disabilities observed during the years.

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Affiliation(s)

Elisa Meldolesi Department of Radiology, Radiation Oncology and Hematology, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Roma, Italy; (E.M.); (G.C.); (B.C.); (S.M.); (V.D.L.); (S.R.); (V.M.); (N.D.); (V.V.); (M.A.G.)
Giuditta Chiloiro Department of Radiology, Radiation Oncology and Hematology, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Roma, Italy; (E.M.); (G.C.); (B.C.); (S.M.); (V.D.L.); (S.R.); (V.M.); (N.D.); (V.V.); (M.A.G.)
Roberta Giannini Department of Radiology, Radiation Oncology and Hematology, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Roma, Italy; (E.M.); (G.C.); (B.C.); (S.M.); (V.D.L.); (S.R.); (V.M.); (N.D.); (V.V.); (M.A.G.) Correspondence:
Roberta Menghi Digestive Surgery Unit, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (R.M.); (R.P.); (C.C.); (C.R.); (L.S.); (A.C.)
Roberto Persiani Digestive Surgery Unit, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (R.M.); (R.P.); (C.C.); (C.R.); (L.S.); (A.C.)
Barbara Corvari Department of Radiology, Radiation Oncology and Hematology, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Roma, Italy; (E.M.); (G.C.); (B.C.); (S.M.); (V.D.L.); (S.R.); (V.M.); (N.D.); (V.V.); (M.A.G.)
Claudio Coco Digestive Surgery Unit, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (R.M.); (R.P.); (C.C.); (C.R.); (L.S.); (A.C.)
Stefania Manfrida Department of Radiology, Radiation Oncology and Hematology, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Roma, Italy; (E.M.); (G.C.); (B.C.); (S.M.); (V.D.L.); (S.R.); (V.M.); (N.D.); (V.V.); (M.A.G.)
Carlo Ratto Digestive Surgery Unit, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (R.M.); (R.P.); (C.C.); (C.R.); (L.S.); (A.C.)
Viola De Luca Department of Radiology, Radiation Oncology and Hematology, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Roma, Italy; (E.M.); (G.C.); (B.C.); (S.M.); (V.D.L.); (S.R.); (V.M.); (N.D.); (V.V.); (M.A.G.)
Luigi Sofo Digestive Surgery Unit, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (R.M.); (R.P.); (C.C.); (C.R.); (L.S.); (A.C.)
Sara Reina Department of Radiology, Radiation Oncology and Hematology, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Roma, Italy; (E.M.); (G.C.); (B.C.); (S.M.); (V.D.L.); (S.R.); (V.M.); (N.D.); (V.V.); (M.A.G.)
Antonio Crucitti Digestive Surgery Unit, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (R.M.); (R.P.); (C.C.); (C.R.); (L.S.); (A.C.)
Valeria Masiello Department of Radiology, Radiation Oncology and Hematology, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Roma, Italy; (E.M.); (G.C.); (B.C.); (S.M.); (V.D.L.); (S.R.); (V.M.); (N.D.); (V.V.); (M.A.G.)
Nicola Dinapoli Department of Radiology, Radiation Oncology and Hematology, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Roma, Italy; (E.M.); (G.C.); (B.C.); (S.M.); (V.D.L.); (S.R.); (V.M.); (N.D.); (V.V.); (M.A.G.)
Vincenzo Valentini Department of Radiology, Radiation Oncology and Hematology, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Roma, Italy; (E.M.); (G.C.); (B.C.); (S.M.); (V.D.L.); (S.R.); (V.M.); (N.D.); (V.V.); (M.A.G.)
Maria Antonietta Gambacorta Department of Radiology, Radiation Oncology and Hematology, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation IRCCS, 00168 Roma, Italy; (E.M.); (G.C.); (B.C.); (S.M.); (V.D.L.); (S.R.); (V.M.); (N.D.); (V.V.); (M.A.G.)

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Shi Z, Yang J, Kong W, Qiu X, Lu C, Liu J, Liu B, Du J. Use of Nab-Paclitaxel Plus Gemcitabine Followed by Hypofractionated Tomotherapy With Simultaneous Integrated Boost in Patients With Locally Advanced Pancreatic Cancer. Front Oncol 2022;12:782730. [PMID: 35299738 PMCID: PMC8922029 DOI: 10.3389/fonc.2022.782730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/31/2022] [Indexed: 12/24/2022] Open

Abstract

Background and Purpose

A phase 2 study LAPACT indicated nab-paclitaxel plus gemcitabine (AG) improved outcomes of patients with locally advanced pancreatic cancer (LAPC). Conventional radiotherapy failed to show benefit, indicating high dose to volume with high risk of recurrence is needed. The high dose can be delivered through hypofractionated tomotherapy with simultaneous integrated boost (SIB). However, there is a lack of such prospective trials and more data are needed to validate the role of AG plus hypofractionated tomotherapy with SIB in patients with LAPC.

Materials and Methods

Patients with LAPC receiving AG plus tomotherapy at the Nanjing Drum Tower Hospital between 2018 and 2021 were retrospectively analyzed. The treatment was scheduled as follows: nab-paclitaxel 125 mg/m² plus gemcitabine 1,000 mg/m² on days 1 and 8 every three weeks for at least two cycles, followed by hypofractionated tomotherapy with SIB (high dose field: 50 Gy/10 fractions, the remainder: 30 Gy/10 fractions). Then patients were given AG until intolerance or disease progression.

Results

Overall, 22 patients completing the chemoradiotherapy were included. The median follow-up was 15.2 months. After the chemoradiotherapy, 5 patients achieved a partial response (PR), 15 had a stable disease (SD), and another 2 patients were with progressive disease (PD). The median progression-free survival (PFS) and overall survival (OS) were 12.8 months (95% confidence interval [CI] 4.3-21.3 months) and 16.3 months (95% CI 10.9-21.6 months), respectively. The optimal carbohydrate antigen (CA) 19-9 response and chemotherapy cycles ≥6 were correlated with favorable PFS and OS. The most common recurrent pattern was peritoneal dissemination (22.7%) and the locoregional recurrence rate was relatively low (4.5%). Treatments were well-tolerated. The most common grade ≥3 adverse event was thrombocytopenia (13.6%).

Conclusion

This study demonstrated the feasibility of AG followed by hypofractionated tomotherapy with SIB in patients with LAPC. The hypofractionated tomotherapy with SIB was safe and showed high local control rate. Further study with a larger population to validate our data is underway.

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Passardi A, Rapposelli IG, Scarpi E, Sullo FG, Bartolini G, Neri E, Ghigi G, Tontini L, Ercolani G, Monti M, Ruscelli S, Matteucci L, Valgiusti M, Frassineti GL, Romeo A. Multimodal Treatment with GEMOX Plus Helical Tomotherapy in Unresectable Locally Advanced Pancreatic Cancer: A Pooled Analysis of Two Phase 2 Studies. Biomolecules 2021;11:biom11081200. [PMID: 34439866 PMCID: PMC8393939 DOI: 10.3390/biom11081200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/29/2021] [Accepted: 08/09/2021] [Indexed: 12/29/2022] Open

Affiliation(s)

Alessandro Passardi Department of Medical Oncology, IRCCS Istituto Romagnolo Per lo Studio dei Tumori “Dino Amadori”—IRST, 47014 Meldola, Italy; (A.P.); (F.G.S.); (G.B.); (M.M.); (S.R.); (L.M.); (M.V.); (G.L.F.)
Ilario Giovanni Rapposelli Department of Medical Oncology, IRCCS Istituto Romagnolo Per lo Studio dei Tumori “Dino Amadori”—IRST, 47014 Meldola, Italy; (A.P.); (F.G.S.); (G.B.); (M.M.); (S.R.); (L.M.); (M.V.); (G.L.F.) Correspondence: ; Tel.: +39-0543-739100
Emanuela Scarpi Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo Per lo Studio dei Tumori “Dino Amadori”—IRST, 47014 Meldola, Italy;
Francesco Giulio Sullo Department of Medical Oncology, IRCCS Istituto Romagnolo Per lo Studio dei Tumori “Dino Amadori”—IRST, 47014 Meldola, Italy; (A.P.); (F.G.S.); (G.B.); (M.M.); (S.R.); (L.M.); (M.V.); (G.L.F.)
Giulia Bartolini Department of Medical Oncology, IRCCS Istituto Romagnolo Per lo Studio dei Tumori “Dino Amadori”—IRST, 47014 Meldola, Italy; (A.P.); (F.G.S.); (G.B.); (M.M.); (S.R.); (L.M.); (M.V.); (G.L.F.)
Elisa Neri Radiotherapy Unit, IRCCS Istituto Romagnolo Per lo Studio dei Tumori “Dino Amadori”—IRST, 47014 Meldola, Italy; (E.N.); (G.G.); (L.T.); (A.R.)
Giulia Ghigi Radiotherapy Unit, IRCCS Istituto Romagnolo Per lo Studio dei Tumori “Dino Amadori”—IRST, 47014 Meldola, Italy; (E.N.); (G.G.); (L.T.); (A.R.)
Luca Tontini Radiotherapy Unit, IRCCS Istituto Romagnolo Per lo Studio dei Tumori “Dino Amadori”—IRST, 47014 Meldola, Italy; (E.N.); (G.G.); (L.T.); (A.R.)
Giorgio Ercolani General and Oncologic Surgery Unit, Morgagni-Pierantoni Hospital, AUSL Romagna, 47121 Forlì, Italy; Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
Manlio Monti Department of Medical Oncology, IRCCS Istituto Romagnolo Per lo Studio dei Tumori “Dino Amadori”—IRST, 47014 Meldola, Italy; (A.P.); (F.G.S.); (G.B.); (M.M.); (S.R.); (L.M.); (M.V.); (G.L.F.)
Silvia Ruscelli Department of Medical Oncology, IRCCS Istituto Romagnolo Per lo Studio dei Tumori “Dino Amadori”—IRST, 47014 Meldola, Italy; (A.P.); (F.G.S.); (G.B.); (M.M.); (S.R.); (L.M.); (M.V.); (G.L.F.)
Laura Matteucci Department of Medical Oncology, IRCCS Istituto Romagnolo Per lo Studio dei Tumori “Dino Amadori”—IRST, 47014 Meldola, Italy; (A.P.); (F.G.S.); (G.B.); (M.M.); (S.R.); (L.M.); (M.V.); (G.L.F.)
Martina Valgiusti Department of Medical Oncology, IRCCS Istituto Romagnolo Per lo Studio dei Tumori “Dino Amadori”—IRST, 47014 Meldola, Italy; (A.P.); (F.G.S.); (G.B.); (M.M.); (S.R.); (L.M.); (M.V.); (G.L.F.)
Giovanni Luca Frassineti Department of Medical Oncology, IRCCS Istituto Romagnolo Per lo Studio dei Tumori “Dino Amadori”—IRST, 47014 Meldola, Italy; (A.P.); (F.G.S.); (G.B.); (M.M.); (S.R.); (L.M.); (M.V.); (G.L.F.)
Antonino Romeo Radiotherapy Unit, IRCCS Istituto Romagnolo Per lo Studio dei Tumori “Dino Amadori”—IRST, 47014 Meldola, Italy; (E.N.); (G.G.); (L.T.); (A.R.)

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