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Buwenge M, Marinelli A, Deodato F, Macchia G, Wondemagegnhu T, Salah T, Cammelli S, Uddin AFMK, Sumon MA, Donati CM, Cilla S, Morganti AG. Definition of fields margins for palliative radiotherapy of pancreatic carcinoma. Mol Clin Oncol 2018; 8:715-718. [PMID: 29844901 PMCID: PMC5958799 DOI: 10.3892/mco.2018.1605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 02/09/2018] [Indexed: 11/05/2022] Open
Abstract
The present study aimed to provide practical guidelines for palliative treatment of advanced carcinoma of the pancreas (CAP) with the 2D technique. Fifteen patients with locally advanced CAP consecutively treated with radiation therapy at the Radiation Oncology Center, Research and Care Foundation 'Giovanni Paolo II' (Campobasso, Italy) underwent computed tomography simulation in supine position. Definition of the clinical target volume (CTV) included the head and body of the pancreas, and the retropancreatic space. The planning target volume was defined by adding a margin of 14 mm to the CTV in the cranio-caudal direction and of 11 mm in radial direction. For each patient, 3 treatment plans were calculated using a cobalt source, 6 MV photons and 15 MV photons (box technique). Beams were drawn using the primary collimators without using multileaf collimators, and progressively optimized in order to respect the minimum dose (Dmin>90%) constraint. Once the final plan was achieved, distances of the fields edges from a set of reference points (bony or duodenal landmarks) were measured. Using this technique, 15 anterior-posterior and postero-anterior (AP-PA) beams and 15 pairs of lateral-lateral (LL) beams were defined for the different patients. Finally, the single minimal AP-PA and LL beams able to include the 15 sets of AP-PA and LL beams were defined. The results of this analysis are reported in tabular form. Guidelines are provided for treatment based on cobalt unit or Linear accelerator (both 6 and 15 MV photons). This study provides information regarding field size and position. A dosimetric study has been planned to identify the dose to be administered with this technique taking into account current dose-volume constraints.
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Affiliation(s)
- Milly Buwenge
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Radiation Oncology Center, University of Bologna, S. Orsola-Malpighi Hospital, I-40138 Bologna, Italy
| | - Alfonso Marinelli
- Radiation Oncology Unit, Research and Care Foundation 'Giovanni Paolo II', Catholic University of Sacred Heart, I-86100 Campobasso, Italy
| | - Francesco Deodato
- Radiation Oncology Unit, Research and Care Foundation 'Giovanni Paolo II', Catholic University of Sacred Heart, I-86100 Campobasso, Italy
| | - Gabriella Macchia
- Radiation Oncology Unit, Research and Care Foundation 'Giovanni Paolo II', Catholic University of Sacred Heart, I-86100 Campobasso, Italy
| | | | - Tareq Salah
- Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Silvia Cammelli
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Radiation Oncology Center, University of Bologna, S. Orsola-Malpighi Hospital, I-40138 Bologna, Italy
| | - A F M Kamal Uddin
- Radiation Oncology Department, United Hospital Limited, Gulshan, Dhaka 1212, Bangladesh
| | - Mostafa A Sumon
- Radiation Oncology Department, United Hospital Limited, Gulshan, Dhaka 1212, Bangladesh
| | - Constanza M Donati
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Radiation Oncology Center, University of Bologna, S. Orsola-Malpighi Hospital, I-40138 Bologna, Italy
| | - Savino Cilla
- Medical Physics Unit, Research and Care Foundation 'Giovanni Paolo II', Catholic University of Sacred Heart, I-86100 Campobasso, Italy
| | - Alessio G Morganti
- Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Radiation Oncology Center, University of Bologna, S. Orsola-Malpighi Hospital, I-40138 Bologna, Italy
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Morganti AG, Marinelli A, Buwenge M, Macchia G, Deodato F, Massaccesi M, Kigula-Mugambe J, Wondemagegnhu T, Dawotola D, Caravatta L, Sallustio G, Piermattei A, Valentini V, Cilla S. Palliative Two-Dimensional Radiotherapy of Pancreatic Carcinoma: A Feasibility Study. Tumori 2013; 99:488-92. [DOI: 10.1177/030089161309900408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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.
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Affiliation(s)
- Alessio G Morganti
- Radiotherapy Unit, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Campobasso, Italy
- Department of Radiotherapy, Policlinico Universitario “A Gemelli”, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alfonso Marinelli
- Radiotherapy Unit, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Milly Buwenge
- Department of Radiotherapy, Mulago Hospital, Kampala, Uganda
| | - Gabriella Macchia
- Radiotherapy Unit, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Francesco Deodato
- Radiotherapy Unit, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Mariangela Massaccesi
- Radiotherapy Unit, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | | | | | - David Dawotola
- Department of Radiotherapy, Radiotherapy and Oncology Centre, Abuth, Zaria, Nigeria
| | - Luciana Caravatta
- Radiotherapy Unit, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Giuseppina Sallustio
- Radiology Unit, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Angelo Piermattei
- Medical Physics Unit, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Vincenzo Valentini
- Department of Radiotherapy, Policlinico Universitario “A Gemelli”, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Savino Cilla
- Medical Physics Unit, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Università Cattolica del Sacro Cuore, Campobasso, Italy
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