Abstract
BackgroundTo consolidate literature reports of serious late gastrointestinal toxicities after hypofractionated radiation treatment of pancreatic cancer and attempt to derive normal tissue complication probability (NTCP) parameters using the Lyman-Kutcher-Burman model.MethodsPublished reports of late grade 3 or greater gastrointestinal toxicity after hypofractionated treatment of pancreatic cancer were reviewed. The biologically equivalent dose in 1.8 Gy fractions was calculated using the EQD model. NTCP parameters were calculated using the LKB model assuming 1–5 % of the normal tissue volume was exposed to the prescription dose with α/β ratios of 3 or 4.ResultsA total of 16 human studies were examined encompassing a total of 1160 patients. Toxicities consisted of ulcers, hemorrhages, obstructions, strictures, and perforations. Non-hemorrhagic and non-perforated ulcers occurred at a rate of 9.1 % and were the most commonly reported toxicity. Derived NTCP parameter ranges were as follows: n = 0.38–0.63, m = 0.48–0.49, and TD50 = 35–95 Gy. Regression analysis showed that among various study characteristics, dose was the only significant predictor of toxicity.ConclusionsPublished gastrointestinal toxicity reports after hypofractionated radiotherapy for pancreatic cancer were compiled. Median dose was predictive of late grade ≥ 3 gastrointestinal toxicity. Preliminary NTCP parameters were derived for multiple volume constraints.
Highlights
To consolidate literature reports of serious late gastrointestinal toxicities after hypofractionated radiation treatment of pancreatic cancer and attempt to derive normal tissue complication probability (NTCP) parameters using the Lyman-Kutcher-Burman model
Toxicity Serious gastrointestinal toxicities consisted of ulcers, hemorrhages, obstructions, strictures, and perforations
The median dose used in these two cohorts was higher than any other study that reported non-hemorrhagic and non-perforated ulcers (EQD41.8 178 and 209, respectively)
Summary
To consolidate literature reports of serious late gastrointestinal toxicities after hypofractionated radiation treatment of pancreatic cancer and attempt to derive normal tissue complication probability (NTCP) parameters using the Lyman-Kutcher-Burman model. With an overall 5-year survival of 5 % and a 5-year survival of 20 % after surgical resection, pancreatic cancer has an extremely poor prognosis [1]. It is the 9th most common malignancy in the United States, but the 5th most common cause of cancer-related death [2]. The only potentially curative treatment for pancreatic cancer is surgical, chemotherapy or chemoradiotherapy are often employed in the adjuvant setting [3, 4]. Radiation therapy is used in the setting of unresectable disease for local control and symptomatic palliation of pain and obstruction
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