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      Using adaptive magnetic resonance image‐guided radiation therapy for treatment of inoperable pancreatic cancer

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          Abstract

          Background

          Adaptive magnetic resonance imaging‐guided radiation therapy (MRgRT) can escalate dose to tumors while minimizing dose to normal tissue. We evaluated outcomes of inoperable pancreatic cancer patients treated using MRgRT with and without dose escalation.

          Methods

          We reviewed 44 patients with inoperable pancreatic cancer treated with MRgRT. Treatments included conventional fractionation, hypofractionation, and stereotactic body radiation therapy. Patients were stratified into high‐dose (biologically effective dose [BED 10] >70) and standard‐dose groups (BED 10 ≤70). Overall survival (OS), freedom from local failure (FFLF) and freedom from distant failure (FFDF) were evaluated using Kaplan‐Meier method. Cox regression was performed to identify predictors of OS. Acute gastrointestinal (GI) toxicity was assessed for 6 weeks after completion of RT.

          Results

          Median follow‐up was 17 months. High‐dose patients (n = 24, 55%) had statistically significant improvement in 2‐year OS (49% vs 30%, P = 0.03) and trended towards significance for 2‐year FFLF (77% vs 57%, P = 0.15) compared to standard‐dose patients (n = 20, 45%). FFDF at 18 months in high‐dose vs standard‐dose groups was 24% vs 48%, respectively ( P = 0.92). High‐dose radiation (HR: 0.44; 95% confidence interval [CI]: 0.21‐0.94; P = 0.03) and duration of induction chemotherapy (HR: 0.84; 95% CI: 0.72‐0.98; P = 0.03) were significantly correlated with OS on univariate analysis but neither factor was independently predictive on multivariate analysis. Grade 3+ GI toxicity occurred in three patients in the standard‐dose group and did not occur in the high‐dose group.

          Conclusions

          Patients treated with dose‐escalated MRgRT demonstrated improved OS. Prospective evaluation of high‐dose RT regimens with standardized treatment parameters in inoperable pancreatic cancer patients is warranted.

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          Most cited references22

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          Radiological and surgical implications of neoadjuvant treatment with FOLFIRINOX for locally advanced and borderline resectable pancreatic cancer.

          On the basis of the ACCORD trial, FOLFIRINOX is effective in metastatic pancreatic adenocarcinoma (PDAC), making it a rational choice for locally advanced PDAC (LA). Aims of this study are to evaluate the accuracy of imaging in determining the resectability of PDAC and to determine the surgical and clinicopathologic outcomes of pancreatic resections after neoadjuvant FOLFIRINOX therapy.
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            Is Open Access

            Phase I trial of stereotactic MR-guided online adaptive radiation therapy (SMART) for the treatment of oligometastatic or unresectable primary malignancies of the abdomen.

            SBRT is used to treat oligometastatic or unresectable primary abdominal malignancies, although ablative dose delivery is limited by proximity of organs-at-risk (OAR). Stereotactic, magnetic resonance (MR)-guided online-adaptive radiotherapy (SMART) may improve SBRT's therapeutic ratio. This prospective Phase I trial assessed feasibility and potential advantages of SMART to treat abdominal malignancies.
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              Focal Radiation Therapy Dose Escalation Improves Overall Survival in Locally Advanced Pancreatic Cancer Patients Receiving Induction Chemotherapy and Consolidative Chemoradiation

              To review outcomes of locally advanced pancreatic cancer (LAPC) patients treated with dose-escalated intensity modulated radiation therapy (IMRT) with curative intent.
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                Author and article information

                Contributors
                pparikh2@hfhs.org
                Journal
                Cancer Med
                Cancer Med
                10.1002/(ISSN)2045-7634
                CAM4
                Cancer Medicine
                John Wiley and Sons Inc. (Hoboken )
                2045-7634
                01 April 2019
                May 2019
                : 8
                : 5 ( doiID: 10.1002/cam4.2019.8.issue-5 )
                : 2123-2132
                Affiliations
                [ 1 ] Department of Radiation Oncology Washington University School of Medicine St. Louis Missouri
                [ 2 ] Department of Radiation Oncology David Geffen School of Medicine at UCLA Los Angeles California
                [ 3 ] Department of Human Oncology University of Wisconsin School of Medicine and Public Health, Carbone Cancer Center Madison Wisconsin
                [ 4 ] Department of Radiation Oncology Sylvester Comprehensive Cancer Center, University of Miami Miami Florida
                [ 5 ] Department of Radiation Oncology VU University Medical Center Amsterdam Netherlands
                [ 6 ]Present address: Department of Radiation Oncology Moffitt Cancer Center 12902 USF Magnolia Drive Tampa Florida 33612
                [ 7 ]Present address: Department of Radiation Oncology University of Colorado 1665 Aurora Court, Suite 1032 Aurora Colorado 80045
                [ 8 ]Present address: Department of Radiation Oncology Henry Ford Cancer Institute 2799 West Grand Blvd Detroit Michigan 48202
                Author notes
                [*] [* ] Correspondence

                Parag J. Parikh, Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, MI.

                Email: pparikh2@ 123456hfhs.org

                Author information
                https://orcid.org/0000-0002-1411-4880
                Article
                CAM42100
                10.1002/cam4.2100
                6536981
                30932367
                e23cbf9d-a1fd-4242-b1bc-2edcf3b55ead
                © 2019 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 05 January 2019
                : 12 February 2019
                : 26 February 2019
                Page count
                Figures: 2, Tables: 4, Pages: 10, Words: 5561
                Categories
                Original Research
                Clinical Cancer Research
                Original Research
                Custom metadata
                2.0
                cam42100
                May 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.3 mode:remove_FC converted:28.05.2019

                Oncology & Radiotherapy
                magnetic resonance imaging,pancreatic cancer,radiation therapy
                Oncology & Radiotherapy
                magnetic resonance imaging, pancreatic cancer, radiation therapy

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