Stereotactic MRI-guided Adaptive Radiation Therapy (SMART) for Locally Advanced Pancreatic Cancer: A Promising Approach
Elaine Luterstein, Minsong Cao, James Lamb, Ann C Raldow, Daniel A Low, Michael L Steinberg, Percy Lee, Elaine Luterstein, Minsong Cao, James Lamb, Ann C Raldow, Daniel A Low, Michael L Steinberg, Percy Lee
Abstract
Locally advanced pancreatic cancer (LAPC) is characterized by poor prognosis and low response durability with standard-of-care chemotherapy or chemoradiotherapy treatment. Stereotactic body radiation therapy (SBRT), which has a shorter treatment course than conventionally fractionated radiotherapy and allows for better integration with systemic therapy, may confer a survival benefit but is limited by gastrointestinal toxicity. Stereotactic MRI-guided adaptive radiation therapy (SMART) has recently gained attention for its potential to increase treatment precision and thus minimize this toxicity through continuous real-time soft-tissue imaging during radiotherapy. The case presented here illustrates the promising outcome of a 69-year-old male patient with LAPC treated with SMART with daily adaptive planning and respiratory-gated technique.
Keywords: locally advanced pancreatic cancer; mri-guided adaptive radiotherapy; sbrt; smart.
Conflict of interest statement
The authors have declared financial relationships, which are detailed in the next section.
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References
- FOLFIRINOX for locally advanced pancreatic cancer: a systematic review and patient-level meta-analysis. Suker M, Beumer BR, Sadot E, et al. Lancet Oncol. 2016;17:801–810.
- Effect of chemoradiotherapy vs chemotherapy on survival in patients with locally advanced pancreatic cancer controlled after 4 months of gemcitabine with or without erlotinib: the LAP07 randomized clinical trial. Hammel P, Huguet F, van Laethem JL, et al. JAMA. 2016;315:1844–1853.
- Outcomes for patients with locally advanced pancreatic adenocarcinoma treated with stereotactic body radiation therapy versus conventionally fractionated radiation. Zhong J, Patel K, Switchenko J, et al. Cancer. 2017;123:3486–3493.
- Induction gemcitabine and stereotactic body radiotherapy for locally advanced nonmetastatic pancreas cancer. Mahadevan A, Miksad R, Goldstein M, et al. Int J Radiat Oncol Biol Phys. 2011;81:0.
- Phase 2 multi-institutional trial evaluating gemcitabine and stereotactic body radiotherapy for patients with locally advanced unresectable pancreatic adenocarcinoma. Herman JM, Chang DT, Goodman KA, et al. Cancer. 2015;121:1128–1137.
- Long-term outcomes of induction chemotherapy and neoadjuvant stereotactic body radiotherapy for borderline resectable and locally advanced pancreatic adenocarcinoma. Mellon EA, Hoffe SE, Springett GM, et al. Acta Oncol. 2015;54:979–985.
- High dose adaptive MRI guided radiation therapy improves overall survival of inoperable pancreatic cancer. Rudra S, Jiang N, Rosenberg SA, et al. Int J Radiat Oncol Biol Phys. 2017;99:0.
Source: PubMed