Potential for dose‐escalation and reduction of risk in pancreatic cancer using IMRT optimization with lexicographic ordering and gEUD‐based cost functions
- 18 January 2007
- journal article
- research article
- Published by Wiley in Medical Physics
- Vol. 34 (2), 521-529
- https://doi.org/10.1118/1.2426403
Abstract
Radiotherapy for pancreatic cancer is limited by the tolerance of local organs at risk (OARs) and frequent overlap of the planning target volume (PTV) and OAR volumes. Using lexicographic ordering (LO), a hierarchical optimization technique, with generalized equivalent uniform dose (gEUD) cost functions, we studied the potential of intensity modulated radiation therapy (IMRT) to increase the dose to pancreatic tumors and to areas of vascular involvement that preclude surgical resection [surgical boost volume (SBV)]. We compared 15 forward planned three-dimensional conformal (3DCRT) and IMRT treatment plans for locally advanced unresectable pancreatic cancer. We created IMRT plans optimized using LO with gEUD-based cost functions that account for the contribution of each part of the resulting inhomogeneous dose distribution. LO-IMRT plans allowed substantial PTV dose escalation compared with 3DCRT; median increase from 52 Gy to 66 Gy (a=-5,p<0.005) and median increase from 50 Gy to 59 Gy (a=-15,p<0.005). LO-IMRT also allowed increases to 85 Gy in the SBV, regardless of a value, along with significant dose reductions in OARs. We conclude that LO-IMRT with gEUD cost functions could allow dose escalation in pancreas tumors with concomitant reduction in doses to organs at risk as compared with traditional 3DCRT.Keywords
Funding Information
- National Institutes of Health (NIHP01-CA59827)
This publication has 52 references indexed in Scilit:
- Phase I/II Trial of Hyperfractionated Accelerated Chemoradiotherapy for Unresectable Advanced Pancreatic CancerJapanese Journal of Clinical Oncology, 2006
- Surgical Resection after Radiochemotherapy in Patients with Unresectable Adenocarcinoma of the PancreasJournal of the American College of Surgeons, 2005
- Cancer Statistics, 2005CA: A Cancer Journal for Clinicians, 2005
- Sensitivity of treatment plan optimisation for prostate cancer using the equivalent uniform dose (EUD) with respect to the rectal wall volume parameterRadiotherapy and Oncology, 2004
- Daily ultrasound-based image-guided targeting for radiotherapy of upper abdominal malignanciesInternational Journal of Radiation Oncology*Biology*Physics, 2004
- Surgical resection following radiation therapy with concurrent gemcitabine in patients with previously unresectable adenocarcinoma of the pancreasJournal of Gastrointestinal Surgery, 2003
- Major vascular resection as part of pancreaticoduodenectomy for cancer: radiologic, intraoperative, and pathologic analysisJournal of Gastrointestinal Surgery, 1999
- Prognostic indicators for survival after resection of pancreatic adenocarcinomaThe American Journal of Surgery, 1993
- Treatment of Locally Unresectable Carcinoma of the Pancreas: Comparison of Combined-Modality Therapy (Chemotheraphy Plus Radiotherapy) to Chemotheraphy Alone1JNCI Journal of the National Cancer Institute, 1988