Late gastrointestinal tissue effects after hypofractionated radiation therapy of the pancreas
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Date
2015
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Authors
Elhammali, Adnan
Patel, Mukund
Weinberg, Benjamin
Verma, Vivek
Liu, Jingxia
Oslen, Jeffrey R.
Gay, Hiram A.
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Abstract
Background: 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.
Methods: Published 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.
Results: A 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.
Conclusions: Published 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.
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DOI
10.1186/s13014-015-0489-2