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Proton Beam Therapy for Pancreatic Tumors: A Consensus Statement from the Particle Therapy Cooperative Group Gastrointestinal Subcommittee

AM. Chhabra, RA. Amos, CB. Simone, A. Kaiser, LA. Perles, H. Giap, CL. Hallemeier, JE. Johnson, H. Lin, AJ. Wroe, ES. Diffenderfer, JA. Wolfgang, H. Sakurai, HM. Lu, TS. Hong, EJ. Koay, K. Terashima, P. Vitek, WG. Rule, SJ. Apisarnthanarax, SN....

. 2025 ; 122 (1) : 19-30. [pub] 20250105

Jazyk angličtina Země Spojené státy americké

Typ dokumentu konsensus - konference, časopisecké články

Perzistentní odkaz   https://www.medvik.cz/link/bmc25015976

Radiation therapy manages pancreatic cancer in various settings; however, the proximity of gastrointestinal (GI) luminal organs at risk (OARs) poses challenges to conventional radiation therapy. Proton beam therapy (PBT) may reduce toxicities compared to photon therapy. This consensus statement summarizes PBT's safe and optimal delivery for pancreatic tumors. Our group has specific expertise using PBT for GI indications and has developed expert recommendations for treating pancreatic tumors with PBT. Computed tomography (CT) simulation: Patients should be simulated supine (arms above head) with custom upper body immobilization. For stomach/duodenum filling consistency, patients should restrict oral intake within 3 hours before simulation/treatments. Fiducial markers may be implanted for image guidance; however, their design and composition require scrutiny. The reconstruction field-of-view should encompass all immobilization devices at the target level (CT slice thickness 2-3 mm). Four-dimensional CT should quantify respiratory motion and guide motion mitigation. Respiratory gating is recommended when motion affects OAR sparing or reduces target coverage. Treatment planning: Beam-angle selection factors include priority OAR-dose minimization, water-equivalent-thickness stability along the beam path, and enhanced relative biological effect consideration due to the increased linear energy transfer at the proton beam end-of-range. Posterior and right-lateral beam angles that avoid traversing GI luminal structures are preferred (minimizing dosimetric impacts of variable anatomies). Pencil beam scanning techniques should use robust optimization. Single-field optimization is preferable to increase robustness, but if OAR constraints cannot be met, multifield optimization may be used. Treatment delivery: Volumetric image guidance should be used daily. CT scans should be acquired ad hoc as necessary (at minimum every other week) to assess the dosimetric impacts of anatomy changes. Adaptive replanning should be performed as required. Our group has developed recommendations for delivering PBT to safely and effectively manage pancreatic tumors.

Citace poskytuje Crossref.org

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$a Chhabra, Arpit M $u Department of Radiation Oncology, New York Proton Center, New York, New York. Electronic address: achhabra@nyproton.com
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$a Proton Beam Therapy for Pancreatic Tumors: A Consensus Statement from the Particle Therapy Cooperative Group Gastrointestinal Subcommittee / $c AM. Chhabra, RA. Amos, CB. Simone, A. Kaiser, LA. Perles, H. Giap, CL. Hallemeier, JE. Johnson, H. Lin, AJ. Wroe, ES. Diffenderfer, JA. Wolfgang, H. Sakurai, HM. Lu, TS. Hong, EJ. Koay, K. Terashima, P. Vitek, WG. Rule, SJ. Apisarnthanarax, SN. Badiyan, JK. Molitoris, M. Chuong, RC. Nichols
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$a Radiation therapy manages pancreatic cancer in various settings; however, the proximity of gastrointestinal (GI) luminal organs at risk (OARs) poses challenges to conventional radiation therapy. Proton beam therapy (PBT) may reduce toxicities compared to photon therapy. This consensus statement summarizes PBT's safe and optimal delivery for pancreatic tumors. Our group has specific expertise using PBT for GI indications and has developed expert recommendations for treating pancreatic tumors with PBT. Computed tomography (CT) simulation: Patients should be simulated supine (arms above head) with custom upper body immobilization. For stomach/duodenum filling consistency, patients should restrict oral intake within 3 hours before simulation/treatments. Fiducial markers may be implanted for image guidance; however, their design and composition require scrutiny. The reconstruction field-of-view should encompass all immobilization devices at the target level (CT slice thickness 2-3 mm). Four-dimensional CT should quantify respiratory motion and guide motion mitigation. Respiratory gating is recommended when motion affects OAR sparing or reduces target coverage. Treatment planning: Beam-angle selection factors include priority OAR-dose minimization, water-equivalent-thickness stability along the beam path, and enhanced relative biological effect consideration due to the increased linear energy transfer at the proton beam end-of-range. Posterior and right-lateral beam angles that avoid traversing GI luminal structures are preferred (minimizing dosimetric impacts of variable anatomies). Pencil beam scanning techniques should use robust optimization. Single-field optimization is preferable to increase robustness, but if OAR constraints cannot be met, multifield optimization may be used. Treatment delivery: Volumetric image guidance should be used daily. CT scans should be acquired ad hoc as necessary (at minimum every other week) to assess the dosimetric impacts of anatomy changes. Adaptive replanning should be performed as required. Our group has developed recommendations for delivering PBT to safely and effectively manage pancreatic tumors.
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$a Amos, Richard A $u Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
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$a Simone, Charles B $u Department of Radiation Oncology, New York Proton Center, New York, New York
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$a Kaiser, Adeel $u Department of Radiation Oncology, Miami Cancer Institute, Miami, Florida
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$a Perles, Luis A $u Department of Radiation Physics, MD Anderson Cancer Center, Houston, Texas
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$a Giap, Huan $u Department of Radiation Oncology, OSF HealthCare Cancer Institute, Peoria, IL
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$a Hallemeier, Christopher L $u Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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$a Johnson, Jedediah E $u Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
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$a Lin, Haibo $u Department of Radiation Oncology, New York Proton Center, New York, New York
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$a Wroe, Andrew J $u Department of Radiation Oncology, Miami Cancer Institute, Miami, Florida
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$a Diffenderfer, Eric S $u Department of Radiation Oncology, University of Pennsylvania Perelmen School of Medicine, Philadelphia, Pennsylvania
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$a Wolfgang, John A $u Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
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$a Sakurai, Hideyuki $u Department of Radiation Oncology, University of Tsukuba Faculty of Medicine, Tsukuba, Japan
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$a Lu, Hsiao-Ming $u Department of Radiation Oncology, Hefei Ion Medical Center, Hefei, Anhui, People's Republic of China
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$a Hong, Theodore S $u Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
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$a Koay, Eugene J $u Department of GI Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
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$a Terashima, Kazuki $u Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Japan
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$a Vitek, Pavel $u Department of Radiation Oncology, Proton Therapy Center Czech, Prague, Czech Republic
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$a Rule, William G $u Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
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$a Apisarnthanarax, Smith Jim $u Depatment of Radiation Oncology, University of Washington, Seattle, Washington
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$a Badiyan, Shahed N $u Department of Radiation Oncology, UT Southwestern, Dallas, Texas
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$a Molitoris, Jason K $u Department of Radiation Oncology, University of Maryland Medical System, Baltimore, Maryland
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$a Chuong, Michael $u Department of Radiation Oncology, Miami Cancer Institute, Miami, Florida
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$a Nichols, Romaine C $u Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
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