Abstract：
OBJECTIVE: Prognosis of locally advanced pancreatic cancer (LAPC) remains poor with limited therapeutic options. Radiation therapy in pancreatic cancer has been restricted by the disease\'s proximity to radiosensitive organs at risk (OAR). However, stereotactic magnetic resonance-guided adaptive radiation therapy (SMART) has demonstrated promise in delivering ablative doses safely. We sought to report clinical outcomes from a UK-based Compassionate Access Programme that provided access to SMART to patients with LAPC.
METHODS: This was a registry retrospective study conducted at a single centre with access to SMART. Patients with LAPC were treated with prescription dose of 40 Gy in 5 fractions. The planning objective was that 98% of PTV received ≥95% of the prescribed dose, prioritising duodenal, stomach and bowel UK SABR consortium constraints. Daily online adaptation was performed using magnetic resonance guidance and on-table re-optimisation. 0-3 months and > 3-month post-treatment-related toxicities, local progression-free survival, metastatic-free survival and overall survival were evaluated.
RESULTS: 55 patients were treated with SMART at our institution from 2020 to 2022. Median follow-up from date of diagnosis was 17 months (range 5-37 months). Median age was 69.87% of patients underwent induction chemotherapy. 71% of patients reported 0-1 grade acute toxicity only. No grade >3 acute toxicity was reported. 5 patients (9%) reported a grade 3 toxicity (fatigue, nausea, abdominal pain, duodenal stricture). No grade >3 toxicity after 3 months was reported. 6 (10%) of patients had grade 3 toxicity (fatigue, nausea, abdominal pain, duodenal haemorrhage). Median local PFS post diagnosis was 17 months (95% CI 15.3-18.7). Median OS post diagnosis was 19 months (95% CI 15.9-22.1). One-year local control post SMART was 65%.
CONCLUSIONS: This is the first UK-reported experience of MR-guided daily adaptive pancreatic SABR. SMART shows promise in delivering ablative doses with acceptable toxicity rates and good clinical outcomes.
METHODS: This was a registry retrospective study conducted at a single centre with access to SMART. Patients with LAPC were treated with prescription dose of 40 Gy in 5 fractions. The planning objective was that 98% of PTV received ≥95% of the prescribed dose, prioritising duodenal, stomach and bowel UK SABR consortium constraints. Daily online adaptation was performed using magnetic resonance guidance and on-table re-optimisation. 0-3 months and > 3-month post-treatment-related toxicities, local progression-free survival, metastatic-free survival and overall survival were evaluated.
RESULTS: 55 patients were treated with SMART at our institution from 2020 to 2022. Median follow-up from date of diagnosis was 17 months (range 5-37 months). Median age was 69.87% of patients underwent induction chemotherapy. 71% of patients reported 0-1 grade acute toxicity only. No grade >3 acute toxicity was reported. 5 patients (9%) reported a grade 3 toxicity (fatigue, nausea, abdominal pain, duodenal stricture). No grade >3 toxicity after 3 months was reported. 6 (10%) of patients had grade 3 toxicity (fatigue, nausea, abdominal pain, duodenal haemorrhage). Median local PFS post diagnosis was 17 months (95% CI 15.3-18.7). Median OS post diagnosis was 19 months (95% CI 15.9-22.1). One-year local control post SMART was 65%.
CONCLUSIONS: This is the first UK-reported experience of MR-guided daily adaptive pancreatic SABR. SMART shows promise in delivering ablative doses with acceptable toxicity rates and good clinical outcomes.
摘要：
目的：治疗方案有限，局部晚期胰腺癌（LAPC）预后较差。胰腺癌的放射治疗受到疾病与放射敏感危险器官(OAR)的接近程度的限制。然而,立体定向磁共振引导的自适应放射治疗(SMART)在安全提供消融剂量方面已被证明是有前景的.我们试图报告来自英国的体恤访问计划的临床结果，该计划为LAPC患者提供了SMART。
方法：这是一项注册回顾性研究，在单一中心使用SMART进行。LAPC患者以5分的40Gy处方剂量治疗。计划目标是98%的PTV接受≥95%的处方剂量，优先考虑十二指肠，英国胃和肠SABR联盟限制。使用磁共振指导和桌上重新优化进行每日在线适应。0-3个月和>3个月治疗后相关毒性，局部无进展生存期，评估无转移生存期和总生存期.
结果：从2020年到2022年，55例患者在我们的机构接受了SMART治疗。从诊断之日起的中位随访时间为17个月（范围5-37个月）。中位年龄为69.87%的患者接受了诱导化疗。71％的患者仅报告0-1级急性毒性。未报告>3级急性毒性。5名患者（9%）报告了3级毒性（疲劳，恶心,腹痛,十二指肠狭窄）。3个月后未报告>3级毒性。6例（10％）患者出现3级毒性（疲劳，恶心,腹痛,十二指肠出血）。诊断后的局部PFS中位数为17个月（95％CI15.3-18.7）。诊断后中位OS为19个月（95%CI15.9-22.1）。SMART后的一年本地控制为65％。
结论：这是英国首次报道的MR引导每日适应性胰腺SABR的经验。SMART在提供具有可接受的毒性率和良好的临床结果的消融剂量方面显示出希望。
方法：这是一项注册回顾性研究，在单一中心使用SMART进行。LAPC患者以5分的40Gy处方剂量治疗。计划目标是98%的PTV接受≥95%的处方剂量，优先考虑十二指肠，英国胃和肠SABR联盟限制。使用磁共振指导和桌上重新优化进行每日在线适应。0-3个月和>3个月治疗后相关毒性，局部无进展生存期，评估无转移生存期和总生存期.
结果：从2020年到2022年，55例患者在我们的机构接受了SMART治疗。从诊断之日起的中位随访时间为17个月（范围5-37个月）。中位年龄为69.87%的患者接受了诱导化疗。71％的患者仅报告0-1级急性毒性。未报告>3级急性毒性。5名患者（9%）报告了3级毒性（疲劳，恶心,腹痛,十二指肠狭窄）。3个月后未报告>3级毒性。6例（10％）患者出现3级毒性（疲劳，恶心,腹痛,十二指肠出血）。诊断后的局部PFS中位数为17个月（95％CI15.3-18.7）。诊断后中位OS为19个月（95%CI15.9-22.1）。SMART后的一年本地控制为65％。
结论：这是英国首次报道的MR引导每日适应性胰腺SABR的经验。SMART在提供具有可接受的毒性率和良好的临床结果的消融剂量方面显示出希望。
