Australasian Gastrointestinal Trials Group (AGITG) and Trans-Tasman Radiation Oncology Group (TROG) Guidelines for Pancreatic Stereotactic Body Radiation Therapy (SBRT)

Andrew Oar; Mark Lee; Hien Le; George Hruby; Raymond Dalfsen; David Pryor; Dominique Lee; Julie Chu; Lois Holloway; Adam Briggs; Andrew Barbour; Sarat Chander; Sweet Ping Ng; Jas Samra; John Shakeshaft; David Goldstein; Nam Nguyen; Karyn A Goodman; Daniel T Chang; Andrew Kneebone

doi:10.1016/j.prro.2019.07.018

Australasian Gastrointestinal Trials Group (AGITG) and Trans-Tasman Radiation Oncology Group (TROG) Guidelines for Pancreatic Stereotactic Body Radiation Therapy (SBRT)

Pract Radiat Oncol. 2020 May-Jun;10(3):e136-e146. doi: 10.1016/j.prro.2019.07.018. Epub 2019 Nov 21.

Authors

Andrew Oar¹, Mark Lee², Hien Le³, George Hruby⁴, Raymond Dalfsen³, David Pryor⁵, Dominique Lee⁵, Julie Chu⁶, Lois Holloway⁷, Adam Briggs⁸, Andrew Barbour⁹, Sarat Chander⁶, Sweet Ping Ng⁶, Jas Samra⁴, John Shakeshaft², David Goldstein¹⁰, Nam Nguyen¹¹, Karyn A Goodman¹², Daniel T Chang¹³, Andrew Kneebone⁴

Affiliations

¹ Icon Cancer Centre, Gold Coast University Hospital, Gold Coast; Liverpool and Macarthur Cancer Therapy Centres, Sydney, Australia. Electronic address: [email protected].
² Icon Cancer Centre, Gold Coast University Hospital, Gold Coast.
³ Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, Australia.
⁴ Royal North Shore Hospital, Sydney, Australia; University of Sydney, Sydney, Australia.
⁵ Princess Alexandra Hospital, Brisbane, Australia.
⁶ Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
⁷ Liverpool and Macarthur Cancer Therapy Centres, Sydney, Australia; South Western Clinical School, University of New South Wales, Sydney, Australia; Institute of Medical Physics, University of Sydney, Sydney, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia.
⁸ Royal North Shore Hospital, Sydney, Australia.
⁹ Princess Alexandra Hospital, Brisbane, Australia; University of Queensland, Diamantina Institute, Translational Research Institute, Woolloongabba, Australia.
¹⁰ Department of Medical Oncology, Nelune Cancer Centre, Prince of Wales Hospital, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
¹¹ Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Discipline of Medicine, University of Adelaide, Adelaide, Australia.
¹² Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado.
¹³ Stanford Cancer Institute, Stanford, California.

PMID: 31761541
DOI: 10.1016/j.prro.2019.07.018

Abstract

Purpose: Nonrandomized data exploring pancreas stereotactic body radiation therapy (SBRT) has demonstrated excellent local control rates and low toxicity. Before commencing a randomized trial investigating pancreas SBRT, standardization of prescription dose, dose constraints, simulation technique, and clinical target volume delineation are required.

Methods and materials: Specialists in radiation oncology, medical oncology, hepatobiliary surgery, and gastroenterology attended 2 consecutive Australasian Gastrointestinal Trials Group workshops in 2017 and 2018. Sample cases were discussed during workshop contact with specifically invited international speakers highly experienced in pancreas SBRT. Furthermore, sample cases were contoured and planned between workshop contact to finalize dose constraints and clinical target volume delineation.

Results: Over 2 separate workshops, consensus was reached on dose and simulation technique. The working group recommended a dose prescription of 40 Gy in 5 fractions. Treatment delivery during end-expiratory breath hold with triple-phase contrast enhanced computed tomography was recommended. In addition, dose constraints, stepwise contouring guidelines, and an anatomic atlas for pancreatic SBRT were developed.

Conclusions: Pancreas SBRT is emerging as a promising treatment modality requiring prospective evaluation in randomized studies. This work attempts to standardize dose, simulation technique, and volume delineation to support the delivery of high quality SBRT in a multicenter study.

MeSH terms

Australia
Female
Guidelines as Topic
Humans
Male
Pancreatic Neoplasms / mortality
Pancreatic Neoplasms / radiotherapy*
Radiosurgery / methods*
Radiotherapy Dosage
Survival Analysis