1019 / 1578
/
Duodenal toxicity – fractionation
Ø
Increased toxicity in SF compared to MF SBRT
Ø
Toxicity risk factor for reduced OS
Stanford experience
167 patients
Fractionation Schema
1 Fx (46%)
1 x 25 Gy
5 Fx (54%)
5 x 6.6 Gy
G2+ GI toxicity
Pollom IJROBP 2014
ESTRO SBRT 2017 - Matthias Guckenberger
15
/
SBRT to achieve resectability
• N=73 with median FU 10.5 months
• Borderline resectable PC:
31/57 achieved R0 resection
• Locally advanced PC:
0 patient underwent resection
• Late GI grade 3+ toxicity:
n=4 (GI bleeding)
Borderline resectable
Locally advanced
Gem Cx
Progression
No progression
CX
SBRT
SBRT:
5 x 7Gy to vessle abutting region
5 x 5Gy to remaining tumor
Chuong IJROBP 2013
ESTRO SBRT 2017 - Matthias Guckenberger
16