title: The technical feasibility of an image-guided intensity-modulated radiotherapy (IG-IMRT) to perform a hypofractionated schedule in terms of toxicity and local control for patients with locally advanced or recurrent pancreatic cancer.
abstract: BACKGROUND
  The purpose of this study was to evaluate the technical feasibility of an image-guided intensity modulated radiotherapy (IG-IMRT) using involved-field technique to perform a hypofractionated schedule for patients with locally advanced or recurrent pancreatic cancer.
  
  
  METHODS
  From May 2009 to November 2011, 12 patients with locally advanced or locally recurrent pancreatic cancer received hypofractionated CCRT using TomoTherapy Hi-Art with concurrent and sequential chemotherapy at Seoul St. Mary's Hospital, the Catholic University of Korea. The total dose delivered was 45 Gy in 15 fractions or 50 Gy in 20 fractions. The target volume did not include the uninvolved regional lymph nodes. Treatment planning and delivery were performed using the IG-IMRT technique. The follow-up duration was a median of 31.1 months (range: 5.7-36.3 months).
  
  
  RESULTS
  Grade 2 or worse acute toxicities developed in 7 patients (58%). Grade 3 or worse gastrointestinal and hematologic toxicity occurred in 0% and 17% of patients, respectively. In the response evaluation, the rates of partial response and stable disease were 58% and 42%, respectively. The rate of local failure was 8% and no regional failure was observed. Distant failure was the main cause of treatment failure. The progression-free survival and overall survival durations were 7.6 and 12.1 months, respectively.
  
  
  CONCLUSIONS
  The involved-field technique and IG-IMRT delivered via a hypofractionated schedule are feasible for patients with locally advanced or recurrent pancreatic cancer.
authors.affiliation: Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Seoul, Korea. hsjang11@catholic.ac.kr
authors.forename: Seok Hyun
authors.initials: SH
authors.lastname: Son
authors.forename: Jin Ho
authors.initials: JH
authors.lastname: Song
authors.forename: Byung Ock
authors.initials: BO
authors.lastname: Choi
authors.forename: Young-Nam
authors.initials: YN
authors.lastname: Kang
authors.forename: Myung Ah
authors.initials: MA
authors.lastname: Lee
authors.forename: Ki Mun
authors.initials: KM
authors.lastname: Kang
authors.forename: Hong Seok
authors.initials: HS
authors.lastname: Jang
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D004307:Dose-Response Relationship, Radiation; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010190:Pancreatic Neoplasms / Q000532:radiotherapy*; D061089:Radiotherapy, Image-Guided / Q000009:adverse effects / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*