Jsme akreditované zařízení pro magnetickou rezonanci v rámci pilotního programu screeningu karcinomu prostaty.

Odborné publikace PTC nádory pankreatu

  1. Arpit M. Chhabra, Richard A. Amos, Charles B. Simone, Adeel Kaiser, Luis A. Perles, Huan Giap, Christopher L. Hallemeier, Jedediah E. Johnson, Haibo Lin, Andrew J. Wroe, Eric S. Diffenderfer, John A. Wolfgang, Hideyuki Sakurai, Hsiao-Ming Lu, Theodore S. Hong, Eugene J. Koay, Kazuki Terashima, Pavel Vitek, William G. Rule, Smith Jim Apisarnthanarax, Shahed N. Badiyan, Jason K. Molitoris, Michael Chuong, Romaine C. Nichols, Jr. Proton Beam Therapy for Pancreatic Tumors – A Consensus Statment from the Particle Therapy Cooperative Group Gastrointestinal Subcommittee. Int J Radiation Oncol Biol Phys, Vol. 122, No. 1, pp. 19−30, 2025. Doi: 10.1016/j.ijrobp.2024.12.020.

Přehled vybraných studií nádory pankreatu

Pracoviště Koncept studie Počet nemocných Objem

(chemoterapie)

 Dávky Výstupní parametry Toxicita
Hyogo Ion Beam Medical Center22) Inoperabilní 50 CTV* + ENI

(gemcitabin wekly x3)

 50GyE/25 frakcí

67,5 GyE/25 frakcí

70,2 GyE/26 frakcí

 1 roční lokální kontrola 81,7%

1 roční přežívání 76,8%

 GI 3.st 10%
Hyogo Ion Beam Medical Center33) Inoperabilní 91 CTV + ENI

(gemcitabin wekly x3)

 67,5 GyE/25 frakcí

 

 Medián sledování 10 měs. GI st. I

GI 4. St. 1,1%, 5. st. 2,2%.

(3x ulcerace duodena, 2x fatální)

 
National Cancer Center  Goyang Korea34) Inoperabilní 37 CTV bez ENI

(capecitabin nebo infuzní 5-FU)

Po indukční CHT FolFirinOx nebo gemcitabin + erlotinib)

 45 GyE resp. 30 GyE/10 frakcí – SIB Medián sledování 16,7 měs.

Medián přežívání 19,3 měs.

 Bez akutní a chronické toxicity st.  > 2
Mayo clinic35) Inoperabilní 13 CTV + ENI

(capecitabin nebo infuzní 5-FU)

 50 GyE resp. 45 GyE/25 frakcí SIB Medián sledování 16 měs.

1 leté a 2 leté přežívání 62 resp. 40%

 Bez akutní a chronické toxicity st.  > 2
Nagoya36) Inoperabilní 13 CTV bez ENI

(S1)

 60 GyE resp. 40 GyE/ 20 frakcí SIB Medián sledování 12 měs. Akuttní toxicita 3. St. 30, 7%

Bez chronické toxicity st.  > 2
UPEN Philadelphia32) Pooperační 38 Lůžko + lymfatika

(capecitabin nebo infuzní 5-FU)

 54 GyE/27 frakcí

 

 Medián sledování 20 měs. Akutní GI toxicita st.    >3 3%
Massahusets General Hospital37) Předoperační

(primárně operabilní)

 48 CTV + ENI

(capecitabin)

 25 GyE/5 frakcí Radikální resekce  81%

Medián sledování 38 měs., medián přežívání 17 měs.

 Akutní toxicita st.    >3  4,1%
Chiba21) Předoperační (primárně operabilní) 26 CTV + ENI 30-36,8 GyE/8 frakcí R0 resekce 73%

Medián přežívání 18,6 měs.

(po R0 resekci neodsažen)

 Akutní resp. chornická toxicita st.    >3  3,8%  resp. 3,8%


Reference, Klinické a dozimetrické studie nádory pankreatu

  1. www.svod.cz
  2. Neoptolemos JP, Palmer DH, Ghaneh P, et al. Comparison of adjuvant gemcitabine and capecitabine with gemcitabine monotherapy in patients with resected pancreatic cancer (ESPAC-4): a multicentre, open-label, randomised, phase 3 trial. Lancet 2017;389:1011-24.
  3. Groot VP, Rezaee N, Wu W, et al. Patterns, Timing, and Predictors of Recurrence Following Pancreatectomy for Pancreatic Ductal Adenocarcinoma. Ann Surg 2018;267:936-45.
  4. Hammel P, Huguet F, van Laethem JL, et al. Effect of Chemoradiotherapy vs. Chemotherapy on Survival in Patients With Locally Advanced Pancreatic Cancer Controlled After 4 Months of Gemcitabine With or Without Erlotinib: The LAP07 Randomized Clinical Trial. JAMA 2016;315:1844-53.
  5. Oettle H, Post S, Neuhaus P, et al. Adjuvant chemotherapy with gemcitabine vs. observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA 2007;297:267-77.
  6. Regine WF, Winter KA, Abrams RA, et al. luorouracil vs. gemcitabine chemotherapy before and after fluorouracil-based chemoradiation following resection of pancreatic adenocarcinoma: a randomized controlled trial. JAMA 2008;299:1019-26.
  7. Tienhoven GV, Versteiine E, Suker M, et al. Preoperative chemoradiotherapy versus immediate surgery for resectable borderline resectable pancreatic cancer (PREOPANC-1): A randomized, controlled, multicenter phase III trial. J Clin Oncol 2018;36:LBA4002.
  8. Murphy JD, Adusumilli S, Griffith KA, Ray ME et al. Full-dose gemcitabine and concurrent radiotherapy for unresectable pancreatic cancer. Int J Radiat Oncol Biol Phys 2007; 68: 801–808.
  9. McGinn CJ, Zalupski MM, Shureiqi I, Robertson JM. Phase I trial of radiation dose escalation with concurrent weekly full-dose gemcitabine in patients with advanced pancreatic cancer. J Clin Oncol 2001; 19: 4202–4208.
  10. Brunner TB, Merkel S, Grabenbauer GG, Meyer T, et al. Definition of elective lymphatic target volume in ductal carcinoma of the pancreatic head based on histopathologic analysis. Int J Radiat Oncol Biol Phys 2005; 62: 1021–1029.
  11. Turrini O, Viret F, Moureau-Zabotto L, Guiramand J. et al. Neoadjuvant 5 fluorouracil-cisplatin chemoradiation effect on survival in patients with resectable pancreatic head adenocarcinoma: a ten-year single institution experience. Oncology 2009; 76: 413–419.
  12. Loehrer PJ, Sr., Feng Y, Cardenes H, et al. Gemcitabine alone versus gemcitabine plus radiotherapy in patients with locally advanced pancreatic cancer: an Eastern Cooperative Oncology. Group trial. J Clin Oncol. 2011;29(31):4105-4112.
  13. Mukherjee S, Hurt CN, Bridgewater J, et al. Gemcitabine-based or capecitabine-based chemoradiotherapy for locally advanced pancreatic cancer (SCALOP): a multicentre, randomised, phase 2 trial. Lancet Oncol. 2013;14(4):317-326.
  14. Huguet F, Goodman KA, Azria D, Racadot S. Radiotherapy technical considerations in the management of locally advanced pancreatic cancer: American-French consensus recommendations. Int J Radiat Oncol Biol Phys 2012; 83: 1355–1364.
  15. Fokas E, Eccles C, Patel N, Chu K-Y et al. Comparison of four target volume definitions for pancreatic cancer. Guidelines for treatment of the lymphatics and the primary tumor. Strahlenther. Onko. 2013; 189:407-416.
  16. Ling TC, Slater JM, Mifflin R, Nookala P et al. Evaluation of normal tissue exposure in patients receiving radiotherapy for pancreatic cancer based on RTOG 0848. Journal of Gastrointestinal Oncology 2015; 6: 108–114.
  17. Thompson RF, Mayekar SU, Zhai H, Both S. et al. A dosimetric comparison of proton and photon therapy in unresectable cancers of the head of pancreas. Medical physics 2014; 41: 081711-1–10.
  18. Abrams RA, Regine WF, Goodman KA, Dawson LA et al. Consensus panel contouring atlas for the delineation of the clinical target volume in the postoperative treatment of pancreatic cancer. http://www.rtog.org/CoreLab/ContouringAtlases/PancreasAtlas.aspx.
  19. Caravatta L, Sallustio G, Pacelli F, Padulla GDA et al. Clinical target volume delinetation uncluding elective nodal irradiation in preoperative and definitive radiotherapy of pancreatic cancer. Radiation Oncology 2012; 7:86.
  20. Morganti AT, Trodella L, Valentin V, Barbi S et al. Pain relief with short-term irradiation in locally advanced carcinoma of the pancreas. J. Palliat. Care 2003; 19:258-262.
  21. Shinoto M, Yamada S, Yasuda S, Imada H et al. Phase 1 trial of preoperative, short-course carbon-ion radiotherapy for patients with resectable pancreatic cancer. Cancer 2013; 119:45-51.
  22. Terashima K, Demizu Y, Hashimoto N, Jin D et al. A phase I/II study of gemcitabine-concurrent proton radiotherapy for locally advanced pancreatic cancer without distant metastasis. Radiother. Oncol. 2012; 103:25-31. 23.
  23. Nichols RC Jr, George TJ, Zaiden RA Jr, Awad ZT. Proton therapy with concomitant capecitabine for pancreatic and ampullary cancers is associated with a low incidence of gastrointestinal toxicity. Acta Oncol. 2013; 52:498-505.
  24. Zurlo A, Lomax A, Hoess A et al. The role of proton therapy in the treatment of large irradiation volumes: a comparative planning study of pancreatic and biliary tumors. Int J Radiat Oncol Biol Phys 2000;48:277-88.
  25. Chuong M, Badiyan SN, Yam M, et al. Pencil beam scanning versus passively scattered proton therapy for unresectable pancreatic cancer. J Gastrointest Oncol 2018;9:687-93.
  26. Nichols RC Jr, Huh SN, Prado KL, et al. Protons offer reduced normal-tissue exposure for patients receiving postoperative radiotherapy for resected pancreatic head cancer. Int J Radiat Oncol Biol Phys 2012;83:158-63.
  27. Nichols RC, Huh S, Li Z, Rutenberg M. Proton therapy for pancreatic cancer. World J. Gastrointestinal Oncol. 2015; 7:141-147.
  28. Verma J, Sulman P, Jhingran A et al. Dosimetric Predictors of Duodenal Toxicity After Intensity Modulated Radiation Therapy for Treatment of the Para-aortic Nodes in Gynecologic Cancer. Int. J. Radiat. Oncol. Biol. Phys. 2014; 88:357-362.
  29. https://www.nccn.org/professionals/physician_gls/pdf/pancreatic_blocks.pdf.
  30. Patrick Kelly P, Das P, Pinnix CC, Beddar S et al. Duodenal Toxicity After Fractionated Chemoradiation for Unresectable Pancreatic Cancer. Int. J. Radiat. Oncol. Biol. Phys. 2013; 85:e143-e149.
  31. Ling TC, Slater JM, Mifflin R, Nookala P et al. Evaluation of normal tissue exposure in patients receiving radiotherapy for pancreatic cancer based on RTOG 0848. J. Gastrointestinal Oncol. 2015; 6:108-114.
  32. Woodhouse KD, Elrakhawy, Jain A, et al. Acute toxicity of proton versus photon adjuvant chemoradiation in the treatment of pancreatic cancer: A cohort study. Int J Radiat Oncol Biol Phys 2016;96:E208-9.
  33. Takatori K, Terashima K, Yoshida R, et al. Upper gastrointestinal complications associated with gemcitabine-concurrent proton radiotherapy for inoperable pancreatic cancer. J Gastroenterol 2014;49:1074-80.
  34. Kim TH, Lee WJ, Woo SM, et al. Effectiveness and Safety of Simultaneous Integrated Boost-Proton Beam Therapy for Localized Pancreatic Cancer. Technol Cancer Res Treat 2018;17:1533033818783879.
  35. Jethwa KR, Tryggestad EJ, Whitaker TJ et al. Initial experience with intensity modulated proton therapy for intact, clinically localized pancreas cancer: Clinical implementation, dosimetric analysis, acute treatment-related adverse events, and patient-reported outcomes. Adv Radiat Oncol 2018;3:314-21.
  36. Hattori Y, Hirano A, Iwata H, et al. Image-Guided Hypofractionated Proton Therapy and Concurrent Chemotherapy for Inoperable Locally Advanced Pancreatic Cancer: Toxicities and Preliminary Outcomes. Int J Radiat Oncol Biol Phys 2017;99:E153.
  37. Hong TS, Ryan DP, Borger DR, et al. A phase 1/2 and biomarker study of preoperative short course chemoradiation with proton beam therapy and capecitabine followed by early surgery for resectable pancreatic ductal adenocarcinoma. Int J Radiat Oncol Biol Phys 2014;89:830-8.
  38. Le Scodan RL, F. Mornex F, Girard N, Mercier C et al. Preoperative chemoradiation in potentially resectable pancreatic adenocarcinoma: feasibility, treatment effect evaluation and prognostic factors, analysis of the SFRO-FFCD 9704 trial and literature review. Ann. Oncol. 2009; 20:1387-1396.
  39. Murphy JE, Wo JY, Ryan DP, Jiang W et al. Total Neoadjuvant Therapy With FOLFIRINOX Followed by Individualized Chemoradiotherapy for Borderline Resectable Pancreatic Adenocarcinoma. JAMA Oncol. 2018 Jul; 4(7): 963–969.
  40. Michael S. Rutenberg, Romaine C. Nichols. Proton beam radiotherapy for pancreas cancer. J. Gastrointestinal Oncol. 2020; 11:165-175.

 

Kniha Protonová radioterapie, autor Pavel Vítek a kol., vydalo nakl. Maxdorf

Kniha k zakoupení prostřednictvím odkazu níže.

Objednat knihu

Proton Therapy Center Czech s.r.o.
Budínova 2437/1a
180 00 Praha 8
Česká republika
ID: 264 667 91
VAT ID: CZ264 466 91
www.ptc.cz
info@ptc.cz

Infolinka 222 999 000
#lecimerakovinu

Předvolby cookies