Feasibility of Stereotactic Body Radiation Therapy for Pancreatic Tumors Abutting Organs at Risk Using Magnetic Resonance Guided Adaptive Radiation Therapy

Alden D'Souza; Kylie H. Kang; John E. Lattin; Bita Kalaghchi; John S. Ginn; Alex T. Price; David S. Lakomy; Michael R. Waters; Joshua P. Schiff; Yi Huang; Richard Tsai; Pamela P. Samson; Carl J. DeSelm; Lauren E. Henke; Farnoush Forghani; Xiaodong Zhao; Eric Morris; Geoffrey D. Hugo; Tong Zhu; Allen Mo; Eric Laugeman; Hyun Kim

doi:10.1016/j.ijrobp.2025.03.049

Feasibility of Stereotactic Body Radiation Therapy for Pancreatic Tumors Abutting Organs at Risk Using Magnetic Resonance Guided Adaptive Radiation Therapy

Alden D'Souza, Kylie H. Kang, John E. Lattin, Bita Kalaghchi, John S. Ginn, Alex T. Price, David S. Lakomy, Michael R. Waters, Joshua P. Schiff, Yi Huang, Richard Tsai, Pamela P. Samson, Carl J. DeSelm, Lauren E. Henke, Farnoush Forghani, Xiaodong Zhao, Eric Morris, Geoffrey D. Hugo, Tong Zhu, Allen MoEric Laugeman, Hyun Kim

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

Purpose: Stereotactic body radiation therapy (SBRT) has historically been contraindicated in patients with tumors abutting gastrointestinal (GI) organs due to risk of toxicity. Adaptive magnetic resonance (MR) guided SBRT (MRgSBRT) is an increasingly used treatment paradigm to prescribe ablative doses to pancreatic tumors. Here we present our institutional experience of adaptive MRgSBRT for pancreatic tumors abutting or invading GI organs at risk (OARs). Methods and Materials: Forty-eight patients with pancreatic adenocarcinoma tumors abutting or invading GI OARs who received MRgSBRT to 50 Gy in 5 fractions at our institution between 2018-2019 were reviewed. Dosimetric variables were compared pre- and postadaptation to determine adequacy of target coverage, reasons for online adaptation, and resulting changes in GI OAR and constraints. Results: Patients’ mean age was 67 years, 50% female, 63% with ECOG 0-1, and with majority of tumors being locally advanced (52%) and located in the pancreatic head, uncinate process, or neck (92%). Tumors abutted or invaded GI OARs in 100% and 21% of cases, respectively. Of the 240 fractions evaluated, 99% required online adaptation and 77% underwent normalization. The mean PTV_opt (PTV minus a 5mm-expansion of GI OAR contours as the plan optimization structure) receiving prescription dose was 93%. The predicted and adapted critical volume (V36Gy ≤0.5 cc) for OARs were found to be statistically significantly different (P < .001). The duodenum had the highest volume receiving 36 Gy for both preadapted (mean 3.4 cc) and postadapted (mean 0.33 cc) plans. Plans for pancreatic head, uncinate process, or neck tumors frequently exceeded duodenum dose constraints and plans for pancreatic body or tail tumors more often exceeded stomach constraints (P < .001). Conclusions: Adaptive MR guidance may permit SBRT for pancreatic tumors abutting or invading OARs with minimal toxicity.

Original language	English
Pages (from-to)	668-677
Number of pages	10
Journal	International Journal of Radiation Oncology Biology Physics
Volume	122
Issue number	3
DOIs	https://doi.org/10.1016/j.ijrobp.2025.03.049
State	Published - Jul 1 2025

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10.1016/j.ijrobp.2025.03.049

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D'Souza, A., Kang, K. H., Lattin, J. E., Kalaghchi, B., Ginn, J. S., Price, A. T., Lakomy, D. S., Waters, M. R., Schiff, J. P., Huang, Y., Tsai, R., Samson, P. P., DeSelm, C. J., Henke, L. E., Forghani, F., Zhao, X., Morris, E., Hugo, G. D., Zhu, T., ... Kim, H. (2025). Feasibility of Stereotactic Body Radiation Therapy for Pancreatic Tumors Abutting Organs at Risk Using Magnetic Resonance Guided Adaptive Radiation Therapy. International Journal of Radiation Oncology Biology Physics, 122(3), 668-677. https://doi.org/10.1016/j.ijrobp.2025.03.049

@article{aeaf467df77342f892e4b1835bc3488b,

title = "Feasibility of Stereotactic Body Radiation Therapy for Pancreatic Tumors Abutting Organs at Risk Using Magnetic Resonance Guided Adaptive Radiation Therapy",

abstract = "Purpose: Stereotactic body radiation therapy (SBRT) has historically been contraindicated in patients with tumors abutting gastrointestinal (GI) organs due to risk of toxicity. Adaptive magnetic resonance (MR) guided SBRT (MRgSBRT) is an increasingly used treatment paradigm to prescribe ablative doses to pancreatic tumors. Here we present our institutional experience of adaptive MRgSBRT for pancreatic tumors abutting or invading GI organs at risk (OARs). Methods and Materials: Forty-eight patients with pancreatic adenocarcinoma tumors abutting or invading GI OARs who received MRgSBRT to 50 Gy in 5 fractions at our institution between 2018-2019 were reviewed. Dosimetric variables were compared pre- and postadaptation to determine adequacy of target coverage, reasons for online adaptation, and resulting changes in GI OAR and constraints. Results: Patients{\textquoteright} mean age was 67 years, 50% female, 63% with ECOG 0-1, and with majority of tumors being locally advanced (52%) and located in the pancreatic head, uncinate process, or neck (92%). Tumors abutted or invaded GI OARs in 100% and 21% of cases, respectively. Of the 240 fractions evaluated, 99% required online adaptation and 77% underwent normalization. The mean PTV_opt (PTV minus a 5mm-expansion of GI OAR contours as the plan optimization structure) receiving prescription dose was 93%. The predicted and adapted critical volume (V36Gy ≤0.5 cc) for OARs were found to be statistically significantly different (P < .001). The duodenum had the highest volume receiving 36 Gy for both preadapted (mean 3.4 cc) and postadapted (mean 0.33 cc) plans. Plans for pancreatic head, uncinate process, or neck tumors frequently exceeded duodenum dose constraints and plans for pancreatic body or tail tumors more often exceeded stomach constraints (P < .001). Conclusions: Adaptive MR guidance may permit SBRT for pancreatic tumors abutting or invading OARs with minimal toxicity.",

author = "Alden D'Souza and Kang, {Kylie H.} and Lattin, {John E.} and Bita Kalaghchi and Ginn, {John S.} and Price, {Alex T.} and Lakomy, {David S.} and Waters, {Michael R.} and Schiff, {Joshua P.} and Yi Huang and Richard Tsai and Samson, {Pamela P.} and DeSelm, {Carl J.} and Henke, {Lauren E.} and Farnoush Forghani and Xiaodong Zhao and Eric Morris and Hugo, {Geoffrey D.} and Tong Zhu and Allen Mo and Eric Laugeman and Hyun Kim",

note = "Publisher Copyright: {\textcopyright} 2025",

year = "2025",

month = jul,

day = "1",

doi = "10.1016/j.ijrobp.2025.03.049",

language = "English",

volume = "122",

pages = "668--677",

journal = "International Journal of Radiation Oncology Biology Physics",

issn = "0360-3016",

number = "3",

}

D'Souza, A, Kang, KH, Lattin, JE, Kalaghchi, B, Ginn, JS, Price, AT, Lakomy, DS, Waters, MR, Schiff, JP, Huang, Y, Tsai, R , Samson, PP , DeSelm, CJ, Henke, LE, Forghani, F, Zhao, X, Morris, E , Hugo, GD , Zhu, T , Mo, A, Laugeman, E & Kim, H 2025, 'Feasibility of Stereotactic Body Radiation Therapy for Pancreatic Tumors Abutting Organs at Risk Using Magnetic Resonance Guided Adaptive Radiation Therapy', International Journal of Radiation Oncology Biology Physics, vol. 122, no. 3, pp. 668-677. https://doi.org/10.1016/j.ijrobp.2025.03.049

Feasibility of Stereotactic Body Radiation Therapy for Pancreatic Tumors Abutting Organs at Risk Using Magnetic Resonance Guided Adaptive Radiation Therapy. / D'Souza, Alden; Kang, Kylie H.; Lattin, John E. et al.
In: International Journal of Radiation Oncology Biology Physics, Vol. 122, No. 3, 01.07.2025, p. 668-677.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Feasibility of Stereotactic Body Radiation Therapy for Pancreatic Tumors Abutting Organs at Risk Using Magnetic Resonance Guided Adaptive Radiation Therapy

AU - D'Souza, Alden

AU - Kang, Kylie H.

AU - Lattin, John E.

AU - Kalaghchi, Bita

AU - Ginn, John S.

AU - Price, Alex T.

AU - Lakomy, David S.

AU - Waters, Michael R.

AU - Schiff, Joshua P.

AU - Huang, Yi

AU - Tsai, Richard

AU - Samson, Pamela P.

AU - DeSelm, Carl J.

AU - Henke, Lauren E.

AU - Forghani, Farnoush

AU - Zhao, Xiaodong

AU - Morris, Eric

AU - Hugo, Geoffrey D.

AU - Zhu, Tong

AU - Mo, Allen

AU - Laugeman, Eric

AU - Kim, Hyun

PY - 2025/7/1

Y1 - 2025/7/1

N2 - Purpose: Stereotactic body radiation therapy (SBRT) has historically been contraindicated in patients with tumors abutting gastrointestinal (GI) organs due to risk of toxicity. Adaptive magnetic resonance (MR) guided SBRT (MRgSBRT) is an increasingly used treatment paradigm to prescribe ablative doses to pancreatic tumors. Here we present our institutional experience of adaptive MRgSBRT for pancreatic tumors abutting or invading GI organs at risk (OARs). Methods and Materials: Forty-eight patients with pancreatic adenocarcinoma tumors abutting or invading GI OARs who received MRgSBRT to 50 Gy in 5 fractions at our institution between 2018-2019 were reviewed. Dosimetric variables were compared pre- and postadaptation to determine adequacy of target coverage, reasons for online adaptation, and resulting changes in GI OAR and constraints. Results: Patients’ mean age was 67 years, 50% female, 63% with ECOG 0-1, and with majority of tumors being locally advanced (52%) and located in the pancreatic head, uncinate process, or neck (92%). Tumors abutted or invaded GI OARs in 100% and 21% of cases, respectively. Of the 240 fractions evaluated, 99% required online adaptation and 77% underwent normalization. The mean PTV_opt (PTV minus a 5mm-expansion of GI OAR contours as the plan optimization structure) receiving prescription dose was 93%. The predicted and adapted critical volume (V36Gy ≤0.5 cc) for OARs were found to be statistically significantly different (P < .001). The duodenum had the highest volume receiving 36 Gy for both preadapted (mean 3.4 cc) and postadapted (mean 0.33 cc) plans. Plans for pancreatic head, uncinate process, or neck tumors frequently exceeded duodenum dose constraints and plans for pancreatic body or tail tumors more often exceeded stomach constraints (P < .001). Conclusions: Adaptive MR guidance may permit SBRT for pancreatic tumors abutting or invading OARs with minimal toxicity.

AB - Purpose: Stereotactic body radiation therapy (SBRT) has historically been contraindicated in patients with tumors abutting gastrointestinal (GI) organs due to risk of toxicity. Adaptive magnetic resonance (MR) guided SBRT (MRgSBRT) is an increasingly used treatment paradigm to prescribe ablative doses to pancreatic tumors. Here we present our institutional experience of adaptive MRgSBRT for pancreatic tumors abutting or invading GI organs at risk (OARs). Methods and Materials: Forty-eight patients with pancreatic adenocarcinoma tumors abutting or invading GI OARs who received MRgSBRT to 50 Gy in 5 fractions at our institution between 2018-2019 were reviewed. Dosimetric variables were compared pre- and postadaptation to determine adequacy of target coverage, reasons for online adaptation, and resulting changes in GI OAR and constraints. Results: Patients’ mean age was 67 years, 50% female, 63% with ECOG 0-1, and with majority of tumors being locally advanced (52%) and located in the pancreatic head, uncinate process, or neck (92%). Tumors abutted or invaded GI OARs in 100% and 21% of cases, respectively. Of the 240 fractions evaluated, 99% required online adaptation and 77% underwent normalization. The mean PTV_opt (PTV minus a 5mm-expansion of GI OAR contours as the plan optimization structure) receiving prescription dose was 93%. The predicted and adapted critical volume (V36Gy ≤0.5 cc) for OARs were found to be statistically significantly different (P < .001). The duodenum had the highest volume receiving 36 Gy for both preadapted (mean 3.4 cc) and postadapted (mean 0.33 cc) plans. Plans for pancreatic head, uncinate process, or neck tumors frequently exceeded duodenum dose constraints and plans for pancreatic body or tail tumors more often exceeded stomach constraints (P < .001). Conclusions: Adaptive MR guidance may permit SBRT for pancreatic tumors abutting or invading OARs with minimal toxicity.

UR - http://www.scopus.com/inward/record.url?scp=105003217056&partnerID=8YFLogxK

U2 - 10.1016/j.ijrobp.2025.03.049

DO - 10.1016/j.ijrobp.2025.03.049

M3 - Article

C2 - 40185211

AN - SCOPUS:105003217056

SN - 0360-3016

VL - 122

SP - 668

EP - 677

JO - International Journal of Radiation Oncology Biology Physics

JF - International Journal of Radiation Oncology Biology Physics

IS - 3

ER -

Feasibility of Stereotactic Body Radiation Therapy for Pancreatic Tumors Abutting Organs at Risk Using Magnetic Resonance Guided Adaptive Radiation Therapy

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