Abstract
Background
Margin negative resection in pancreatic cancer remains the only curative option but
is challenging, especially with the retroperitoneal margin. Intraoperative radiation
therapy (IORT) can improve rates of local control but requires specially designed
facilities and equipment. This retrospective review describes initial results of a
novel implantable mesh of uni-directional low dose rate (LDR) Pd-103 sources (sheet)
used to deliver a focal margin-directed high-dose boost in patients with concern for
close or positive margins.
Methods
Eleven consecutive patients from a single institution with resectable or borderline
resectable pancreatic cancer with concern for positive margins were selected for sheet
placement and retrospectively reviewed. Procedural outcomes, including the time to
implant the device and complications, and clinical outcomes, including survival and
patterns of failure, are reported. A dosimetric comparison of the LDR sheet with hypothetical
stereotactic body radiotherapy (SBRT) boost is reported.
Results
One patient had a resectable disease, and 10 patients had a borderline resectable
disease and underwent neoadjuvant treatment. Sheet placement added 15 min to procedural
time with no procedural or sheet-related complications. At a median follow up of 13 months,
64% (n = 7) of patients are alive and 55% (n = 6) are disease-free. Compared to a
hypothetical SBRT boost, the LDR sheet delivered a negligible dose to kidneys, liver,
and spinal cord with a 50% reduction in max dose to the small bowel.
Conclusion
This is the first report of the use of an implantable uni-directional LDR brachytherapy
sheet in patients with resected pancreatic cancer with concern for margin clearance,
with no associated toxicity and favorable clinical outcomes.
Keywords
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Article info
Publication history
Published online: September 23, 2020
Accepted:
August 18,
2020
Received in revised form:
August 17,
2020
Received:
April 27,
2020
Footnotes
Disclosures: The authors have no conflicts of interest to declare.
The study was approved by the institutional review board of Virginia Commonwealth University (VCU).
(No. HM20010844) and written informed consent was obtained from all patients.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Identification
Copyright
© 2021 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
