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First report on the feasibility of a permanently implantable uni-directional planar low dose rate brachytherapy sheet for patients with resectable or borderline resectable pancreatic cancer

  • Joshua B. Dault
    Correspondence
    Corresponding author. Department of Radiation Oncology, Virginia Commonwealth University Health System, Massey Cancer Center, 401 College Street, Box 980058, Richmond, VA 23298-0058. Tel.: 804-828-7232; fax: 804-828-6042.
    Affiliations
    Department of Radiation Oncology, Virginia Commonwealth University Health System, Massey Cancer Center, Richmond, VA
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  • Dorin Todor
    Affiliations
    Department of Radiation Oncology, Virginia Commonwealth University Health System, Massey Cancer Center, Richmond, VA
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  • Brian J. Kaplan
    Affiliations
    Division of Surgical Oncology, Department of Surgery, Virginia Commonwealth University Health System, Massey Cancer Center, Richmond, VA
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  • Jennifer L. Myers
    Affiliations
    Division of Hematology, Department of Internal Medicine, Virginia Commonwealth University Health System, Massey Cancer Center, Oncology, and Palliative Care, Richmond, VA
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  • Emma C. Fields
    Affiliations
    Department of Radiation Oncology, Virginia Commonwealth University Health System, Massey Cancer Center, Richmond, VA
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Published:September 23, 2020DOI:https://doi.org/10.1016/j.brachy.2020.08.010

      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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