PMU-Autor/inn/en
Papadopoulos ThomasAbstract
Purpose: In chemoradiation for pancreatic carcinoma three-dimensional target volume definitions could maximize tolerability and therapeutic effect at the same time because toxicity correlates with treatment volume. We aimed to define guidelines for elective treatment of nodal areas based on pathologic nodal involvement to optimize treatment volume for this tumor. Methods and Materials: Pathologic patterns of regional nodal spread in 175 patients who underwent primary pancreatoduodenectomy with >= 10 assessed nodes and literature data on para-aortic spread were the base of the definition of the target volume. Significant correlations between spread to lymphatic areas and tumor characteristics were determined using Fisherxxxs exact test. Computed tomography scans and a Pinnacle(3) (Philips, Best, The Netherlands) system were used for treatment planning. Results: Among 175 resected tumors without pretreatment, 76% had regional nodal metastasis and 22% had spread to distant nodes. High-risk lymphatic areas were identified and selected for elective treatment. A standardized planning procedure was derived and tested under treatment conditions. Conclusions: Histopathologic data allowed us to develop recommendations for standardized treatment planning for ductal carcinoma of the pancreatic head. These are proposed for quality assurance in multicenter studies and routine use. (c) 2005 Elsevier Inc.
Useful keywords (using NLM MeSH Indexing)
Adult
Aged
Aged, 80 and over
Carcinoma, Pancreatic Ductal/radiotherapy*
Carcinoma, Pancreatic Ductal/secondary
Carcinoma, Pancreatic Ductal/surgery
Female
Humans
Lymph Node Excision
Lymphatic Irradiation/methods
Lymphatic Irradiation/standards*
Lymphatic Metastasis
Male
Middle Aged
Pancreatic Neoplasms/pathology
Pancreatic Neoplasms/radiotherapy*
Pancreatic Neoplasms/surgery
Pancreaticoduodenectomy
Practice Guidelines as Topic
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted
Radiotherapy, Conformal/standards
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