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Cancers
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Radiation Therapy for Pancreatic Cancer
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Radiation Therapy for Pancreatic Cancer

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: 31 October 2024 | Viewed by 7608

Special Issue Editors

Dr. Kai Ding

E-Mail Website
Guest Editor
Johns Hopkins School of Medicine, Baltimore, MD, USA
Interests: image-guided radiotherapy; machine learning; medical image analysis
Dr. Hamed Hooshangnejad

E-Mail Website
Guest Editor
Johns Hopkins School of Medicine, Baltimore, MD, USA
Interests: precision medicine in radiation oncology; image-guided interventions; artificial intelligence

Special Issue Information

Dear Colleagues,

Pancreatic cancer is a devastating disease, the third leading cause of cancer-related death in the United States. Nearly 60,000 cases are diagnosed with pancreatic cancer each year in the US, and only less than 10% survive after 5 years. More than one-third of the patients present with local and local/regional metastases stage and are at great risk of distant progression. Radiation therapy (RT), as a local–regional anticancer treatment, is an effective way to achieve local control for pancreatic cancer patients. Moreover, dose-escalated RT can significantly increase overall survival rate at 2 years from 19% to 36%, and at 3 years from 9% to 31%; but RT effectiveness is highly limited by adjacent radiosensitive organs at risk.

The aim of this Special Issue of Cancers on “Radiation Therapy for Pancreatic Cancer” is to highlight both original articles and reviews addressing the current strategies of pancreatic cancer RT, and recent advancements such as image-guided adaptive radiation therapy and artificial-intelligence-based systems to increase the effectiveness of RT for devastating pancreatic cancer.

Dr. Kai Ding
Dr. Hamed Hooshangnejad
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • radiation therapy
  • pancreatic cancer
  • image-guided adaptive radiation therapy
  • artificial-intelligence-based systems
  • RT effectiveness

Published Papers (6 papers)

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Research

16 pages, 40346 KiB  
Article
Enhancing Image-Guided Radiation Therapy for Pancreatic Cancer: Utilizing Aligned Peak Response Beamforming in Flexible Array Transducers
by Ziwei Feng, Edward Sun, Debarghya China, Xinyue Huang, Hamed Hooshangnejad, Eduardo A. Gonzalez, Muyinatu A. Lediju Bell and Kai Ding
Cancers 2024, 16(7), 1244; https://doi.org/10.3390/cancers16071244 - 22 Mar 2024
Viewed by 642
Abstract
To develop ultrasound-guided radiotherapy, we proposed an assistant structure with embedded markers along with a novel alternative method, the Aligned Peak Response (APR) method, to alter the conventional delay-and-sum (DAS) beamformer for reconstructing ultrasound images obtained from a flexible array. We simulated imaging [...] Read more.
To develop ultrasound-guided radiotherapy, we proposed an assistant structure with embedded markers along with a novel alternative method, the Aligned Peak Response (APR) method, to alter the conventional delay-and-sum (DAS) beamformer for reconstructing ultrasound images obtained from a flexible array. We simulated imaging targets in Field-II using point target phantoms with point targets at different locations. In the experimental phantom ultrasound images, image RF data were acquired with a flexible transducer with in-house assistant structures embedded with needle targets for testing the accuracy of the APR method. The lateral full width at half maximum (FWHM) values of the objective point target (OPT) in ground truth ultrasound images, APR-delayed ultrasound images with a flat shape, and images acquired with curved transducer radii of 500 mm and 700 mm were 3.96 mm, 4.95 mm, 4.96 mm, and 4.95 mm. The corresponding axial FWHM values were 1.52 mm, 4.08 mm, 5.84 mm, and 5.92 mm, respectively. These results demonstrate that the proposed assistant structure and the APR method have the potential to construct accurate delay curves without external shape sensing, thereby enabling a flexible ultrasound array for tracking pancreatic tumor targets in real time for radiotherapy. Full article
(This article belongs to the Special Issue Radiation Therapy for Pancreatic Cancer)
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11 pages, 1772 KiB  
Article
A 15-Year Single-Institution Retrospective Study of Primary Pancreatic Cancer Treated with Non-Ablative Palliative Radiotherapy
by Randa Kamel, Tinghua Zhang, Suzanne Comino and Kristopher Dennis
Cancers 2024, 16(5), 881; https://doi.org/10.3390/cancers16050881 - 22 Feb 2024
Viewed by 527
Abstract
We studied the use of palliative radiotherapy (RT) among patients with primary, non-curable, locally advanced pancreatic cancer. In this subset of patients, with very poor survival, various palliative RT dose fractionation schemes are used; but, in the absence of a guideline, practice patterns [...] Read more.
We studied the use of palliative radiotherapy (RT) among patients with primary, non-curable, locally advanced pancreatic cancer. In this subset of patients, with very poor survival, various palliative RT dose fractionation schemes are used; but, in the absence of a guideline, practice patterns vary, and dose choice is mainly based on the physician’s intuition. We divided the patients into three groups, according to the dose fractionation schedules received: low (A), intermediate (B), and high (C) dose groups, to study the potential differences in outcome between the different dose prescriptions. Cohort: n = 184. Median age: 69 years. Male: n = 105 (57%), female: n = 79 (43%). Stage IV: n = 117 (64%). T4: n = 127 (69%). Tumor location: head: n = 109 (59%), body: n = 37 (20%), tail: n = 25 (14%), neck: n = 11 (6%), and uncinate: n = 2 (1%). Prior systemic therapy: n = 66 (36%). Most common dose fractionations received: 20 Gy in five fractions n = 67 (36%), 30 Gy in 10 fractions n = 49 (27%), and 8 Gy in one fraction n = 23 (13%). Group A: n = 33 (18%), median overall survival (OS) 19 days (95% CI 4–33). Group B: n = 84 (46%), median OS 52 days (95% CI 43–60). Group C: n = 67 (36%), median OS 126 days (95% CI 77–174). Median days to in-field progression: Group A 59 days (range 7–109), Group B 96 days (range 19–173), and Group C 97 days (range 13–475). To our knowledge, this is the largest reported retrospective cohort of patients receiving non-ablative palliative RT to treat their primary pancreatic tumors. Most patients had metastatic disease, T4 tumors of the pancreatic head and had not received prior systemic therapy. A significant survival benefit was seen favoring the high dose/longer RT fractionation group, presumably due to appropriate patient selection rather than an RT effect. Despite the relatively short median overall survival, one fifth of the patients were found to experience an in-field progression following RT. Full article
(This article belongs to the Special Issue Radiation Therapy for Pancreatic Cancer)
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20 pages, 7706 KiB  
Article
Ultrasound Imaging with Flexible Array Transducer for Pancreatic Cancer Radiation Therapy
by Xinyue Huang, Hamed Hooshangnejad, Debarghya China, Ziwei Feng, Junghoon Lee, Muyinatu A. Lediju Bell and Kai Ding
Cancers 2023, 15(13), 3294; https://doi.org/10.3390/cancers15133294 - 22 Jun 2023
Cited by 3 | Viewed by 1368
Abstract
Pancreatic cancer with less than 10% 3-year survival rate is one of deadliest cancer types and greatly benefits from enhanced radiotherapy. Organ motion monitoring helps spare the normal tissue from high radiation and, in turn, enables the dose escalation to the target that [...] Read more.
Pancreatic cancer with less than 10% 3-year survival rate is one of deadliest cancer types and greatly benefits from enhanced radiotherapy. Organ motion monitoring helps spare the normal tissue from high radiation and, in turn, enables the dose escalation to the target that has been shown to improve the effectiveness of RT by doubling and tripling post-RT survival rate. The flexible array transducer is a novel and promising solution to address the limitation of conventional US probes. We proposed a novel shape estimation for flexible array transducer using two sequential algorithms: (i) an optical tracking-based system that uses the optical markers coordinates attached to the probe at specific positions to estimate the array shape in real-time and (ii) a fully automatic shape optimization algorithm that automatically searches for the optimal array shape that results in the highest quality reconstructed image. We conducted phantom and in vivo experiments to evaluate the estimated array shapes and the accuracy of reconstructed US images. The proposed method reconstructed US images with low full-width-at-half-maximum (FWHM) of the point scatters, correct aspect ratio of the cyst, and high-matching score with the ground truth. Our results demonstrated that the proposed methods reconstruct high-quality ultrasound images with significantly less defocusing and distortion compared with those without any correction. Specifically, the automatic optimization method reduced the array shape estimation error to less than half-wavelength of transmitted wave, resulting in a high-quality reconstructed image. Full article
(This article belongs to the Special Issue Radiation Therapy for Pancreatic Cancer)
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17 pages, 5649 KiB  
Article
deepPERFECT: Novel Deep Learning CT Synthesis Method for Expeditious Pancreatic Cancer Radiotherapy
by Hamed Hooshangnejad, Quan Chen, Xue Feng, Rui Zhang and Kai Ding
Cancers 2023, 15(11), 3061; https://doi.org/10.3390/cancers15113061 - 05 Jun 2023
Cited by 5 | Viewed by 1579
Abstract
Major sources of delay in the standard of care RT workflow are the need for multiple appointments and separate image acquisition. In this work, we addressed the question of how we can expedite the workflow by synthesizing planning CT from diagnostic CT. This [...] Read more.
Major sources of delay in the standard of care RT workflow are the need for multiple appointments and separate image acquisition. In this work, we addressed the question of how we can expedite the workflow by synthesizing planning CT from diagnostic CT. This idea is based on the theory that diagnostic CT can be used for RT planning, but in practice, due to the differences in patient setup and acquisition techniques, separate planning CT is required. We developed a generative deep learning model, deepPERFECT, that is trained to capture these differences and generate deformation vector fields to transform diagnostic CT into preliminary planning CT. We performed detailed analysis both from an image quality and a dosimetric point of view, and showed that deepPERFECT enabled the preliminary RT planning to be used for preliminary and early plan dosimetric assessment and evaluation. Full article
(This article belongs to the Special Issue Radiation Therapy for Pancreatic Cancer)
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12 pages, 1382 KiB  
Article
Ablative vs. Non-Ablative Radiotherapy in Palliating Locally Advanced Pancreatic Cancer: A Single Institution Experience and a Systematic Review of the Literature
by Randa Kamel, Kristopher Dennis, Janice Doody and Jason Pantarotto
Cancers 2023, 15(11), 3016; https://doi.org/10.3390/cancers15113016 - 01 Jun 2023
Viewed by 1089
Abstract
We studied the dose–local control (LC) relationship in ablative vs. non-ablative radiotherapy in a non-radical treatment setting of “locally advanced pancreatic cancer (LAPC)” by comparing our patients (n = 89) treated with SBRT on the CyberKnife unit vs. conventional radiation between January 2005 [...] Read more.
We studied the dose–local control (LC) relationship in ablative vs. non-ablative radiotherapy in a non-radical treatment setting of “locally advanced pancreatic cancer (LAPC)” by comparing our patients (n = 89) treated with SBRT on the CyberKnife unit vs. conventional radiation between January 2005 and January 2021, and by reviewing the literature. A systematic search was performed leveraging Medline for references on SBRT use in pancreatic cancer without date terms or language restrictions. A total of 3702 references were identified and the search was then repeated in Embase and the Cochrane database. Ultimately, 12 studies were eligible for inclusion, which either compared SBRT to conventional radiation, or SBRT use in dose escalation for primary LAPC in a non-neoadjuvant setting. Our cohort’s median overall survival was 152 days (CI 95%, 118–185); including 371 days (CI 95%, 230–511) vs. 126 days (CI 95%, 90–161) favoring SBRT, p = 0.004. The median time to local progression was 170 days (48–923) for SBRT vs. 107 days (27–489) for the non-ablative group. In our SBRT patients, no local progressions were seen with BED10 > 60 Gy. Even when palliating LAPC, SBRT should be considered as an alternative to conventional radiation, especially in patients with a low disease burden. BED10 ≥ 60–70 Gy offers better local control without increasing toxicity rates. Less local progression may provide a better quality of life to those patients who already have a short life expectancy. Full article
(This article belongs to the Special Issue Radiation Therapy for Pancreatic Cancer)
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13 pages, 2333 KiB  
Article
Survival Outcomes and Failure Patterns in Patients with Inoperable Non-Metastatic Pancreatic Cancer Treated with Definitive Radiotherapy
by Biyang Cao, Letian Zhang, Chenchen Wu, Xiaoliang Liu, Qianqian Wang, Fang Tong, Wei Yang and Jing Wang
Cancers 2023, 15(8), 2213; https://doi.org/10.3390/cancers15082213 - 09 Apr 2023
Cited by 2 | Viewed by 1660
Abstract
This study investigated the long-term results, failure patterns, and prognostic factors of patients with initially inoperable non-metastatic pancreatic cancer (PC) receiving definitive radiotherapy (RT). Between January 2016 and December 2020, a total of 168 non-metastatic PC patients, who were surgically unresectable or medically [...] Read more.
This study investigated the long-term results, failure patterns, and prognostic factors of patients with initially inoperable non-metastatic pancreatic cancer (PC) receiving definitive radiotherapy (RT). Between January 2016 and December 2020, a total of 168 non-metastatic PC patients, who were surgically unresectable or medically inoperable, were enrolled to receive definitive RT, with or without chemotherapy. Overall survival (OS) and progression-free survival (PFS) were evaluated using the Kaplan–Meier method with a log-rank test. The cumulative incidence of locoregional and distant progression was estimated using the competing risks model. The Cox proportional-hazards model was used to determine the influence of prognostic variables on OS. With a median follow-up of 20.2 months, the median OS (mOS) and median PFS (mPFS) from diagnosis were 18.0 months [95% confidence interval (CI), 16.5–21.7 months] and 12.3 months (95% CI, 10.2–14.3 months), respectively. The mOS and mPFS from RT were 14.3 months (95% CI, 12.7–18.3 months) and 7.7 months (95% CI, 5.5–12.0 months), respectively. The corresponding 1-year, 2-year, and 3-year OS from diagnosis and RT were 72.1%, 36.6%, and 21.5% as well as 59.0%, 28.8%, and 19.0%, respectively. In a multivariate analysis, stage I–II (p = 0.032), pre-RT CA19–9 ≤ 130 U/mL (p = 0.011), receiving chemotherapy (p = 0.003), and a biologically effective dose (BED10) > 80 Gy (p = 0.014) showed a significant favorable influence on OS. Among the 59 available patients with definite progression sites, the recurrences of local, regional, and distant progression were 33.9% (20/59), 18.6% (11/59), and 59.3% (35/59), respectively. The 1-year and 2-year cumulative incidences of locoregional progression after RT were 19.5% (95% CI, 11.5–27.5%) and 32.8% (95% CI, 20.8–44.8%), respectively. Definitive RT was associated with long-term primary tumor control, resulting in superior survival in patients with inoperable non-metastatic PC. Further prospective randomized trials are warranted to validate our results in these patients. Full article
(This article belongs to the Special Issue Radiation Therapy for Pancreatic Cancer)
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