Table 2:
Summary of Currently Published Modern Era Image Guided Ablative Dosing Series
| Series | N | Methods/Outcomes | Citation |
|---|---|---|---|
| Krishna et al. | 200 | • Single institution, retrospective • Induction chemo followed by chemo-RT • Range of dose fractionation schedules (63/28, 70/28, 67.5/15, 60/10, 50/5) • Patients who received BED >70 Gy had a superior OS (17.8 vs 15.0 months, P = .03) • Minimal toxicity, Grade 1 nausea, vomiting, diarrhea, or fatigue was seen in 37 patients (80%); grade 2 abdominal pain, diarrhea, anorexia, nausea, or fatigue in 13 patients (28%); and grade 3 diarrhea in 1 patient (2%), 4 patients required transfusion. • Radiation dose escalation, done in a highly experienced center, improves OS |
25 |
| Rudra et al. | 44 | • Multi-institutional, 5 centers, retrospective • Variety of systemic therapies, including FOLFIRINOX, Gem alone, FOLFOX, typically given before adaptive MR guided RT • Grade 3 or higher GI toxicity occurred in 7% of patients • Patients treated with high dose RT (BED over 70) had improved overall survival • 2 year OS of 49% as compared with 30% • Adaptive MR guidance can result in improved OS, with low toxicity, across multiple centers |
23 |
| Hassanzadeh et al | 54 | • Single institution, retrospective • Late toxicity consisted of 2 (4.6%) grade 3 (gastrointestinal ulcers) and 3 (6.8%) grade 2 toxicities • Median OS was 15.7 months • 1-year and 2-year overall survival rates were 68.2% and 37.9% |
26 |
| Choung et al | 35 | • Single institution, retrospective • Mid inspiration breath hold, MR guidance • 50 Gy in 5 fractions • One-year LC, distant metastasis-free survival, progression-free survival, cause-specific survival, and OS were 87.8%, 63.1%, 52.4%, 77.6%, and 58.9%, respectively • Minimal severe treatment toxicity was observed and encouraging local control |
27 |
| Reygold et al | 136- primary • 33-recurrent |
• Single institution, prospective registry • Range of fractionation schedules (75/25, 67.5/15, 50/5) • Median follow up of 12 months • In the primary cohort median FFLP and OS were not met • 2 year FFLP and 2 year OS were 76% and 71% respectively • Toxicity included grade 3 GI hemorrhage (5%) and grade 2 vertebral body fractures (3%), and grade 3 bile duct stenosis (2%), finally grade 2 duodenal ulcer (1%) |
28 |
BED- biologically equivalent dose, OS- overall survival, MR- magnetic resonance, FFLP- freedom from local progression, LC- local control