A group of 30 patients with adenocarcinoma of the pancreas including some patients with very advanced disease, were treated with the so-called mixed beam modality employing photon treatments three times per week and neutron treatments twice a week. Two hundred Rads or equivalent Rads (RBE 3.3) were given in daily fractions aiming at a total dose of 6000 Rads in 6 to 8 weeks. The treatments were well tolerated and significant palliation was achieved in 26 to 30 cases. Twelve months survival was 33 percent with a median survival of 7 months or 210 days. Treatment techniques and localization procedures are discussed

Blue, J.

Bukowski, R.

Gahbauer, R.

Horton, J.

Jelden, G. L.

Koh, K. Y.

Reimer, R.

Roberts, W.

Rodriguez-Antunez, A.

Turco, R. F.

English

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(NASA-TH-81516) PRELIMIAARY RESULTS OF FAST
NEUTRON TREATMENTS IN CARCINOMA OF THE
PANCREAS (NASA) 4 p HC A02/MF A01 CSCL 06E
NASA Technical Memorandum 81516
PRELIMINARY RESULTS OF EAST
NEUTRON TREATMENTS IN
CARCINOMA OF THE PANCREAS
Reinhard Gahbauer, Kyee Y. Koh, Antonio Rodriguez-Antunez,
Gwynn L. Jelden, Robert F. Turco, j ohn Horton,
Ronald Bukowski, and Ronald Reimer
,leveland Clinic Foundation
Cleveland, Ohio
and
James Blue, William Roberts, and Regis Leonard
Lewis Research Center
Cleveland, Ohio
Prepared for the
National Pancreatic Project
New Orleans, Louisiana, April 18, 1980
N80-24983
Unclas
G3/51 20949
ZIP
PRELIMI14ARY RESULTS OF FAST NEUTRON TREATMENTS
IN CARCINOMA OF THE PANCREAS
by Reinhard Gahbauer, Kyee Y. Koh, Antonio Rodriguez-Antunez,
Gwynn L. Jelden, Robert F. Turco, John Horton, Ronald Bukowski,
Ronald Reimer, James Blue, William Roberts, and Regis Leonard
Between December 1977 and March 1978 thirty patients with histologi-
cally proven carcinoma of the pancreas were treated at the Cleveland Clinic
and NASA Lewis Research Center cyclotron. The cyclotron is located
approximately 20 minutes from the Clinic Radiotherapy Department and offers
i	 the tr--date unique opportunity to treat deep-seated abdominal, pelvic, and
W	 thoracic tumors with a vertical neutron beam.
Throughout the report period, the neutrons were produced by a 25-MeV
deuteron on beryllium reaction offering depth dose characteristics very
similar to those of a cobalt beam; that is, approximately 50 percent of
Dmax dose at 10 centimeters depth with Dmax at approximately 4 milli-
meters. The photon treatments were delivered at the Cleveland Clinic with a
10-MeV linear accelerator.
For tumor localization, surgical clips were available in most patients;
in the remaining few, barium swallows and CAT scans were used for precise
localization. After defining tumor and target volume by those means, treat-
ment portals were mapped out with the help of a fluoroscopic simulation
technique and subsequently verified in all cases by CAT scanning. The
unique feature of a vertical neutron beam allowed CAT scan verification and
localization in the actual treatment position. Day-to-day reproduction of
patient positioning was further aided by a sophisticated laser system.
Patients were usually treated with a four gamma field and a two neutron
field technique. The gamma fields were parallel opposed AP 6 PA and lat-
eral, and the neutron fields were parallel opposed AP & PA. Typical field
sizes were 12 centimeters by 10 centimeters for both the AP-PA and lateral
fields.
All patients were treated with the so-called mixed beam, that is,
photon treatments on Monday, Wednesday, and Friday at the Cleveland Clinic
and neutron treatments on Tuesday and Thursday at the cyclotron facility. A
neutron RBE of 3.33 was used to convert 60 neutron rads to 200 equivalent
rads per treatment; this regimen results in 40 percent of the equivalent
dose coming from the neutron component. All patients in this report were
treated to a total dose of 6000 equivalent rads in 30 fractions over 6 to 8
weeks. In the initial phase of this trial, patient acceptance was very
liberal. Five of the patients had liver metastases at the time of treat-
ment, six others had extensive regional disease, and in 19 the extent of the
disease was described as 'localized'. Eighteen of 30 patients presented
with jaundice, 20 of 30 with weight loss, 17 of 30 with pain, and 22 of 30
had had some form of surgical bypass operation. All patients had a
diagnostic laparotomy and histological verification of their malignancy. At
the time of this review, the tumor grading was known in 20 patients.
1
RESULTS
Treatment was generally well tolerated. Mild diarrhea and nausea were
common but easily controlled with conservative treatment. The majority of
patients received significant palliation of their symptoms with improvement
of the main symptom reported in 26 of 30 cases and weight gain reported in
15 of 30 cases.
At the time of this review four pa--.nts were still alive, two at more
than 2 years. From the date of diagnos%a the 12 months survival was 33 per-
cent, th- median survival 7 months or 210 days. Twenty-one patients with
carcinoma of the head of the pancreas did slightly better at 9 months median
survival versus 6.5 months in the remainder of the group.
From the reported onset of symptoms to death, patients with carcinoma
of the head of the pancreas have survived 10 months compared to patients
with body and tail of the pancreas carcinomas who survived 13 months from
the recorded onset of symptoms. Patients with the presenting symptom of
jaundice did slightly better at 7 months median survival than did those with
the presenting symptom of weight loss with a median survival of 6 months.
As expected, patients with poorly differentiated carcinoma had a shorter
median survival at 5 months compared to patients with moderately dif-
ferentiated carcinoma and a median survival of 9 months. Also patients who
were considered to have localized or regional disease survived 9 months com-
pared to a median survival of patients with extensive disease of 5 months.
At the time of this review, four patients were known to have had
episode_ of bleeding gastric or duodenal ulcers. At least one of those pa-
tients was endoscopically biopsied and was found to have a tumor. One pa-
tient had gangrene of the small bowel with volvulus after choledocho-
jejunostomy. These problems developed between 4 and 12 months after treat-
ment.
CONCLUSIONS
Our initial clinical impression is that the treatments were well toler-
ated with early morbidity similar to conventional treatment modalities.
Significant palliation was obtained in most patients.
We feel encouraged to proceed with a well-controlled clinical trial to
test the merit of mixed beam versus conventional precision high dose photon
treatments. Careful surgical selection of truly localized carcinomas with
meticulous care devoted to outlining the tumor volume with radio-opaque
clips is imperative.
High precision techniques for tumor localization and verification are
essential to evaluate the true value of radiotherapy in this disease for
long-term palliation or cure.
2
1. Report No. 2. Government Accession No. 3. Recipient's Catalog No.
NASA TM-81516
d. Title and Subtitle 5. Report Date
PRELIMINARY RESULTS OF FAST NEUTRON TREATMENTS
IN CARCINOMA OF THE PANCREAS 6. Performing Organization Code
7. Author(s) 8. Performing Organization Report No.
Reinhard Gahbauer, Kyee Y. Koh, Antonio Rodriguez-Antunez, Gwynn L. E-460Jelden, Robert F. Turco, John Horton, Ronald Bukowski, Ronald Reimer,
James Blue. William Roberts, and Regis Leonard 10. Work Unit No.
9. Performing Organization Name and Address
National Aeronautics and Space Administration
11. Contract or Grant No. 
Lewis Research Center
Cleveland, Ohio 44135
13. Type of Report and Period Covered
Technical Memorandum12. Sponsoring Agency Name and Address
National Aeronautics and Space Administration
14. sponsoring Agency code
Washington, D. C.	 20546
15. Supplementary Notes
Reinhard Gabbauer, Kyee Y. Koh, Antonio Rodriguez—Antunez, Gwynn L. Jelden, Robert F. Turco,
John Horton, Ronald Bukowski, and Ronald Reimer, Cleveland Clinic Foundation, Cleveland, Ohio;
James Blue, William Roberts, and Regis Leonard, Lewis Research Center.
Prepared for the National Pancreatic Project, New Orleans. Louisiana, April 18, 1980.
16. Abstract
A group of 30 patients with adenocarcinoma of the pancreas including some patients with very
advanced disease, were treated in a Pilot Phase 2 Study. 	 All patients were treated with the
so-called mixed beam modality employing photon treatments three times per week and neutron
treatments twice a week. 	 200 Rads or equivalent rads (RBE 3.3) were given in daily fractions
aiming at a total dose of 6000 rads in 6 to 8 weeks. 	 The treatments were well tolerated and
significant palliation was achieved in 26 of 30 cases.	 Twelve months survival was 33 percent
with a median survival of 7 months or 210 days.	 Treatment techniques and localization proce-
dures are discussed in the paper.
17. Key Words (Suggested by Author(s)) 18. Distribution Statement
Neutron cancer therapy Unclassified - unlimited
Pancreas STAR Category 51
19. Security Classlf. (of this report) 20. Satu► ity Classif. (of this page) 21. No. of Pages 72.	 Price*
Unclassified Unclassified
For sale by the National Technical Information Service, Springfield, Virginia 22161


Preliminary results of fast neutron treatments in carcinoma of the pancreas

Preliminary results of fast neutron treatments in carcinoma of the pancreas

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