Crowd control.

The HyTEC project is compiling data-driven reports on tumor control and normal tissue toxicity in various disease sites using extremely hypofractionated (i.e. SBRT) regimens. This HyTEC study aggregates data from multiple studies of pancreas SBRT to analyse tumor control across various dose and fractionation regimens. They chose to convert regimens from the included studies to 3-fraction equivalent doses. There was an apparent dose-response relationship ranging from the equivalent of 25 to 36 Gy in 3 fractions with 1-year local control rates ranging from ~70→ 86%, respectively. The commonly used 33 Gy in 5 fractions regimen comes out to ~28 Gy/3 and had an estimated 1-year control rate of 77%. At 24 Gy in 3 fractions, 1-year local control fell below 70%. Target coverage and dose heterogeneity are important nuances of pancreas SBRT planning, but unfortunately this study was limited in exploring how those factors affect tumor control. TBL: We have a long way to go before finding the optimal dose and fractionation regimen for pancreas SBRT. | Mahadevan, Int J Radiat Oncol Biol Phys 2020

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