Three sided.

An emerging concept in pancreatic cancer surgery is an extended compartmental resection for tumors of the pancreatic head and neck called the “triangle operation.” The “Triangle Volume (TV)” is an anatomic space bounded by the celiac artery, superior mesenteric artery, superior mesenteric vein, common hepatic artery, and portal vein. This retrospective study from Johns Hopkins analyzed 31 local failures after SBRT for borderline resectable and locally advanced pancreatic cancer. Original target volumes included gross disease and involved vasculature, which were about ⅔ the size of the TV. They contoured the TV based on vascular anatomy (see Table 1) and found that the centroid of 90% of local failures was within this volume. Only about 50% and 70% of the TV received 33Gy and 25Gy, respectively, from the delivered plans. The Triangle Volume may eventually serve as a basis for an anatomically-derived high risk CTV. | Hill, Pract Radiat Oncol 2022

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