{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T00:55:06Z","timestamp":1792716906200,"version":"4.5.0"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,1,24]],"date-time":"2023-01-24T00:00:00Z","timestamp":1674518400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005010","name":"Associazione Italiana per la Ricerca sul Cancro","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005010","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p>To assess dosimetry predictors of gastric and duodenal toxicities for locally advanced pancreatic cancer (LAPC) patients treated with chemo-radiotherapy in 15 fractions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data from 204 LAPC patients treated with induction+concurrent chemotherapy and radiotherapy (44.25 Gy in 15 fractions) were available. Forty-three patients received a simultaneous integrated boost of 48\u201358 Gy. Gastric\/duodenal Common Terminology Criteria for Adverse Events v. 5 (CTCAEv5) Grade \u22652 toxicities were analyzed. Absolute\/% duodenal and stomach dose\u2013volume histograms (DVHs) of patients with\/without toxicities were compared: the most predictive DVH points were identified, and their association with toxicity was tested in univariate and multivariate logistic regressions together with near-maximum dose (D<jats:sub>0.03<\/jats:sub>) and selected clinical variables.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Toxicity occurred in 18 patients: 3 duodenal (ulcer and duodenitis) and 10 gastric (ulcer and stomatitis); 5\/18 experienced both. At univariate analysis, V44cc (duodenum: p = 0.02, OR = 1.07; stomach: p = 0.01, OR = 1.12) and D<jats:sub>0.03<\/jats:sub> (p = 0.07, OR = 1.19; p = 0.008, OR = 1.12) were found to be the most predictive parameters. Stomach\/duodenum V44Gy and stomach D<jats:sub>0.03<\/jats:sub> were confirmed at multivariate analysis and found to be sufficiently robust at internal, bootstrap-based validation; the results regarding duodenum D<jats:sub>0.03<\/jats:sub> were less robust. No clinical variables or %DVH was significantly associated with toxicity. The best duodenum cutoff values were V44Gy &amp;lt; 9.1 cc (and D<jats:sub>0.03<\/jats:sub> &amp;lt; 47.6 Gy); concerning the stomach, they were V44Gy &amp;lt; 2 cc and D<jats:sub>0.03<\/jats:sub> &amp;lt; 45 Gy. The identified predictors showed a high negative predictive value (&amp;gt;94%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In a large cohort treated with hypofractionated radiotherapy for LAPC, the risk of duodenal\/gastric toxicities was associated with duodenum\/stomach DVH. Constraining duodenum V44Gy &amp;lt; 9.1 cc, stomach V44Gy &amp;lt; 2 cc, and stomach D<jats:sub>0.03<\/jats:sub> &amp;lt; 45 Gy should keep the toxicity rate at approximately or below 5%. The association with duodenum D<jats:sub>0.03<\/jats:sub> was not sufficiently robust due to the limited number of events, although results suggest that a limit of 45\u201346 Gy should be safe.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2022.983984","type":"journal-article","created":{"date-parts":[[2023,1,24]],"date-time":"2023-01-24T05:29:06Z","timestamp":1674538146000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Stomach and duodenum dose\u2013volume constraints for locally advanced pancreatic cancer patients treated in 15 fractions in combination with 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