A Multi-Institutional Safety and Feasibility Study Exploring the Use of Hydrogel to Create Spatial Separation between the Pancreas and Duodenum in Patients with Pancreatic Cancer

Amol Kumar Narang; Theodore S Hong; Kai Ding; Joseph Herman; Jeffrey Meyer; Elizabeth Thompson; Manoop S Bhutani; Kumar Krishnan; Brenna Casey; Eun Ji Shin; Eugene J Koay

doi:10.1016/j.prro.2023.11.011

A Multi-Institutional Safety and Feasibility Study Exploring the Use of Hydrogel to Create Spatial Separation between the Pancreas and Duodenum in Patients with Pancreatic Cancer

Pract Radiat Oncol. 2023 Dec 2:S1879-8500(23)00340-5. doi: 10.1016/j.prro.2023.11.011. Online ahead of print.

Authors

Affiliations

¹ Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland. Electronic address: anarang2@jhmi.edu.
² Department of Radiation Oncology, Massachusetts General Hospital Harvard Medical School, Boston, Massachusetts.
³ Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland.
⁴ Dept of Radiation Medicine, Northwell Health Cancer Institute, Lake Success, New York.
⁵ Department of Pathology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.
⁶ Dept of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, Texas.
⁷ Division of Gastroenterology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts.
⁸ Division of Gastroenterology and Hepatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
⁹ Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.

PMID: 38043645
DOI: 10.1016/j.prro.2023.11.011

Abstract

Purpose: The administration of dose-escalated radiation for pancreatic adenocarcinoma remains challenging because of the proximity of dose-limiting stomach and bowel, particularly the duodenum for pancreatic head tumors. We explore whether endoscopic injection of a temporary, absorbable hydrogel into the pancreatico-duodenal (PD) groove is safe and feasible for the purpose of increasing spatial separation between pancreatic head tumors and the duodenum.

Methods and materials: Six patients with localized pancreatic adenocarcinoma underwent endoscopic injection of hydrogel into the PD groove. Safety was assessed based on the incidence of procedure-related adverse events resulting in a delay of radiation therapy initiation. Feasibility was defined as the ability to create spatial separation between the pancreas and duodenum, as assessed on simulation CT.

Results: All 6 patients were able to undergo endoscopic injection of hydrogel into the PD groove. No device-related events were experienced at any point in follow-up. Presence of hydrogel in the PD groove was apparent on simulation CT in all 6 patients. Mean space created by the hydrogel was 7.7 mm +/- 2.4 mm. In 3 patients who underwent Whipple resection, presence of hydrogel in the PD groove was pathologically confirmed with no evidence of damage to the duodenum.

Conclusions: Endoscopic injection of hydrogel into the PD groove is safe and feasible. Characterization of the dosimetric benefit that this technique may offer in the setting of dose-escalated radiation should also be pursued, as should the ability of such dosimetric benefit to translate into clinically improved tumor control.