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Irabor OC, Swanson W, Shaukat F, Wirtz J, Mallum AA, Ngoma T, Elzawawy A, Nguyen P, Incrocci L, Ngwa W. Can the Adoption of Hypofractionation Guidelines Expand Global Radiotherapy Access? An Analysis for Breast and Prostate Radiotherapy. JCO Glob Oncol 2021; 6:667-678. [PMID: 32343628 PMCID: PMC7193821 DOI: 10.1200/jgo.19.00261] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The limited radiotherapy resources for global cancer control have resulted in increased interest in developing time- and cost-saving innovations to expand access to those resources. Hypofractionated regimens could minimize cost and increase access for limited-resource countries. In this investigation, we estimated the percentage cost-savings per radiotherapy course and increased radiotherapy access in African countries after adopting hypofractionation for breast and prostate radiotherapy. For perspective, results were compared with high-income countries. METHODS The cost and course of breast and prostate radiotherapy for conventional and hypofractionated regimens in low-resource facilities were calculated using the Radiotherapy Cost Estimator tool developed by the International Atomic Energy Agency (IAEA) and then compared with another activity-based costing model. The potential maximum cost savings in each country over 7 years for breast and prostate radiotherapy were then estimated using cancer incidence data from the Global Cancer Observatory database with use rates applied. The increase in radiotherapy access was estimated by current national capacities from the IAEA directory. RESULTS The estimated cost per course of conventional and hypofractionated regimens were US$2,232 and $1,339 for breast treatment, and $3,389 and $1,699 for prostate treatment, respectively. The projected potential maximum cost savings with full hypofractionation implementation were $1.1 billion and $606 million for breast and prostate treatment, respectively. The projected increase of radiotherapy access due to implementing hypofractionation varied between +0.3% to 25% and +0.4% to 36.0% for breast and prostate treatments, respectively. CONCLUSION This investigation demonstrates that adopting hypofractionated regimens as standard treatment of breast and prostate cancers can result in substantial savings and increase radiotherapy access in developing countries. Given reduced delivery cost and treatment times, we anticipate a substantial increase in radiotherapy access with additional innovations that will allow progressive hypofractionation without compromising quality.
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Affiliation(s)
- Omoruyi Credit Irabor
- Dana Farber Cancer Institute, Boston, MA.,Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - William Swanson
- Dana Farber Cancer Institute, Boston, MA.,University of Massachusetts Lowell, Lowell, MA
| | | | - Johanna Wirtz
- Dana Farber Cancer Institute, Boston, MA.,Ulm University, Ulm, Germany
| | | | - Twalib Ngoma
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Paul Nguyen
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | | | - Wilfred Ngwa
- Dana Farber Cancer Institute, Boston, MA.,Brigham and Women's Hospital, Harvard Medical School, Boston, MA.,University of Massachusetts Lowell, Lowell, MA
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Janic B, Brown SL, Neff R, Liu F, Mao G, Chen Y, Jackson L, Chetty IJ, Movsas B, Wen N. Therapeutic enhancement of radiation and immunomodulation by gold nanoparticles in triple negative breast cancer. Cancer Biol Ther 2021; 22:124-135. [PMID: 33459132 PMCID: PMC7928016 DOI: 10.1080/15384047.2020.1861923] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Gold nanoparticles (AuNPs) have been shown to enhance cancer radiotherapy (RT) gain by localizing the absorption of radiation energy in the tumor while sparing surrounding normal tissue from radiation toxicity. Previously, we showed that AuNPs enhanced RT induced DNA damage and cytotoxicity in MCF7 breast cancer cells. Interestingly, we found that cancer cells exhibited a size-dependent AuNPs intracellular localization (4 nm preferentially in the cytoplasm and 14 nm in the nucleus). We extended those studies to an in vivo model and examined the AuNPs effects on RT cytotoxicity, survival and immunomodulation of tumor microenvironment (TME) in human triple negative breast cancer (TNBC) xenograft mouse model. We also explored the significance of nanoparticle size in these AuNPs’ effects. Mice treated with RT and RT plus 4 nm or 14 nm AuNPs showed a significant tumor growth delay, compared to untreated animals, while dual RT plus AuNPs treatment exhibited additive effect compared to either RT or AuNPs treatment alone. Survival log-rank test showed significant RT enhancement with 14 nm AuNP alone; however, 4 nm AuNPs did not exhibit RT enhancement. Both sizes of AuNPs enhanced RT induced immunogenic cell death (ICD) that was coupled with significant macrophage infiltration in mice pretreated with 14 nm AuNPs. These results showing significant AuNP size-dependent RT enhancement, as evident by both tumor growth delay and overall survival, reveal additional underlying immunological mechanisms and provide a platform for studying RT multimodal approaches for TNBC that may be combined with immunotherapies, enhancing their effect.
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Affiliation(s)
| | - Stephen L Brown
- Radiation Oncology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Ryan Neff
- University of Notre Dame, South Bend, Indiana, USA
| | - Fangchao Liu
- Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, Michigan, USA
| | - Guangzhao Mao
- Department of Chemical Engineering and Materials Science, Wayne State University, Detroit, Michigan, USA.,School of Chemical Engineering, Unsw Sydney, Kensington, Australia
| | - Yalei Chen
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan, USA
| | - Latoya Jackson
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan, USA
| | - Indrin J Chetty
- Radiation Oncology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Benjamin Movsas
- Radiation Oncology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Ning Wen
- Radiation Oncology, Henry Ford Hospital, Detroit, Michigan, USA
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Tumor Response After Neoadjuvant Magnetic Resonance Guided Single Ablative Dose Partial Breast Irradiation. Int J Radiat Oncol Biol Phys 2020; 106:821-829. [DOI: 10.1016/j.ijrobp.2019.11.406] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/14/2019] [Accepted: 11/17/2019] [Indexed: 12/12/2022]
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Evaluating dose to thyroid gland in women with breast cancer during radiotherapy with different radiation energies at supraclavicular fossa region. JOURNAL OF RADIOTHERAPY IN PRACTICE 2018. [DOI: 10.1017/s1460396918000134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground and aimDuring the treatment of breast cancer, radiotherapy to the supraclavicular fossa region results in absorption of radiation by the thyroid gland and consequently leads to hypothyroidism in 40% of patients. The aim of this study was to compare thyroid gland radiation absorption during radiotherapy with different anterioposterior beam radiation of 6–15 and 15–15 MV photon beam energies.Materials and methodsIn total, 29 patients with breast cancer were recruited to this study. Adjuvant radiotherapy with a total dose of 50 Gy was performed for each participant. Thyroid gland dosimetric measurements were evaluated including, mean dose, minimum and maximum dose, and V20, V30, V40 and V50 (percentage of thyroid volume receiving ≥20, ≥30, ≥40 and ≥50 Gy, respectively). The irradiation delivered doses were measured using Prowess Panther treatment planning system (Version 5.5). All data were evaluated using SPSS software.ResultsIn total, 29 subjects with mean age of 53·4±9·4 were studied. According to the obtained results, at 15–15 MV energies, a significantly lower dose was absorbed by the thyroid gland, was observed in contrast to their counterparts who were treated with 6–15 MV photon beam energies.FindingsUsing 15–15 MV photon beam energies field can significantly reduce the absorbed dose to the thyroid gland and consequently can reduce the risk of developing hypothyroidism in breast cancer patients treated with radiotherapy.
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Charaghvandi KR, Van't Westeinde T, Yoo S, Houweling AC, Rodrigues A, Verkooijen HM, Philippens MEP, van Asselen B, Horton JK, van den Bongard HJGD. Single dose partial breast irradiation using an MRI linear accelerator in the supine and prone treatment position. Clin Transl Radiat Oncol 2018; 14:1-7. [PMID: 30406210 PMCID: PMC6215022 DOI: 10.1016/j.ctro.2018.09.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/20/2018] [Accepted: 09/03/2018] [Indexed: 11/25/2022] Open
Abstract
Background In selected patients with early-stage and low-risk breast cancer, an MRI-linac based treatment might enable a radiosurgical, non-invasive alternative for current standard breast conserving therapy. Aim To investigate whether single dose accelerated partial breast (APBI) to the intact tumor in both the prone and supine radiotherapy positions on the MRI-linac is dosimetrically feasible with respect to predefined coverage and organs at risk (OAR) constraints. Material & methods For 20 patients with cTis or low-risk cT1N0M0 non-lobular breast carcinoma, previously treated with single dose preoperative APBI in the supine (n = 10) or prone (n = 10) position, additional intensity modulated radiotherapy plans with 7 coplanar beams in the presence of a 1.5T magnetic field were generated. A 20 Gy and 15 Gy dose was prescribed to the gross tumor and clinical target volume, respectively. The percentage of plans achieving predefined organ at risk (OAR) constraints, currently used in clinical practice, was assessed. Dosimetry differences between the prone versus supine approach and the MRI-linac versus clinically delivered plans were evaluated. Results All MRI-linac plans met the coverage and predefined OAR constraints. The prone approach appeared to be more favorable with respect to the chest wall, and ipsilateral lung dose compared to the supine position. No dosimetric differences were observed for the ipsilateral breast. No treatment position was clearly more beneficial for the skin or heart, since dosimetry varied among parameters. Overall, the MRI-linac and clinical plans were comparable, with minor absolute dosimetric differences. Conclusion MRI-linac based single dose APBI to the intact tumor is a promising and a dosimetrically feasible strategy in patients with low-risk breast cancer. Preliminary OAR dosimetry favored the prone radiotherapy position.
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Affiliation(s)
- K R Charaghvandi
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - T Van't Westeinde
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S Yoo
- Department of Radiation Oncology, Duke Cancer Center, Durham, United States
| | - A C Houweling
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A Rodrigues
- Department of Radiation Oncology, Duke Cancer Center, Durham, United States
| | - H M Verkooijen
- Imaging Division, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M E P Philippens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B van Asselen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J K Horton
- Department of Radiation Oncology, Duke Cancer Center, Durham, United States
| | - H J G D van den Bongard
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
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