1
|
Zemek RM, Anagnostou V, Pires da Silva I, Long GV, Lesterhuis WJ. Exploiting temporal aspects of cancer immunotherapy. Nat Rev Cancer 2024; 24:480-497. [PMID: 38886574 DOI: 10.1038/s41568-024-00699-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 06/20/2024]
Abstract
Many mechanisms underlying an effective immunotherapy-induced antitumour response are transient and critically time dependent. This is equally true for several immunological events in the tumour microenvironment induced by other cancer treatments. Immune checkpoint therapy (ICT) has proven to be very effective in the treatment of some cancers, but unfortunately, with many cancer types, most patients do not experience a benefit. To improve outcomes, a multitude of clinical trials are testing combinations of ICT with various other treatment modalities. Ideally, those combination treatments should take time-dependent immunological events into account. Recent studies have started to map the dynamic cellular and molecular changes that occur during treatment with ICT, in the tumour and systemically. Here, we overlay the dynamic ICT response with the therapeutic response following surgery, radiotherapy, chemotherapy and targeted therapies. We propose that by combining treatments in a time-conscious manner, we may optimally exploit the interactions between the individual therapies.
Collapse
Affiliation(s)
- Rachael M Zemek
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Valsamo Anagnostou
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Inês Pires da Silva
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Crown Princess Mary Cancer Centre Westmead, Blacktown Hospital, Sydney, New South Wales, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Royal North Shore and Mater Hospitals, Sydney, New South Wales, Australia
| | - Willem Joost Lesterhuis
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.
| |
Collapse
|
2
|
Seravalli E, Kroon PS, Bolle S, Dunlea C, Harrabi SB, Laprie A, Lassen-Ramshad Y, Whitfield G, Janssens GO. Surface guided radiotherapy practice in paediatric oncology: a survey on behalf of the SIOPE Radiation Oncology Working Group. Br J Radiol 2024; 97:1044-1049. [PMID: 38445717 DOI: 10.1093/bjr/tqae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/06/2024] [Accepted: 02/20/2024] [Indexed: 03/07/2024] Open
Abstract
INTRODUCTION Surface guided radiotherapy (SGRT) is increasingly being implemented to track patient's surface movement and position during radiation therapy. However, limited information is available on the SGRT use in paediatrics. The aim of this double survey was to map SIOPE (European Society for Paediatric Oncology)-affiliated centres using SGRT and to gain information on potential indications, observed, or expected benefits. METHODS A double online survey was distributed to 246 SIOPE-affiliated radiotherapy (RT) centres. Multiple choices, yes/no, and open answers were included. The first survey (41 questions) was active from February to March 2021. A shortened version (13 questions) was repeated in March 2023 to detect trends in SGRT use within the same community. RESULTS Respectively, 76/142 (54%) and 28/142 (20%) responding centres used and planned to use SGRT clinically, including 4/34 (12%) new centres since 2021. Among the SGRT users, 33/76 (43%) already applied this technology to paediatric treatments. The main benefits of improved patient comfort, better monitoring of intrafraction motion, and more accurate initial patient set-up expected by future users did not differ from current SGRT-users (P = .893). Among non-SGRT users, the main hurdles to implement SGRT were costs and time for installation. In paediatrics, SGRT is applied to all anatomical sites. CONCLUSION This work provides information on the practice of SGRT in paediatrics across SIOPE-affiliated RT centres which can serve as a basis for departments when considering the purchase of SGRT systems. ADVANCES IN KNOWLEDGE Since little information is available in the literature on the use of SGRT in paediatrics, the results of this double survey can serve as a basis for departments treating children when considering the purchase of an SGRT system.
Collapse
Affiliation(s)
- Enrica Seravalli
- Department of Radiation Oncology, University Medical Center Utrecht, 3508 GA, The Netherlands
| | - Petra S Kroon
- Department of Radiation Oncology, University Medical Center Utrecht, 3508 GA, The Netherlands
| | - Stephanie Bolle
- Department of Radiation Oncology, Gustave Roussy Campus, Villejuif 94 800, France
| | - Cathy Dunlea
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London NW1 2PB, United Kingdom
| | - Semi B Harrabi
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg 69120, Germany
| | - Anne Laprie
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse 31100, France
| | - Yasmin Lassen-Ramshad
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus DK-8200, Denmark
| | - Gillian Whitfield
- The Christie NHS Foundation Trust and Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Manchester Academic Health Science Centre, Manchester M20 4BX, United Kingdom
| | - Geert O Janssens
- Department of Radiation Oncology, University Medical Center Utrecht, 3508 GA, The Netherlands
- Princess Maxima Center for Pediatric Oncology, Utrecht 3582CS, The Netherlands
| |
Collapse
|
3
|
Janssens GO, Timmermann B, Laprie A, Mandeville H, Padovani L, Chargari C, Kearns P, Kozhaeva O, Kameric L, Kienesberger A, van Rossum PSN, Boterberg T, Lievens Y, Vassal G. The organization of care in pediatric radiotherapy across SIOP Europe affiliated centers: A multicenter survey in the framework of the 'Joint Action on Rare Cancers' project. Radiother Oncol 2024; 191:110075. [PMID: 38159681 DOI: 10.1016/j.radonc.2023.110075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/21/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND/PURPOSE To reduce inequalities among SIOPE-affiliated countries, standard and optional levels to deliver 'Good Clinical Practice' compliant treatment in pediatric radiation oncology have been published. The aim of this project was to map the availability of pediatric radiotherapy resources across SIOPE-affiliated radiotherapy departments. MATERIALS/METHODS An online survey with 34 questions was distributed to 246 radiotherapy departments across 35 SIOPE-affiliated countries. In addition to demographic data, 15 general items related to the organization of the radiotherapy process, and 10 radiotherapy-specific items were defined. For each of the 25 items, sum scores were calculated per center and country. Mann-Whitney U tests were used to analyze associations. RESULTS Between March-June 2019, 121 departments (49 %) out of 31 countries (89 %) completed the survey. At center level, involvement of core disciplines in tumor boards (28 %), and integration of dedicated pediatric radiation therapy technologists (24 %) are limited, while rare & complex brachytherapy procedures are performed in many centers (23 %). For general and radiotherapy-specific items respectively, a relevant variation of sum scores was observed across countries (Δgeneral: ≤10 points; ΔRT_specific: ≤5 points) and among centers within a country (Δgeneral: ≤9 points; ΔRT_specific: ≤6 points). Sum scores for general and radiotherapy-specific items were higher in countries with a high-income (p < 0.01) and higher health development index (p < 0.01). A larger annual number of irradiated pediatric patients was associated with higher sum scores for general items (p < 0.01). CONCLUSION This survey demonstrates the disparities in organization of pediatric radiotherapy departments between SIOPE-affiliated countries and centers within the same country. Investment is needed to reduce inequalities in pediatric radiotherapy care.
Collapse
Affiliation(s)
- Geert O Janssens
- Department of Radiation Oncology, University Medical Center, Utrecht, the Netherlands; Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), German Cancer Consortium (DKTK), Germany
| | - Anne Laprie
- Department of Radiation Oncology, Oncopole Claudius Regaud at Institut Universitaire du Cancer de Toulouse IUCT-Oncopole, Toulouse, France
| | - Henry Mandeville
- The Royal Marsden Hospital and Institute of Cancer Research, Sutton, United Kingdom
| | - Laetitia Padovani
- Aix-Marseille University, Oncology-Radiotherapy-Department, CRCM Inserm UMR1068, CNRSUMR7258 AMUUM105, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - Cyrus Chargari
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Pamela Kearns
- Cancer Research UK Clinical Trials Unit, National Institute for Health Research Birmingham Biomedical Research Centre, Institute of Cancer and Genomic Sciences, University of Birmingham, B15 2TT, Birmingham, United Kingdom
| | - Olga Kozhaeva
- Policy Department, European Society for Pediatric Oncology, SIOP Europe, Brussels, Belgium
| | - Leila Kameric
- Childhood Cancer International - Europe, Vienna, Austria
| | | | - Peter S N van Rossum
- Department of Radiation Oncology, University Medical Center, Utrecht, the Netherlands
| | - Tom Boterberg
- Department of Radiation Oncology, Ghent University Hospital and Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Particle Therapy Interuniversity Center Leuven (PARTICLE), Leuven, Belgium
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital and Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Gilles Vassal
- Department of Children and Adolescent Oncology, Gustave Roussy Comprehensive Cancer Center, Paris-Saclay University, Villejuif, France
| |
Collapse
|
4
|
Kelly SM, Turcas A, Corning C, Bailey S, Cañete A, Clementel E, di Cataldo A, Dieckmann K, Gaze MN, Horan G, Jenney M, Ladenstein R, Padovani L, Valteau-Couanet D, Boterberg T, Mandeville H. Radiotherapy quality assurance in paediatric clinical trials: first report from six QUARTET-affiliated trials. Radiother Oncol 2023; 182:109549. [PMID: 36828140 DOI: 10.1016/j.radonc.2023.109549] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/02/2023] [Accepted: 02/04/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND AND PURPOSE SIOP Europe's QUARTET project launched in 2016; aiming to improve access to high-quality radiotherapy for children and adolescents treated within clinical trials across Europe. The aim of this report is to present the profile of institutions participating in six QUARTET-affiliated trials and a description of the initial individual case review (ICR) outcomes. METHODS This is a two-part analysis. Firstly, using facility questionnaires, beam output audit certificates, and advanced technique credentialing records to create a profile of approved institutions, and secondly, collating trial records for ICRs submitted prior to 31/10/2022. Trials included are: SIOPEN HR-NBL1, SIOPEN-LINES, SIOPEN- VERITAS, SIOP-BTG HRMB, EpSSG-FaR-RMS, and SIOPEN HR-NBL2. RESULTS By 31/10/2022, a total of 103 institutions had commenced QUARTET site approval procedures to participate in QUARTET-affiliated trials; 66 sites across 20 countries were approved. These participating institutions were often paediatric referral sites with intensity modulated radiotherapy or proton beam therapy, designated paediatric radiation oncologists, and paediatric adapted facilities and imaging protocols available. In total, 263 patient plans were submitted for ICR, 254 ICRs from 15 countries were completed. ICRs had a rejection rate of 39.8%, taking an average of 1.4 submissions until approval was achieved. Target delineation was the most frequent reason for rejection. CONCLUSION The QUARTET facility questionnaire is a valuable tool for mapping resources, personnel, and technology available to children and adolescents receiving radiotherapy. Prospective ICR is essential for paediatric oncology clinical trials and should be prioritised to reduce protocol violations.
Collapse
Affiliation(s)
- Sarah M Kelly
- The European Society for Paediatric Oncology (SIOP Europe), Clos Chapelle-aux-Champs 30, Brussels, Belgium; European Organisation for the Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Andrada Turcas
- The European Society for Paediatric Oncology (SIOP Europe), Clos Chapelle-aux-Champs 30, Brussels, Belgium; European Organisation for the Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Department of Oncology, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Romania
| | - Coreen Corning
- European Organisation for the Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Simon Bailey
- Newcastle Cancer Centre, Newcastle University and Great North Children's Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Adela Cañete
- Pediatric Oncohematology Unit, University and Polytechnic la Fe Hospital, Department of Pediatrics, University of Valencia, Spain
| | - Enrico Clementel
- European Organisation for the Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Andrea di Cataldo
- Department of Clinical and Experimental Medicine, Unit of Pediatric Hematology and Oncology, University of Catania, Catania, Italy
| | - Karin Dieckmann
- Children's Cancer Research Institute, St Anna Children's Hospital, Vienna, Austria; Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Mark N Gaze
- Department of Oncology, University College London Hospitals NHS Foundation Trust, United Kingdom
| | - Gail Horan
- Oncology Centre, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Meriel Jenney
- Department of Paediatric Oncology, Children's Hospital for Wales, Heath Park, Cardiff, United Kingdom
| | - Ruth Ladenstein
- Children's Cancer Research Institute, St Anna Children's Hospital, Vienna, Austria
| | - Laetitia Padovani
- Department of Radiation Oncology, Assistance Publique Hôpitaux de Marseille, France
| | | | - Tom Boterberg
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Henry Mandeville
- The European Society for Paediatric Oncology (SIOP Europe), Clos Chapelle-aux-Champs 30, Brussels, Belgium; The Royal Marsden Hospital and Institute of Cancer Research, Sutton, United Kingdom
| |
Collapse
|
5
|
Vallero SG, Bertero L, Morana G, Sciortino P, Bertin D, Mussano A, Ricci FS, Peretta P, Fagioli F. Pediatric diffuse midline glioma H3K27- altered: A complex clinical and biological landscape behind a neatly defined tumor type. Front Oncol 2023; 12:1082062. [PMID: 36727064 PMCID: PMC9885151 DOI: 10.3389/fonc.2022.1082062] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023] Open
Abstract
The 2021 World Health Organization Classification of Tumors of the Central Nervous System, Fifth Edition (WHO-CNS5), has strengthened the concept of tumor grade as a combination of histologic features and molecular alterations. The WHO-CNS5 tumor type "Diffuse midline glioma, H3K27-altered," classified within the family of "Pediatric-type diffuse high-grade gliomas," incarnates an ideally perfect integrated diagnosis in which location, histology, and genetics clearly define a specific tumor entity. It tries to evenly characterize a group of neoplasms that occur primarily in children and midline structures and that have a dismal prognosis. Such a well-defined pathological categorization has strongly influenced the pediatric oncology community, leading to the uniform treatment of most cases of H3K27-altered diffuse midline gliomas (DMG), based on the simplification that the mutation overrides the histological, radiological, and clinical characteristics of such tumors. Indeed, multiple studies have described pediatric H3K27-altered DMG as incurable tumors. However, in biology and clinical practice, exceptions are frequent and complexity is the rule. First of all, H3K27 mutations have also been found in non-diffuse gliomas. On the other hand, a minority of DMGs are H3K27 wild-type but have a similarly poor prognosis. Furthermore, adult-type tumors may rarely occur in children, and differences in prognosis have emerged between adult and pediatric H3K27-altered DMGs. As well, tumor location can determine differences in the outcome: patients with thalamic and spinal DMG have significantly better survival. Finally, other concomitant molecular alterations in H3K27 gliomas have been shown to influence prognosis. So, when such additional mutations are found, which one should we focus on in order to make the correct clinical decision? Our review of the current literature on pediatric diffuse midline H3K27-altered DMG tries to address such questions. Indeed, H3K27 status has become a fundamental supplement to the histological grading of pediatric gliomas; however, it might not be sufficient alone to exhaustively define the complex biological behavior of DMG in children and might not represent an indication for a unique treatment strategy across all patients, irrespective of age, additional molecular alterations, and tumor location.
Collapse
Affiliation(s)
- Stefano Gabriele Vallero
- Pediatric Oncohematology Division, Regina Margherita Children’s Hospital, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin, Italy,*Correspondence: Stefano Gabriele Vallero,
| | - Luca Bertero
- Pathology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giovanni Morana
- Neuroradiology Unit, Department of Neuroscience, University of Turin, Turin, Italy
| | - Paola Sciortino
- Department of Neuroradiology, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin, Italy
| | - Daniele Bertin
- Pediatric Oncohematology Division, Regina Margherita Children’s Hospital, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin, Italy
| | - Anna Mussano
- Radiotherapy Unit, Regina Margherita Children’s Hospital, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin, Italy
| | - Federica Silvia Ricci
- Child and Adolescent Neuropsychiatry Division, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
| | - Paola Peretta
- Pediatric Neurosurgery Division, Regina Margherita Children’s Hospital, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin, Italy
| | - Franca Fagioli
- Pediatric Oncohematology Division, Regina Margherita Children’s Hospital, Azienda Ospedaliera Universitaria (AOU) Città della Salute e della Scienza, Turin, Italy,Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| |
Collapse
|
6
|
Kelly SM, Effeney R, Gaze MN, Bernier-Chastagner V, Blondeel A, Clementel E, Corning C, Dieckmann K, Essiaf S, Gandola L, Janssens GO, Kearns PR, Lacombe D, Lassen-Ramshad Y, Merks H, Miles E, Padovani L, Scarzello G, Schwarz R, Timmermann B, van Rijn RR, Vassal G, Boterberg T, Mandeville HC. QUARTET: A SIOP Europe project for quality and excellence in radiotherapy and imaging for children and adolescents with cancer. Eur J Cancer 2022; 172:209-220. [PMID: 35780527 DOI: 10.1016/j.ejca.2022.05.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/20/2022] [Accepted: 05/26/2022] [Indexed: 12/21/2022]
Abstract
The European Society for Paediatric Oncology (SIOPE) Radiation Oncology Working Group presents the QUARTET Project: a centralised quality assurance programme designed to standardise care and improve the quality of radiotherapy and imaging for international clinical trials recruiting children and adolescents with cancer throughout Europe. QUARTET combines the paediatric radiation oncology expertise of SIOPE with the infrastructure and experience of the European Organisation for Research and Treatment of Cancer to deliver radiotherapy quality assurance programmes for large, prospective, international clinical trials. QUARTET-affiliated trials include children and adolescents with brain tumours, neuroblastoma, sarcomas including rhabdomyosarcoma, and renal tumours including Wilms' tumour. With nine prospective clinical trials and two retrospective studies within the active portfolio in March 2022, QUARTET will collect one of the largest repositories of paediatric radiotherapy and imaging data, support the clinical assessment of radiotherapy, and evaluate the role and benefit of radiotherapy quality assurance for this cohort of patients within the context of clinical trials.
Collapse
Affiliation(s)
- Sarah M Kelly
- European Society for Paediatric Oncology (SIOPE), Clos Chapelle-aux-Champs 30, Brussels, Belgium; The European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Avenue E. Mounier 83, Brussels, Belgium; Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
| | - Rachel Effeney
- European Society for Paediatric Oncology (SIOPE), Clos Chapelle-aux-Champs 30, Brussels, Belgium; The European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Avenue E. Mounier 83, Brussels, Belgium
| | - Mark N Gaze
- Department of Oncology, University College London Hospitals NHS Foundation Trust, 250 Euston Road, London, NW1 2PG, United Kingdom
| | | | - Anne Blondeel
- European Society for Paediatric Oncology (SIOPE), Clos Chapelle-aux-Champs 30, Brussels, Belgium
| | - Enrico Clementel
- The European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Avenue E. Mounier 83, Brussels, Belgium
| | - Coreen Corning
- The European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Avenue E. Mounier 83, Brussels, Belgium
| | - Karin Dieckmann
- Children's Cancer Research Institute, St Anna Kinderkrebsforschung, Medical University of Vienna, Vienna, Austria; Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Samira Essiaf
- European Society for Paediatric Oncology (SIOPE), Clos Chapelle-aux-Champs 30, Brussels, Belgium
| | - Lorenza Gandola
- Department of Radiation Oncology, Fondazione IRCCS-Istituto Nazionale Dei Tumori, Milan, Italy
| | - Geert O Janssens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands; Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Pamela R Kearns
- European Society for Paediatric Oncology (SIOPE), Clos Chapelle-aux-Champs 30, Brussels, Belgium; Cancer Research UK Clinical Trials Unit, National Institute for Health Research Birmingham Biomedical Research Centre, Institute of Cancer and Genomic Services, University of Birmingham, United Kingdom
| | - Denis Lacombe
- The European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Avenue E. Mounier 83, Brussels, Belgium
| | | | - Hans Merks
- Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Elizabeth Miles
- National Radiotherapy Trials Quality Assurance (RTTQA) Group, Mount Vernon Cancer Centre, United Kingdom
| | - Laetitia Padovani
- Department of Radiation Oncology, Assistance Publique Hôpitaux de Marseille, France
| | - Giovanni Scarzello
- Radiation Therapy Department, Veneto Institute of Oncology IRCCS, Padua, Italy
| | - Rudolf Schwarz
- Department of Radiation Oncology, Medical Center Hamburg-Eppendorf, Hamburg, Martinistr. 52, D 20246 Hamburg Germany
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), Germany; German Consortium for Translational Cancer Research (DKTK), Essen, Germany
| | - Rick R van Rijn
- Department of Radiology and Nuclear Medicine, Emma Children's Hospital - Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Gilles Vassal
- European Society for Paediatric Oncology (SIOPE), Clos Chapelle-aux-Champs 30, Brussels, Belgium; Department of Pediatric Oncology, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Tom Boterberg
- Department of Radiation Oncology, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Henry C Mandeville
- Department of Radiotherapy, The Royal Marsden Hospital and the Institute of Cancer Research, Sutton, United Kingdom
| |
Collapse
|
7
|
Siddique S, Bhyat F, Lewis S. The lived experiences of radiotherapists treating paediatric patients: Gauteng, South Africa. J Med Imaging Radiat Sci 2022; 53:412-419. [DOI: 10.1016/j.jmir.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/03/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022]
|
8
|
Di Ruscio V, Del Baldo G, Fabozzi F, Vinci M, Cacchione A, de Billy E, Megaro G, Carai A, Mastronuzzi A. Pediatric Diffuse Midline Gliomas: An Unfinished Puzzle. Diagnostics (Basel) 2022; 12:diagnostics12092064. [PMID: 36140466 PMCID: PMC9497626 DOI: 10.3390/diagnostics12092064] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/22/2022] [Indexed: 11/15/2022] Open
Abstract
Diffuse midline glioma (DMG) is a heterogeneous group of aggressive pediatric brain tumors with a fatal prognosis. The biological hallmark in the major part of the cases is H3K27 alteration. Prognosis remains poor, with median survival ranging from 9 to 12 months from diagnosis. Clinical and radiological prognostic factors only partially change the progression-free survival but they do not improve the overall survival. Despite efforts, there is currently no curative therapy for DMG. Radiotherapy remains the standard treatment with only transitory benefits. No chemotherapeutic regimens were found to significantly improve the prognosis. In the new era of a deeper integration between histological and molecular findings, potential new approaches are currently under investigation. The entire international scientific community is trying to target DMG on different aspects. The therapeutic strategies involve targeting epigenetic alterations, such as methylation and acetylation status, as well as identifying new molecular pathways that regulate oncogenic proliferation; immunotherapy approaches too are an interesting point of research in the oncology field, and the possibility of driving the immune system against tumor cells has currently been evaluated in several clinical trials, with promising preliminary results. Moreover, thanks to nanotechnology amelioration, the development of innovative delivery approaches to overcross a hostile tumor microenvironment and an almost intact blood–brain barrier could potentially change tumor responses to different treatments. In this review, we provide a comprehensive overview of available and potential new treatments that are worldwide under investigation, with the intent that patient- and tumor-specific treatment could change the biological inauspicious history of this disease.
Collapse
Affiliation(s)
- Valentina Di Ruscio
- Department of Onco-Hematology, Cell and Gene Therapies, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Giada Del Baldo
- Department of Onco-Hematology, Cell and Gene Therapies, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Francesco Fabozzi
- Department of Onco-Hematology, Cell and Gene Therapies, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
- Department of Pediatrics, University of Rome Tor Vergata, 00165 Rome, Italy
| | - Maria Vinci
- Department of Onco-Hematology, Cell and Gene Therapies, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Antonella Cacchione
- Department of Onco-Hematology, Cell and Gene Therapies, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Emmanuel de Billy
- Department of Onco-Hematology, Cell and Gene Therapies, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Giacomina Megaro
- Department of Onco-Hematology, Cell and Gene Therapies, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Andrea Carai
- Neurosurgery Unit, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Angela Mastronuzzi
- Department of Onco-Hematology, Cell and Gene Therapies, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
- Faculty of Medicine and Surgery, Saint Camillus International University of Health Sciences, 00131 Rome, Italy
- Correspondence:
| |
Collapse
|
9
|
[Pediatric Radiation Oncology in France: State of the Art]. Cancer Radiother 2022; 26:789-793. [PMID: 36031495 DOI: 10.1016/j.canrad.2022.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 06/27/2022] [Accepted: 06/30/2022] [Indexed: 10/15/2022]
Abstract
Pediatric radiotherapy differs greatly from its practice in adults mainly because of the age (median age 6 years), which poses the problem of irradiation of healthy tissues in a growing organism, causing sequelae, difficult compliance and management of parents. These particularities require a dedicated education and specific organization that was set progressively concerning indications, quality control, exhaustive collection of native dosimetry, long-term follow-up and clinical and translational research, as well as accreditations to practice pediatric radiotherapy, in close collaboration with the French Society of Child and Adolescent Cancer and Leukemia (SFCE), under the aegis of the French Group of Pediatric Radiotherapy (GFRP). This organization is a pioneer in the development of pediatric radiotherapy quality controls, which are becoming the European standard and in the collection of native dosimetry integrated with the follow-up of possible late-effects, constituting the most important international database.
Collapse
|
10
|
Boterberg T, Dunlea C, Harrabi S, Janssens G, Laprie A, Whitfield G, Gaze M. Contemporary paediatric radiation oncology. Arch Dis Child 2022; 108:archdischild-2021-323059. [PMID: 35851293 DOI: 10.1136/archdischild-2021-323059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 07/03/2022] [Indexed: 11/03/2022]
Abstract
Treatment with ionising radiation is a valuable component of treatment schedules for a many children and young people with cancer. While some form of radiotherapy has been in use for over 100 years, a series of innovations has revolutionised paediatric radiation oncology. Mostly, high-energy X-ray photons are used, but proton beam radiotherapy is increasingly offered, especially in children and young people. This is to reduce the radiation exposure of healthy normal tissues and so the likelihood of adverse effects. Other methods of radiotherapy delivery include brachytherapy and molecular radiotherapy. The most appropriate treatment technique should be selected for every child. Advances in computers and imaging, developments in the technology of radiation delivery and a better understanding of pathology and molecular biology of cancer, coupled with parallel improvements in surgery and systemic therapy, have led to a transformation of practice in recent decades. Initially an empirical art form, radiotherapy for children has become a technically advanced, evidence-based cornerstone of increasingly personalised cancer medicine with solid scientific foundations. Late sequelae of treatment-the adverse effects once accepted as the cost of cure-have been significantly reduced in parallel with increased survival rates. The delivery of radiotherapy to children and young people requires a specialised multiprofessional team including radiation oncologists, therapeutic radiographers, play specialists and physicists among others. This article reviews the types of radiotherapy now available and outlines the pathway of the child through treatment. It aims to demonstrate to paediatricians how contemporary paediatric radiation oncology differs from past practice.
Collapse
Affiliation(s)
- Tom Boterberg
- Department of Radiotherapy, University of Ghent, Ghent, Belgium
| | - Cathy Dunlea
- Department of Radiotherapy, University College London Hospitals NHS Foundation Trust, London, UK
| | - Semi Harrabi
- Department of Radiotherapy, University Hospital Heidelberg, Heidelberg, Baden-Württemberg, Germany
| | - Geert Janssens
- Department of Paediatric Oncology, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
- Department of Radiotherapy, University Medical Centre, Utrecht, The Netherlands
| | - Anne Laprie
- Department of Radiotherapy, Institut Universitaire du Cancer Toulouse Oncopole, Toulouse, France
| | - Gillian Whitfield
- Department of Radiotherapy, Christie Hospital, Manchester, Manchester, UK
| | - Mark Gaze
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
11
|
Brachytherapy for Pediatric Patients at Gustave Roussy Cancer Campus: A Model of International Cooperation for Highly Specialized Treatments. Int J Radiat Oncol Biol Phys 2022; 113:602-613. [PMID: 35278672 DOI: 10.1016/j.ijrobp.2022.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/23/2022] [Accepted: 03/02/2022] [Indexed: 12/18/2022]
Abstract
PURPOSE Childhood cancer is rare, and treatment is frequently associated with long-term morbidity. Disparities in survival and long-term side effects encourage the establishment of networks to increase access to complex organ-conservative strategies, such as brachytherapy. We report our experience of an international cooperation model in childhood cancers. METHODS AND MATERIALS We examined the outcome of all children referred to our center from national or international networks to be treated according to a multimodal organ-conservative approach, including brachytherapy. RESULTS We identified 305 patients whose median age at diagnosis was 2.2 years (range, 1.4 months to 17.2 years). Among these patients, 99 (32.4%) were treated between 2015 and 2020; 172 (56.4%) were referred from national centers; and 133 (43.6%) were international patients from 31 countries (mainly Europe). Also, 263 patients were referred for primary treatment and 42 patients were referred for salvage treatment. Genitourinary tumors were the most frequent sites, with 56.4% bladder/prostate rhabdomyosarcoma and 28.5% gynecologic tumors. In addition to brachytherapy, local treatment consisted of partial tumor resection in 207 patients (67.9%), and 39 patients (13%) had additional external radiation therapy. Median follow-up was 58 months (range, 1 month to 48 years), 93 months for national patients, and 37 months for international patients (P < .0001). Five-year local control, disease-free survival, and overall survival rates were 90.8% (95% confidence interval [CI], 87.3%-94.4%), 84.4% (95% CI, 80.1%-89.0%), and 93.3% (95% CI, 90.1%-96.5%), respectively. Patients referred for salvage treatment had poorer disease-free survival (P < .01). Implementation of image guided pulse-dose-rate brachytherapy was associated with better local control among patients with rhabdomyosarcoma referred for primary treatment (hazard ratio, 9.72; 95% CI, 1.24-71.0). At last follow-up, 16.7% patients had long-term severe treatment-related complications, and 2 patients (0.7%) had developed second malignancy. CONCLUSIONS This retrospective series shows the feasibility of a multinational referral network for brachytherapy allowing high patient numbers in rare pediatric cancers. High local control probability and acceptable late severe complication probability could be achieved despite very challenging situations. This cooperation model could serve as a basis for generating international reference networks for high-tech radiation such as brachytherapy to increase treatment care opportunities and cure probability.
Collapse
|
12
|
Owusu-Agyemang P, Tsai JY, Kapoor R, Van Meter A, Tan GM, Peters S, Opitz L, Pedrotti D, DeSoto HS, Zavala AM. Survey of Anesthesia, Sedation, and Non-sedation Practices for Children Undergoing Repetitive Cranial or Craniospinal Radiotherapy. Cureus 2022; 14:e24075. [PMID: 35573580 PMCID: PMC9097856 DOI: 10.7759/cureus.24075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 11/24/2022] Open
Abstract
Background Children undergoing cranial or craniospinal radiotherapy may require over 30 treatments within a six-week period. Facilitating these many treatments with the patient under anesthesia presents a significant challenge, and the most preferred anesthetic methods remain unknown. The primary goal of this study was to determine the most preferred anesthetic methods and agents for children undergoing daily cranial or craniospinal radiotherapy. Methods An 83-item web-based survey was developed. An introductory email was sent to 505 physicians and child-life specialists with expertise in pediatric anesthesia and/or affiliated with pediatric radiation oncology departments. Results The response rate was 128/505 (25%) and included specialists from Africa (5, 4%), Asia (18, 14%), Australia/Oceania (5, 4%), Europe (45, 35%), North America (50, 39%), and South America (5, 4%). The 128 respondents included 91 anesthesiologists (71%), 20 physicians who were not anesthesiologists (16%), 14 child life/social education specialists (11%), one radiotherapist, one pediatric radiation nurse, and one non-specified medical professional (all = 2%). Of the 128 respondents, 95 (74%) used anesthesia or sedation to facilitate repetitive cranial or craniospinal radiotherapy. Overall, total intravenous anesthesia without intubation was preferred by 67 of 95 (71%) specialists during one or more forms of radiotherapy. During photon-based radiotherapy, total intravenous anesthesia without intubation was the preferred anesthetic method with the patient in the supine (57/84, 68%) and prone positions (25/40, 63%). Propofol was the most used anesthetic agent for both supine (73/84, 87%) and prone positions (38/40, 95%). For proton radiotherapy, total intravenous anesthesia without intubation was the most preferred anesthetic method for the supine (32/42, 76%) and prone treatment positions (11/18, 61%), and propofol was the most used anesthetic (supine: 40/43, 93%; prone: 16/18, 89%). Conclusions In this survey of 95 specialists responsible for anesthesia or sedation of children undergoing repetitive cranial or craniospinal radiotherapy, propofol-based total intravenous anesthesia without intubation was the preferred anesthetic technique.
Collapse
|
13
|
Boterberg T, Dunlea C, Harrabi S, Janssens GO, Laprie A, Whitfield G, Gaze MN. European clinical trials in paediatric radiation oncology. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:843-845. [PMID: 34555350 DOI: 10.1016/s2352-4642(21)00273-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/16/2021] [Accepted: 08/16/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Tom Boterberg
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Cathy Dunlea
- Radiotherapy Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Semi Harrabi
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Geert O Janssens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands; Princess Máxima Center for Paediatric Oncology, Utrecht, Netherlands
| | - Anne Laprie
- Department of Radiotherapy, University Institute of Cancer Toulouse-Oncopôle, Toulouse, France
| | - Gillian Whitfield
- Manchester Academic Health Science Centre, The Christie NHS Foundation Trust and The Children's Brain Tumour Research Network, Royal Manchester Children's Hospital, University of Manchester, Manchester, UK
| | - Mark N Gaze
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London NW1 2PG, UK.
| | | |
Collapse
|
14
|
Hess CB, Parkes J, Janssens GO, Lin C, Wong K, Zaghloul MS, Marconi DG, Boterberg T, Esiashvili N. Global pediatric radiation therapy in resource-limited settings. Pediatr Blood Cancer 2021; 68 Suppl 2:e28299. [PMID: 32743983 DOI: 10.1002/pbc.28299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 03/10/2020] [Indexed: 12/24/2022]
Abstract
This report provides a summary of the global burden of childhood cancer morbidity and mortality, which disproportionately affects low- and middle-income countries as well as low- and middle-income communities within high-income countries. We review past successes and current challenges to improving clinical pediatric radiotherapy, education, and research in these regions. The Pediatric Radiation Oncology Society Taskforce in Low- and Middle-Income Countries recently outlined specific aims: (a) to increase access and quality of radiotherapy for children and adolescents afflicted with cancer; (b) to enumerate, engage, and educate a global community of providers of childhood and adolescent radiotherapy; and (c) to create evidence establishing the outcomes of setting-specific treatment standards of care when first-world standards are not achievable. This report will improve awareness of these disparities and promote attempts to correct them.
Collapse
Affiliation(s)
- Clayton B Hess
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia.,Department of Radiation Oncology, Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Jeannette Parkes
- Department of Radiation Oncology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Geert O Janssens
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Chi Lin
- Department of Radiation Oncology, University of Nebraska Medical Center, University of Nebraska, Omaha, Nebraska
| | - Kenneth Wong
- Department of Radiation Oncology, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California
| | - Mohamed S Zaghloul
- Children's Cancer Hospital, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Daniel G Marconi
- Department of Radiation Oncology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Tom Boterberg
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Natia Esiashvili
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| |
Collapse
|
15
|
Hoeben BA, Pazos M, Albert MH, Seravalli E, Bosman ME, Losert C, Boterberg T, Manapov F, Ospovat I, Milla SM, Abakay CD, Engellau J, Kos G, Supiot S, Bierings M, Janssens GO. Towards homogenization of total body irradiation practices in pediatric patients across SIOPE affiliated centers. A survey by the SIOPE radiation oncology working group. Radiother Oncol 2021; 155:113-119. [DOI: 10.1016/j.radonc.2020.10.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/07/2020] [Accepted: 10/21/2020] [Indexed: 02/06/2023]
|
16
|
Huijskens SC, Kroon PS, Gaze MN, Gandola L, Bolle S, Supiot S, Abakay CD, Alexopoulou A, Bokun J, Chojnacka M, Escande A, Giralt J, Harrabi S, Maduro JH, Mandeville H, Mussano A, Napieralska A, Padovani L, Scarzello G, Timmermann B, Claude L, Seravalli E, Janssens GO. Radical radiotherapy for paediatric solid tumour metastases: An overview of current European protocols and outcomes of a SIOPE multicenter survey. Eur J Cancer 2021; 145:121-131. [PMID: 33461061 DOI: 10.1016/j.ejca.2020.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/22/2020] [Accepted: 12/07/2020] [Indexed: 12/18/2022]
Abstract
PURPOSE/OBJECTIVE About 20% of children with solid tumours (ST) present with distant metastases (DM). Evidence regarding the use of radical radiotherapy of these DM is sparse and open for personal interpretation. The aim of this survey was to review European protocols and to map current practice regarding the irradiation of DM across SIOPE-affiliated countries. MATERIALS/METHODS Radiotherapy guidelines for metastatic sites (bone, brain, distant lymph nodes, lung and liver) in eight European protocols for rhabdomyosarcoma, non-rhabdomyosarcoma soft-tissue sarcoma, Ewing sarcoma, neuroblastoma and renal tumours were reviewed. SIOPE centres irradiating ≥50 children annually were invited to participate in an online survey. RESULTS Radiotherapy to at least one metastatic site was recommended in all protocols, except for high-risk neuroblastoma. Per protocol, dose prescription varied per site, and information on delineation and treatment planning/delivery was generally missing. Between July and September 2019, 20/27 centres completed the survey. Around 14% of patients were deemed to have DM from ST at diagnosis, of which half were treated with curative intent. A clear cut-off for a maximum number of DM was not used in half of the centres. Regardless of the tumour type and site, conventional radiotherapy regimens were most commonly used to treat DM. When stereotactic radiotherapy was used, a wide range of fractionation regimens were applied. CONCLUSION Current radiotherapy guidelines for DM do not allow a consistent approach in a multicentre setting. Prospective (randomised) trials are needed to define the role of radical irradiation of DM from paediatric ST.
Collapse
Affiliation(s)
- Sophie C Huijskens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Petra S Kroon
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Mark N Gaze
- Department of Oncology, University College London Hospitals, London, UK
| | - Lorenza Gandola
- Paediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Stephanie Bolle
- Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Stephane Supiot
- Oncologie Radiotherapie, Institut de Cancérologie de l'Ouest, Nantes, France
| | - Candan D Abakay
- Department of Radiation Oncology, Uludag University, Bursa, Turkey
| | | | - Jelena Bokun
- Institute of Oncology and Radiology of Serbia, Belgrado, Serbia
| | - Marzanna Chojnacka
- Department of Radiation Oncology, Maria Sklodowska-Curie Memorial Cancer Center-Institute, Warsaw, Poland
| | - Alexandre Escande
- Department of Radiation Oncology, Oscar Lambret Comprehensive Cancer Center, Lille, France
| | - Jordi Giralt
- Department of Radiation Oncology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Semi Harrabi
- Department of Radiation Oncology and Radiotherapy, Heidelberg University Hospital, Heidelberg, Germany
| | - John H Maduro
- Department of Radiation Oncology, University Medical Center Groningen/Groningen Proton Center, Groningen, The Netherlands; Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands
| | | | - Anna Mussano
- Department of Radiation Oncology, Citta della Salute e della Scienza, Torino, Italy
| | - Aleksandra Napieralska
- Department of Radiation Oncology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - Laetitia Padovani
- Department of Radiation Oncology, Centre Hospitalier Universitaire, Marseille, France
| | - Giovanni Scarzello
- Department of Radiation Oncology, Veneto Institute of Oncology, Padua, Italy
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), German Cancer Consortium (DKTK), Essen, Germany
| | - Line Claude
- Department of Radiation Oncology, Centre Leon Berard, Lyon, France
| | - Enrica Seravalli
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geert O Janssens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands; Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands
| |
Collapse
|