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Toussaint L, Matysiak W, Alapetite C, Aristu J, Bannink-Gawryszuk A, Bolle S, Bolsi A, Calvo F, Cerron Campoo F, Charlwood F, Demoor-Goldschmidt C, Doyen J, Drosik-Rutowicz K, Dutheil P, Embring A, Engellau J, Goedgebeur A, Goudjil F, Harrabi S, Kopec R, Kristensen I, Lægsdmand P, Lütgendorf-Caucig C, Meijers A, Mirandola A, Missohou F, Montero Feijoo M, Muren LP, Ondrova B, Orlandi E, Pettersson E, Pica A, Plaude S, Righetto R, Rombi B, Timmermann B, Van Beek K, Vela A, Vennarini S, Vestergaard A, Vidal M, Vondracek V, Weber DC, Whitfield G, Zimmerman J, Maduro JH, Lassen-Ramshad Y. Clinical practice in European centres treating paediatric posterior fossa tumours with pencil beam scanning proton therapy. Radiother Oncol 2024; 198:110414. [PMID: 38942120 DOI: 10.1016/j.radonc.2024.110414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 04/17/2024] [Accepted: 06/21/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND AND PURPOSE As no guidelines for pencil beam scanning (PBS) proton therapy (PT) of paediatric posterior fossa (PF) tumours exist to date, this study investigated planning techniques across European PT centres, with special considerations for brainstem and spinal cord sparing. MATERIALS AND METHODS A survey and a treatment planning comparison were initiated across nineteen European PBS-PT centres treating paediatric patients. The survey assessed all aspects of the treatment chain, including but not limited to delineations, dose constraints and treatment planning. Each centre planned two PF tumour cases for focal irradiation, according to their own clinical practice but based on common delineations. The prescription dose was 54 Gy(RBE) for Case 1 and 59.4 Gy(RBE) for Case 2. For both cases, planning strategies and relevant dose metrics were compared. RESULTS Seventeen (89 %) centres answered the survey, and sixteen (80 %) participated in the treatment planning comparison. In the survey, thirteen (68 %) centres reported using the European Particle Therapy Network definition for brainstem delineation. In the treatment planning study, while most centres used three beam directions, their configurations varied widely across centres. Large variations were also seen in brainstem doses, with a brainstem near maximum dose (D2%) ranging from 52.7 Gy(RBE) to 55.7 Gy(RBE) (Case 1), and from 56.8 Gy(RBE) to 60.9 Gy(RBE) (Case 2). CONCLUSION This study assessed the European PBS-PT planning of paediatric PF tumours. Agreement was achieved in e.g. delineation-practice, while wider variations were observed in planning approach and consequently dose to organs at risk. Collaboration between centres is still ongoing, striving towards common guidelines.
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Affiliation(s)
- Laura Toussaint
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus N, Denmark; Aarhus University, Department of Clinical Medicine, Aarhus N, Denmark.
| | - Witold Matysiak
- University of Groningen, University Medical Centre Groningen, Department of Radiation Oncology, Groningen, the Netherlands
| | - Claire Alapetite
- Institut Curie, Department of Radiation Oncology & Proton Centre, Paris, France
| | - Javier Aristu
- Clínica Universidad de Navarra, Proton Therapy Unit, Madrid, Spain
| | - Agata Bannink-Gawryszuk
- University of Groningen, University Medical Centre Groningen, Department of Radiation Oncology, Groningen, the Netherlands
| | - Stephanie Bolle
- Institut Curie, Department of Radiation Oncology & Proton Centre, Paris, France; Institut Gustave Roussy, Department of Radiation Oncology, Villejuif, France; Centro de Protonterapia Quironsalud, Madrid, Spain
| | - Alessandra Bolsi
- Paul Scherrer Institute, Centre for Proton Therapy, ETH Domain, Villigen, Switzerland
| | - Felipe Calvo
- Clínica Universidad de Navarra, Proton Therapy Unit, Madrid, Spain
| | | | - Frances Charlwood
- University of Manchester, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Charlotte Demoor-Goldschmidt
- Centre Regional Francois Baclesse, Department of Radiation Oncology, Caen, France; Angers University Hospital, Department of Paediatric Oncology, Angers, France
| | - Jérôme Doyen
- Centre Antoine Lacassagne, Department of Radiation Oncology, Nice, France
| | - Katarzyna Drosik-Rutowicz
- National Research Institute of Oncology Kraków/Gliwice branch, Department of Radiation Oncology, Kraków, Poland
| | - Pauline Dutheil
- Centre Regional Francois Baclesse, Department of Radiation Oncology, Caen, France
| | - Anna Embring
- Karolinska University Hospital, Department of Radiotherapy, Stockholm, Sweden
| | - Jacob Engellau
- Skåne University Hospital, Hematology, Oncology and Radiation Physics, Lund, Sweden
| | - Anneleen Goedgebeur
- PARTICLE Proton Therapy Centre University Hospital Leuven, Department of Radiation Oncology, Leuven, Belgium
| | - Farid Goudjil
- Institut Curie, Department of Radiation Oncology & Proton Centre, Paris, France
| | - Semi Harrabi
- Heidelberg Ion Beam Therapy Centre, University Hospital Heidelberg, Department of Radiation Oncology, Heidelberg, Germany
| | - Renata Kopec
- Institute of Nuclear Physics, Polish Academy of Sciences, Kraków, Poland
| | - Ingrid Kristensen
- Skåne University Hospital, Hematology, Oncology and Radiation Physics, Lund, Sweden
| | - Peter Lægsdmand
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus N, Denmark; Aarhus University, Department of Clinical Medicine, Aarhus N, Denmark
| | | | - Arturs Meijers
- Paul Scherrer Institute, Centre for Proton Therapy, ETH Domain, Villigen, Switzerland
| | - Alfredo Mirandola
- Radiation Oncology Unit, Clinical Department, National Centre for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Fernand Missohou
- Centre Regional Francois Baclesse, Department of Radiation Oncology, Caen, France
| | | | - Ludvig P Muren
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus N, Denmark; Aarhus University, Department of Clinical Medicine, Aarhus N, Denmark
| | - Barbora Ondrova
- Proton Therapy Centre Czech, Department of Radiation Oncology, Prague, Czech Republic
| | - Ester Orlandi
- Radiation Oncology Unit, Clinical Department, National Centre for Oncological Hadrontherapy (CNAO), Pavia, Italy; University of Pavia, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, Pavia, Italy
| | - Erik Pettersson
- Sahlgrenska University Hospital, Department of Therapeutic Radiation Physics, Medical Physics and Biomedical Engineering, Gothenburg, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Department of Medical Radiation Sciences, Gothenburg, Sweden
| | - Alessia Pica
- Paul Scherrer Institute, Centre for Proton Therapy, ETH Domain, Villigen, Switzerland
| | - Sandija Plaude
- West German Proton Therapy Centre Essen (WPE), Essen University Hospital, Essen, Germany
| | | | - Barbara Rombi
- Trento Proton Therapy Centre,epartment of Radiation Oncology, APSS Trento, Italy
| | - Beate Timmermann
- West German Proton Therapy Centre Essen (WPE), Essen University Hospital, Essen, Germany; Department of Particle Therapy, University Hospital Essen, Essen, Germany; West German Cancer Centre (WTZ), German Cancer Consortium (DKTK), Essen, Germany
| | - Karen Van Beek
- PARTICLE Proton Therapy Centre University Hospital Leuven, Department of Radiation Oncology, Leuven, Belgium
| | - Anthony Vela
- Centre Regional Francois Baclesse, Department of Radiation Oncology, Caen, France
| | - Sabina Vennarini
- Paediatric Radiotherapy Unit, IRCCS Foundation Institute of Cancer, Milano, Italy
| | - Anne Vestergaard
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus N, Denmark
| | - Marie Vidal
- Centre Antoine Lacassagne, Department of Radiation Oncology, Nice, France
| | - Vladimir Vondracek
- Proton Therapy Centre Czech, Department of Radiation Oncology, Prague, Czech Republic
| | - Damien C Weber
- Paul Scherrer Institute, Centre for Proton Therapy, ETH Domain, Villigen, Switzerland
| | - Gillian Whitfield
- University of Manchester, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; University of Manchester, Royal Manchester Children's Hospital, The Children's Brain Tumour Research Network, Manchester, United Kingdom
| | - Jens Zimmerman
- Karolinska University Hospital, Department of Radiotherapy Physics and Engineering, Stockholm, Sweden
| | - John H Maduro
- University of Groningen, University Medical Centre Groningen, Department of Radiation Oncology, Groningen, the Netherlands
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Dalmasso C, Alapetite C, Bolle S, Goudjil F, Lusque A, Desrousseaux J, Claude L, Doyen J, Bernier-Chastagner V, Ducassou A, Sevely A, Roques M, Tensaouti F, Laprie A. Brainstem toxicity after proton or photon therapy in children and young adults with localized intracranial ependymoma: A French retrospective study. Radiother Oncol 2024; 194:110157. [PMID: 38367939 DOI: 10.1016/j.radonc.2024.110157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 02/06/2024] [Accepted: 02/10/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND AND PURPOSE Ependymoma is the third most frequent childhood braintumor. Standard treatment is surgery followed by radiation therapy including proton therapy (PBT). Retrospective studies have reported higher rates of brainstem injury after PBT than after photon therapy (XRT). We report a national multicenter study of the incidence of brainstem injury after XRT versus PBT, and their correlations with dosimetric data. MATERIAL AND METHODS We included all patients aged < 25 years who were treated with PBT or XRT for intracranial ependymoma at five French pediatric oncology reference centers between 2007 and 2020. We reviewed pre-irradiation MRI, follow-up MRIs over the 12 months post-treatment and clinical data. RESULTS Of the 83 patients, 42 were treated with PBT, 37 with XRT, and 4 with both (median dose: 59.4 Gy, range: 53‑60). No new or progressive symptomatic brainstem injury was found. Four patients presented asymptomatic radiographic changes (punctiform brainstem enhancement and FLAIR hypersignal), with median onset at 3.5 months (range: 3.0‑9.4) after radiation therapy, and median offset at 7.6 months (range: 3.7‑7.9). Two had been treated with PBT, one with XRT, and one with mixed XRT-PBT. Prescribed doses were 59.4, 55.8, 59.4 and 54 Gy. CONCLUSION Asymptomatic radiographic changes occurred in 4.8% of patients with ependymoma in a large national series. There was no correlation with dose or technique. No symptomatic brainstem injury was identified.
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Affiliation(s)
- Céline Dalmasso
- Department of Radiation Therapy, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse- Oncopole, Toulouse, France
| | - Claire Alapetite
- Department of Radiation Therapy, Institut Curie, Paris, France; Institut Curie - Centre de Protontherapie d', Orsay, Orsay, France
| | - Stéphanie Bolle
- Institut Curie - Centre de Protontherapie d', Orsay, Orsay, France; Department of Radiation Oncology, Gustave Roussy, Villejuif, France
| | - Farid Goudjil
- Institut Curie - Centre de Protontherapie d', Orsay, Orsay, France
| | - Amélie Lusque
- Department of Biostatistics, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse- Oncopole, Toulouse, France
| | - Jacques Desrousseaux
- Department of Radiation Therapy, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse- Oncopole, Toulouse, France
| | - Line Claude
- Department of Radiation Therapy, Centre Léon Bérard, Lyon, France
| | - Jérome Doyen
- Department of Radiation Therapy, Centre Antoine Lacassagne, Nice, France
| | | | - Anne Ducassou
- Department of Radiation Therapy, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse- Oncopole, Toulouse, France
| | - Annick Sevely
- Department of Radiology, CHU de Toulouse, Toulouse, France
| | - Margaux Roques
- Department of Radiology, CHU de Toulouse, Toulouse, France
| | - Fatima Tensaouti
- Department of Radiation Therapy, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse- Oncopole, Toulouse, France; ToNIC, Toulouse NeuroImaging Center, INSERM, UPS, Toulouse, France
| | - Anne Laprie
- Department of Radiation Therapy, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse- Oncopole, Toulouse, France; ToNIC, Toulouse NeuroImaging Center, INSERM, UPS, Toulouse, France.
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Indelicato DJ. No Question: Proton Therapy Is Safe. Neuro Oncol 2022; 24:1582-1583. [PMID: 35512698 PMCID: PMC9435487 DOI: 10.1093/neuonc/noac121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Daniel J Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL
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Bertolet A, Abolfath R, Carlson DJ, Lustig RA, Hill-Kayser C, Alonso-Basanta M, Carabe A. Correlation of LET With MRI Changes in Brain and Potential Implications for Normal Tissue Complication Probability for Patients With Meningioma Treated With Pencil Beam Scanning Proton Therapy. Int J Radiat Oncol Biol Phys 2021; 112:237-246. [PMID: 34425196 DOI: 10.1016/j.ijrobp.2021.08.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/11/2021] [Accepted: 08/15/2021] [Indexed: 01/05/2023]
Abstract
PURPOSE This study aimed to investigate the correlation between imaging changes in brain normal tissue and the spatial distribution of linear energy transfer (LET) for a cohort of patients with meningioma treated with scanned proton beams. Then, assuming imaging changes are induced by cell lethality, we studied the correlation between normal tissue complication probability and LET. METHODS AND MATERIALS Magnetic resonance imaging T2/fluid attenuated inversion recovery acquired at different intervals after proton radiation were coregistered with the planning computed tomography (CT) images from 26 patients with meningioma with abnormalities after proton radiation therapy. For this purpose, the T2/fluid attenuated inversion recovery areas not on the original magnetic resonance images were contoured, and the LET values for each voxel in the patient geometry were calculated to investigate the correlation between the position of imaging changes and the LET at those positions. To separate the effect of the dose as the inductor of these changes, we compared the LET in these areas with a sample of voxels matching the dose distributions across the image change areas. Patients with a higher LET in image change areas were grouped to verify whether they shared common characteristics. RESULTS Eleven of the patients showed higher dose-averaged LET (LETd) in imaging change regions than in the group of voxels with the same dose. This group of patients had significantly shallower targets for their treatment than the other 15 and used fewer beams and angles. CONCLUSIONS This study points toward the possibility that areas with imaging change are more likely to occur in regions with high dose or in areas with lower dose but increased LETd. The effect of LETd on imaging changes seems to be more relevant when treating superficial lesions with few nonopposed beams. However, most patients did not show a spatial correlation between their image changes and the LETd values, limiting the cases for the possible role of high LET as a toxicity inductor.
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Affiliation(s)
- Alejandro Bertolet
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ramin Abolfath
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Radiation Oncology, New Jersey Urology, West Orange, New Jersey
| | - David J Carlson
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert A Lustig
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christine Hill-Kayser
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Alejandro Carabe
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania; Hampton University Proton Institute, Hampton, Virginia.
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Indelicato DJ, Ioakeim-Ioannidou M, Bradley JA, Mailhot-Vega RB, Morris CG, Tarbell NJ, Yock T, MacDonald SM. Proton Therapy for Pediatric Ependymoma: Mature Results From a Bicentric Study. Int J Radiat Oncol Biol Phys 2021; 110:815-820. [PMID: 33508372 DOI: 10.1016/j.ijrobp.2021.01.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/17/2020] [Accepted: 01/20/2021] [Indexed: 01/15/2023]
Abstract
PURPOSE To report the long-term efficacy and toxicity of proton therapy for pediatric ependymoma. METHODS AND MATERIALS Between 2000 and 2019, 386 children with nonmetastatic grade 2/3 intracranial ependymoma received proton therapy at 1 of 2 academic institutions. Median age at treatment was 3.8 years (range, 0.7-21.3); 56% were male. Most (72%) tumors were in the posterior fossa and classified as World Health Organization grade 3 (65%). Eighty-five percent had a gross total or near total tumor resection before radiation therapy; 30% received chemotherapy. Median radiation dose was 55.8 Gy relative biologic effectiveness (RBE) (range, 50.4-59.4). RESULTS Median follow-up was 5.0 years (range, 0.4-16.7). The 7-year local control, progression-free survival, and overall survival rates were 77.0% (95% confidence interval [CI], 71.9%-81.5%), 63.8% (95% CI, 58.0%-68.8%), and 82.2% (95% CI, 77.2%-86.3%), respectively. Subtotal resection was associated with inferior local control (59% vs 80%; P < .005), progression-free survival (48% vs 66%; P < .001), and overall survival (70% vs 84%; P < .05). Male sex was associated with inferior progression-free (60% vs 69%; P < .05) and overall survival (76% vs 89%; P < .05). Posterior fossa tumor site was also associated with inferior progression-free (59% vs 74%; P < .05) and overall survival (79% vs 89%; P < .01). Twenty-one patients (5.4%) required hearing aids; of these, 13 received cisplatin, including the 3 with bilateral hearing loss. Forty-five patients (11.7%) required hormone replacement, typically growth hormone (38/45). The cumulative incidence of grade 2+ brain stem toxicity was 4% and occurred more often in patients who received >54 GyRBE. Two patients (0.5%) died of brain stem necrosis. The second-malignancy rate was 0.8%. CONCLUSION Proton therapy offers disease control commensurate with modern photon therapy without unexpected toxicity. The high rate of long-term survival justifies efforts to reduce radiation exposure in this young population. Independent of radiation modality, this large series confirms extent of resection as the most important modifiable factor for survival.
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Affiliation(s)
- Daniel J Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida.
| | | | - Julie A Bradley
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Raymond B Mailhot-Vega
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Christopher G Morris
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Nancy J Tarbell
- Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts
| | - Torunn Yock
- Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts
| | - Shannon M MacDonald
- Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts
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Greenberger BA, Yock TI. The role of proton therapy in pediatric malignancies: Recent advances and future directions. Semin Oncol 2020; 47:8-22. [PMID: 32139101 DOI: 10.1053/j.seminoncol.2020.02.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/03/2020] [Accepted: 02/03/2020] [Indexed: 11/11/2022]
Abstract
Proton radiotherapy has promised an advantage in safely treating pediatric malignancies with an increased capability to spare normal tissues, reducing the risk of both acute and late toxicity. The past decade has seen the proliferation of more than 30 proton facilities in the United States, with increased capacity to provide access to approximately 3,000 children per year who will require radiotherapy for their disease. We provide a review of the initial efforts to describe outcomes after proton therapy across the common pediatric disease sites. We discuss the main attempts to assess comparative efficacy between proton and photon radiotherapy concerning toxicity. We also discuss recent efforts of multi-institutional registries aimed at accelerating research to better define the optimal treatment paradigm for children requiring radiotherapy for cure.
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Affiliation(s)
- Benjamin A Greenberger
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | - Torunn I Yock
- Department of Radiation Oncology, Massachusetts General Hospital/Harvard Medical School, Francis H. Burr Proton Therapy Center, Boston, MA.
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Vogel J, Grewal A, O’Reilly S, Lustig R, Kurtz G, Minturn JE, Shah AC, Waanders AJ, Belasco JB, Cole KA, Fisher MJ, Phillips PC, Balamuth NJ, Storm PB, Hill-Kayser CE. Risk of brainstem necrosis in pediatric patients with central nervous system malignancies after pencil beam scanning proton therapy. Acta Oncol 2019; 58:1752-1756. [PMID: 31512931 DOI: 10.1080/0284186x.2019.1659996] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background: Radiation therapy (RT) plays an important role in management of pediatric central nervous system (CNS) malignancies. Centers are increasingly utilizing pencil beam scanning proton therapy (PBS-PT). However, the risk of brainstem necrosis has not yet been reported. In this study, we evaluate the rate of brainstem necrosis in pediatric patients with CNS malignancies treated with PBS-PT.Material and methods: Pediatric patients with non-hematologic CNS malignancies treated with PBS-PT who received dose to the brainstem were included. All procedures were approved by the institutional review board. Brainstem necrosis was defined as symptomatic toxicity. The actuarial rate was analyzed by the Kaplan Meier method.Results: One hundred and sixty-six consecutive patients were reviewed. Median age was 10 years (range 0.5-21 years). Four patients (2.4%) had prior radiation. Median maximum brainstem dose in the treated course was 55.4 Gy[RBE] (range 0.15-61.4 Gy[RBE]). In patients with prior RT, cumulative median maximum brainstem dose was 98.0 Gy [RBE] (range 17.0-111.0 Gy [RBE]). Median follow up was 19.6 months (range, 2.0-63.0). One patient who had previously been treated with twice-daily radiation therapy and intrathecal (IT) methotrexate experienced brainstem necrosis. The actuarial incidence of brainstem necrosis was 0.7% at 24 months (95% CI 0.1-5.1%).Conclusion: The rate of symptomatic brainstem necrosis was extremely low after treatment with PBS-PT in this study. Further work to clarify clinical and dosimetric parameters associated with risk of brainstem necrosis after PBS-PT is needed.
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Affiliation(s)
- J. Vogel
- Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - A. Grewal
- Radiation Oncology, The Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - S. O’Reilly
- Radiation Oncology, The Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - R. Lustig
- Radiation Oncology, The Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - G. Kurtz
- Radiation Oncology, The Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - J. E. Minturn
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - A. C. Shah
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - A. J. Waanders
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - J. B. Belasco
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - K. A. Cole
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - M. J. Fisher
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - P. C. Phillips
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - N. J. Balamuth
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - P. B. Storm
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - C. E. Hill-Kayser
- Radiation Oncology, The Hospital of the University of Pennsylvania, Philadelphia, PA, USA
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
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Brainstem Injury in Pediatric Patients Receiving Posterior Fossa Photon Radiation. Int J Radiat Oncol Biol Phys 2019; 105:1034-1042. [PMID: 31472183 DOI: 10.1016/j.ijrobp.2019.08.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 08/09/2019] [Accepted: 08/15/2019] [Indexed: 01/23/2023]
Abstract
PURPOSE Brainstem necrosis is a rare, but dreaded complication of radiation therapy; however, data on the incidence of brainstem injury for tumors involving the posterior fossa in photon-treated patient cohorts are still needed. METHODS AND MATERIALS Clinical characteristics and dosimetric parameters were recorded for 107 pediatric patients who received photon radiation for posterior fossa tumors without brainstem involvement from 2000 to 2016. Patients were excluded if they received a prescription dose <50.4 Gy, a brainstem maximum dose <50.4 Gy, or had fewer than 2 magnetic resonance imaging scans within 18 months after radiation. Post-radiation therapy magnetic resonance imaging findings were recorded, and brainstem toxicity was graded using National Cancer Institute Common Terminology Criteria for Adverse Events, version 5. RESULTS The most common histologies were medulloblastoma (61.7%) and ependymoma (15.9%), and median age at diagnosis was 8.3 years (range, 0.8-20.7). Sixty-seven patients (62.6%) received craniospinal irradiation (median, 23.4 Gy; range, 18.0-39.6) as a component of their radiation therapy, and 39.3% and 40.2% of patients received an additional involved field or whole posterior fossa boost, respectively. Median prescribed dose was 55.8 Gy (range, 50.4-60.0). Median clinical and imaging follow-up were 4.7 years (range, 0.1-17.5) and 4.2 years (range, 0.1-17.3), respectively. No grade ≥2 toxicities were observed. The incidence of grade 1 brainstem necrosis was 1.9% (2 of 107). These patients were by definition asymptomatic and experienced resolution of imaging abnormality after 5.3 months and 2.1 years, respectively. CONCLUSIONS Risk of brainstem necrosis was minimal in this multi-institutional study of pediatric patients treated with photon radiation therapy for tumors involving the posterior fossa with no cases of symptomatic brainstem injury, suggesting that brainstem injury risk is minimal in patients treated with photon therapy.
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Lu VM, Welby JP, Mahajan A, Laack NN, Daniels DJ. Reirradiation for diffuse intrinsic pontine glioma: a systematic review and meta-analysis. Childs Nerv Syst 2019; 35:739-746. [PMID: 30879125 DOI: 10.1007/s00381-019-04118-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 03/08/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Diffuse intrinsic pontine glioma (DIPG) is a pediatric brain tumor with dismal prognosis despite initial radiation therapy (RT). The clinical consequences of attempting reirradiation (reRT) in these patients to alleviate both symptomatology and improve prognosis are currently unclear. Thus, the aim of this systematic review and meta-analysis was to clarify the efficacy and safety of reRT in DIPG. METHODS Searches of seven electronic databases from inception to January 2019 were conducted following the appropriate guidelines. Articles were screened against prespecified criteria. The incidence and duration of clinical outcomes were then extracted and pooled by means of meta-analysis from the included studies. RESULTS A total of 7 studies satisfied all criteria, describing 90 cases of DIPG in which reRT was attempted 11.8-14 months after initial RT. Based on a random-effects model, the incidences of clinical improvement and radiologic response following reRT were 87% (95% CI, 78-95%) and 69% (95% CI, 52-84%), respectively. The incidence of acute serious toxicity was 0% (95% CI, 0-4%). Pooled overall survivals from initial diagnosis and time of reRT were 18.0 months (95% CI, 14.2-21.7) and 6.2 months (95% CI, 5.5-7.0), respectively. CONCLUSIONS Based on these results, the clinical consequences of reRT for DIPG when administered appropriately and safely at first progression appear acceptable, and potentially favorable, based on the limited evidence in the current literature. Concerns regarding acute serious toxicity were not realized. It is likely that a subcohort of all DIPG diagnoses will be most amenable to improve prognosis with reRT, and greater investigation is required to identify their characteristics.
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Affiliation(s)
- Victor M Lu
- Department of Neurosurgery, Mayo Clinic, 200 First St. SW, Rochester, MN, USA.
| | - John P Welby
- Department of Neurosurgery, Mayo Clinic, 200 First St. SW, Rochester, MN, USA
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Nadia N Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - David J Daniels
- Department of Neurosurgery, Mayo Clinic, 200 First St. SW, Rochester, MN, USA.
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10
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Haas-Kogan D, Indelicato D, Paganetti H, Esiashvili N, Mahajan A, Yock T, Flampouri S, MacDonald S, Fouladi M, Stephen K, Kalapurakal J, Terezakis S, Kooy H, Grosshans D, Makrigiorgos M, Mishra K, Poussaint TY, Cohen K, Fitzgerald T, Gondi V, Liu A, Michalski J, Mirkovic D, Mohan R, Perkins S, Wong K, Vikram B, Buchsbaum J, Kun L. National Cancer Institute Workshop on Proton Therapy for Children: Considerations Regarding Brainstem Injury. Int J Radiat Oncol Biol Phys 2019; 101:152-168. [PMID: 29619963 DOI: 10.1016/j.ijrobp.2018.01.013] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 12/21/2017] [Accepted: 01/01/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE Proton therapy can allow for superior avoidance of normal tissues. A widespread consensus has been reached that proton therapy should be used for patients with curable pediatric brain tumor to avoid critical central nervous system structures. Brainstem necrosis is a potentially devastating, but rare, complication of radiation. Recent reports of brainstem necrosis after proton therapy have raised concerns over the potential biological differences among radiation modalities. We have summarized findings from the National Cancer Institute Workshop on Proton Therapy for Children convened in May 2016 to examine brainstem injury. METHODS AND MATERIALS Twenty-seven physicians, physicists, and researchers from 17 institutions with expertise met to discuss this issue. The definition of brainstem injury, imaging of this entity, clinical experience with photons and photons, and potential biological differences among these radiation modalities were thoroughly discussed and reviewed. The 3 largest US pediatric proton therapy centers collectively summarized the incidence of symptomatic brainstem injury and physics details (planning, dosimetry, delivery) for 671 children with focal posterior fossa tumors treated with protons from 2006 to 2016. RESULTS The average rate of symptomatic brainstem toxicity from the 3 largest US pediatric proton centers was 2.38%. The actuarial rate of grade ≥2 brainstem toxicity was successfully reduced from 12.7% to 0% at 1 center after adopting modified radiation guidelines. Guidelines for treatment planning and current consensus brainstem constraints for proton therapy are presented. The current knowledge regarding linear energy transfer (LET) and its relationship to relative biological effectiveness (RBE) are defined. We review the current state of LET-based planning. CONCLUSIONS Brainstem injury is a rare complication of radiation therapy for both photons and protons. Substantial dosimetric data have been collected for brainstem injury after proton therapy, and established guidelines to allow for safe delivery of proton radiation have been defined. Increased capability exists to incorporate LET optimization; however, further research is needed to fully explore the capabilities of LET- and RBE-based planning.
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Affiliation(s)
- Daphne Haas-Kogan
- Department of Radiation Oncology, Harvard Medical School and Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston Children's Hospital, Boston, Massachusetts
| | - Daniel Indelicato
- Department of Radiation Oncology, University of Florida, Jacksonville, Florida
| | - Harald Paganetti
- Department of Radiation Oncology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Natia Esiashvili
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Anita Mahajan
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Torunn Yock
- Department of Radiation Oncology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Stella Flampouri
- Department of Radiation Oncology, University of Florida, Jacksonville, Florida
| | - Shannon MacDonald
- Department of Radiation Oncology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - Maryam Fouladi
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kry Stephen
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John Kalapurakal
- Department of Radiation Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Stephanie Terezakis
- Department of Radiation Oncology, Johns Hopkins Medical Institute, Baltimore, Maryland
| | - Hanne Kooy
- Department of Radiation Oncology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts
| | - David Grosshans
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mike Makrigiorgos
- Department of Radiation Oncology, Harvard Medical School and Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kavita Mishra
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California
| | - Tina Young Poussaint
- Department of Radiology, Harvard Medical School and Dana-Farber Cancer Institute, Boston Children's Hospital, Boston, Massachusetts
| | - Kenneth Cohen
- Department of Pediatrics, Johns Hopkins Medical Institute, Baltimore, Maryland
| | - Thomas Fitzgerald
- Department of Radiation Oncology, UMass Memorial Medical Center, Worcester, Massachusetts
| | - Vinai Gondi
- Northwestern Medicine Chicago Proton Center, Chicago, Illinois
| | - Arthur Liu
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Dragan Mirkovic
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Radhe Mohan
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephanie Perkins
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Kenneth Wong
- Children's Hospital of Angeles and University of Southern California Keck School of Medicine, Los Angles, California
| | - Bhadrasain Vikram
- Radiation Research Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Jeff Buchsbaum
- Radiation Research Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Larry Kun
- Department of Radiation Oncology, University of Texas Southwestern Medical School, Dallas, Texas.
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11
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Thorp N, Gandola L. Management of Ependymoma in Children, Adolescents and Young Adults. Clin Oncol (R Coll Radiol) 2019; 31:162-170. [PMID: 30616927 DOI: 10.1016/j.clon.2018.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 11/18/2018] [Accepted: 11/22/2018] [Indexed: 12/20/2022]
Abstract
Paediatric ependymomas are rare, malignant tumours arising throughout the central nervous system, but most frequently (in children) the posterior fossa. The standard of care for localised disease is gross total resection and focal radiotherapy, resulting in overall survival rates of up to 85%. Despite improvements in survival, treatment remains challenging, with persistently high rates of (rarely curable) relapse alongside risks of significant tumour and treatment-related toxicity. Systemic therapy is currently used to delay radiotherapy in very young children and in the management of metastatic or recurrent disease. Its use in the adjuvant setting is the subject of ongoing studies. Current research efforts are aimed at eliciting a better understanding of molecular biology, correlating this with tumour behaviour and defining targets for potential new agents. Prognosis seems to be related to the extent of surgical resection and the age at presentation. This article reviews clinical aspects of ependymoma management in children and young people.
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Affiliation(s)
- N Thorp
- Clatterbridge Cancer Centre, Wirral, UK.
| | - L Gandola
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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12
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Radiotherapy Advances in Pediatric Neuro-Oncology. Bioengineering (Basel) 2018; 5:bioengineering5040097. [PMID: 30400370 PMCID: PMC6315761 DOI: 10.3390/bioengineering5040097] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 10/26/2018] [Accepted: 11/01/2018] [Indexed: 12/31/2022] Open
Abstract
Radiation therapy (RT) represents an integral component in the treatment of many pediatric brain tumors. Multiple advances have emerged within pediatric radiation oncology that aim to optimize the therapeutic ratio—improving disease control while limiting RT-related toxicity. These include innovations in treatment planning with magnetic resonance imaging (MRI) simulation, as well as increasingly sophisticated radiation delivery techniques. Advanced RT techniques, including photon-based RT such as intensity-modulated RT (IMRT) and volumetric-modulated arc therapy (VMAT), as well as particle beam therapy and stereotactic RT, have afforded an array of options to dramatically reduce radiation exposure of uninvolved normal tissues while treating target volumes. Along with advances in image guidance of radiation treatments, novel RT approaches are being implemented in ongoing and future prospective clinical trials. As the era of molecular risk stratification unfolds, personalization of radiation dose, target, and technique holds the promise to meaningfully improve outcomes for pediatric neuro-oncology patients.
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13
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Ladra MM, MacDonald SM, Terezakis SA. Proton therapy for central nervous system tumors in children. Pediatr Blood Cancer 2018; 65:e27046. [PMID: 29630784 DOI: 10.1002/pbc.27046] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 01/29/2018] [Accepted: 01/31/2018] [Indexed: 11/08/2022]
Abstract
Proton therapy is a form of particle therapy with physical properties that provide a superior dose distribution compared to photons. The ability to spare healthy, developing tissues from low dose radiation with proton therapy is well known. The capability to decrease radiation exposure for children has been lauded as an important advance in pediatric cancer care, particularly for central nervous system (CNS) tumors. Favorable clinical outcomes have been reported and justify the increased cost and burden of this therapy. In this review, we summarize the current literature for proton therapy for pediatric CNS malignancies, with a focus on clinical outcomes to date.
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Affiliation(s)
- Matthew M Ladra
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Shannon M MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Stephanie A Terezakis
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
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14
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Indelicato DJ, Bradley JA, Rotondo RL, Nanda RH, Logie N, Sandler ES, Aldana PR, Ranalli NJ, Beier AD, Morris CG, Mendenhall NP. Outcomes following proton therapy for pediatric ependymoma. Acta Oncol 2018; 57:644-648. [PMID: 29239262 DOI: 10.1080/0284186x.2017.1413248] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Proton therapy can reduce the low and intermediate radiation dose to uninvolved brain tissue in children with intracranial ependymomas, which may improve functional outcomes and reduce second malignancies in survivors. Accordingly, ependymoma has become the most common pediatric tumor treated with proton therapy, yet data on efficacy and toxicity are limited. MATERIAL AND METHODS Between June 2007 and February 2017, 179 children (≤21 years old) with nonmetastatic grade II/III intracranial ependymoma received proton therapy at our institution. Median age, 3.5 years (range, 0.7-21); 58% were male. Most (66%) tumors were in the posterior fossa and classified as WHO grade III (67%). 27% underwent multiple operations to maximize the extent of resection; ultimately 85% had a gross total or near total tumor resection before radiotherapy. 33% received preradiation chemotherapy. Median radiation dose in children ≤3 years old, 54 Gy(RBE). Most (>90%) children over 3 years old received 59.4 Gy(RBE). Patient and treatment variables were assessed for correlation with disease control. RESULTS Median follow-up, 3.2 years. 3-year local control, progression-free survival, and overall survival rates were 85%, 76%, and 90%, respectively. First site of progression was local, metastatic, or simultaneous in 14, 17 and 6 patients, respectively. On multivariate analysis, subtotal resection was associated with inferior local control (67% vs. 88%; p ≤ .01) and progression-free survival (59% vs. 79%; p < .05). Male sex was associated with inferior progression-free (67% vs. 87%; p< .05) and overall survival (84% vs. 99%; p < .01). The 3-year CTCAE grade 2 + brainstem toxicity rate was 5.5% (95% CI: 2.9-10.2), including 1 grade 5 toxicity. CONCLUSIONS This series of proton therapy for pediatric intracranial ependymoma demonstrates disease control comparable to photon series without unexpected toxicity. Subtotal resection and male sex were associated with inferior disease control. Additional follow-up to quantify the expected reductions in late toxicity with proton therapy is ongoing.
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Affiliation(s)
- Daniel J. Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Julie A. Bradley
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Ronny L. Rotondo
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Ronica H. Nanda
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Natalie Logie
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Eric S. Sandler
- Department of Pediatric Hematology-Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Philipp R. Aldana
- Department of Neurosurgery, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Nathan J. Ranalli
- Department of Neurosurgery, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Alexandra D. Beier
- Department of Neurosurgery, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Christopher G. Morris
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Nancy P. Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
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15
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Gentile MS, Yeap BY, Paganetti H, Goebel CP, Gaudet DE, Gallotto SL, Weyman EA, Morgan ML, MacDonald SM, Giantsoudi D, Adams J, Tarbell NJ, Kooy H, Yock TI. Brainstem Injury in Pediatric Patients With Posterior Fossa Tumors Treated With Proton Beam Therapy and Associated Dosimetric Factors. Int J Radiat Oncol Biol Phys 2018; 100:719-729. [DOI: 10.1016/j.ijrobp.2017.11.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 10/13/2017] [Accepted: 11/16/2017] [Indexed: 10/18/2022]
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16
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Lühr A, von Neubeck C, Krause M, Troost EGC. Relative biological effectiveness in proton beam therapy - Current knowledge and future challenges. Clin Transl Radiat Oncol 2018; 9:35-41. [PMID: 29594249 PMCID: PMC5862688 DOI: 10.1016/j.ctro.2018.01.006] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 01/25/2018] [Accepted: 01/27/2018] [Indexed: 12/25/2022] Open
Affiliation(s)
- Armin Lühr
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany.,Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Cläre von Neubeck
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Mechthild Krause
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz Association/Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany.,Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Esther G C Troost
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany; German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz Association/Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany.,Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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17
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Indelicato DJ, Bradley JA, Sandler ES, Aldana PR, Sapp A, Gains JE, Crellin A, Rotondo RL. Clinical outcomes following proton therapy for children with central nervous system tumors referred overseas. Pediatr Blood Cancer 2017; 64. [PMID: 28544746 DOI: 10.1002/pbc.26654] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 04/20/2017] [Accepted: 05/01/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND International, multidisciplinary care of children with central nervous system (CNS) tumors presents unique challenges. The aim of this study is to report patient outcomes of U.K. children referred for proton therapy to a North American facility. METHODS From 2008 to 2016, 166 U.K. children with approved CNS tumors were treated with proton therapy at a single academic medical center in the United States. Median age was 7 years (range, 1-19). Median follow-up was 2.6 years. RESULTS The 3-year actuarial overall survival (OS) and local control (LC) rates were 96% and 91%, respectively, for the overall group, 92% and 85% for the ependymoma subgroup (n = 57), 95% and 88% for the low-grade glioma subgroup (n = 54), and 100% and 100%, respectively, for the craniopharyngioma subgroup (n = 45). Cyst expansion was observed in 13 patients, including one case resulting in visual impairment. Serious side effects included new-onset seizures in three patients (1.8%), symptomatic vasculopathy in three patients (1.8%), and symptomatic brainstem necrosis in one patient (0.6%). CONCLUSIONS In this cohort of British children referred overseas for proton therapy, disease control does not appear compromised, toxicity is acceptable, and improvement in long-term function is anticipated in survivors owing to the reduced brain exposure afforded by proton therapy.
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Affiliation(s)
- Daniel J Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Julie A Bradley
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Eric S Sandler
- Department of Pediatric Hematology/Oncology, Nemours Children's Health System, Jacksonville, Florida
| | - Philipp R Aldana
- Department of Neurosurgery, University of Florida College of Medicine, Jacksonville, Florida
| | - Amy Sapp
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
| | - Jennifer E Gains
- NHS England Radiotherapy Clinical Reference Group, London, United Kingdom
| | - Adrian Crellin
- NHS England Radiotherapy Clinical Reference Group, London, United Kingdom
| | - Ronny L Rotondo
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, Florida
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