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Paganetti H, Simone CB, Bosch WR, Haas-Kogan D, Kirsch DG, Li H, Liang X, Liu W, Mahajan A, Story MD, Taylor PA, Willers H, Xiao Y, Buchsbaum JC. NRG Oncology White Paper on the Relative Biological Effectiveness in Proton Therapy. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)02974-2. [PMID: 39059509 DOI: 10.1016/j.ijrobp.2024.07.2152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 06/17/2024] [Accepted: 07/06/2024] [Indexed: 07/28/2024]
Abstract
This position paper, led by the NRG Oncology Particle Therapy Work Group, focuses on the concept of relative biologic effect (RBE) in clinical proton therapy (PT), with the goal of providing recommendations for the next-generation clinical trials with PT on the best practice of investigating and using RBE, which could deviate from the current standard proton RBE value of 1.1 relative to photons. In part 1, current clinical utilization and practice are reviewed, giving the context and history of RBE. Evidence for variation in RBE is presented along with the concept of linear energy transfer (LET). The intertwined nature of tumor radiobiology, normal tissue constraints, and treatment planning with LET and RBE considerations is then reviewed. Part 2 summarizes current and past clinical data and then suggests the next steps to explore and employ tools for improved dynamic models for RBE. In part 3, approaches and methods for the next generation of prospective clinical trials are explored, with the goal of optimizing RBE to be both more reflective of clinical reality and also deployable in trials to allow clinical validation and interpatient comparisons. These concepts provide the foundation for personalized biologic treatments reviewed in part 4. Finally, we conclude with a summary including short- and long-term scientific focus points for clinical PT. The practicalities and capacity to use RBE in treatment planning are reviewed and considered with more biological data in hand. The intermediate step of LET optimization is summarized and proposed as a potential bridge to the ultimate goal of case-specific RBE planning that can be achieved as a hypothesis-generating tool in near-term proton trials.
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Affiliation(s)
- Harald Paganetti
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts; Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts
| | - Charles B Simone
- New York Proton Center, New York, New York; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Walter R Bosch
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - Daphne Haas-Kogan
- Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston Children's Hospital, Boston, Massachusetts
| | - David G Kirsch
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Heng Li
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Xiaoying Liang
- Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, Florida
| | - Wei Liu
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Michael D Story
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Henning Willers
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts; Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts
| | - Ying Xiao
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey C Buchsbaum
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
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2
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Ajithkumar T, Avanzo M, Yorke E, Tsang DS, Milano MT, Olch AJ, Merchant TE, Dieckmann K, Mahajan A, Fuji H, Paulino AC, Timmermann B, Marks LB, Bentzen SM, Jackson A, Constine LS. Brain and Brain Stem Necrosis After Reirradiation for Recurrent Childhood Primary Central Nervous System Tumors: A PENTEC Comprehensive Review. Int J Radiat Oncol Biol Phys 2024; 119:655-668. [PMID: 38300187 DOI: 10.1016/j.ijrobp.2023.12.043] [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: 05/12/2023] [Revised: 12/19/2023] [Accepted: 12/26/2023] [Indexed: 02/02/2024]
Abstract
PURPOSE Reirradiation is increasingly used in children and adolescents/young adults (AYA) with recurrent primary central nervous system tumors. The Pediatric Normal Tissue Effects in the Clinic (PENTEC) reirradiation task force aimed to quantify risks of brain and brain stem necrosis after reirradiation. METHODS AND MATERIALS A systematic literature search using the PubMed and Cochrane databases for peer-reviewed articles from 1975 to 2021 identified 92 studies on reirradiation for recurrent tumors in children/AYA. Seventeen studies representing 449 patients who reported brain and brain stem necrosis after reirradiation contained sufficient data for analysis. While all 17 studies described techniques and doses used for reirradiation, they lacked essential details on clinically significant dose-volume metrics necessary for dose-response modeling on late effects. We, therefore, estimated incidences of necrosis with an exact 95% CI and qualitatively described data. Results from multiple studies were pooled by taking the weighted average of the reported crude rates from individual studies. RESULTS Treated cancers included ependymoma (n = 279 patients; 7 studies), medulloblastoma (n = 98 patients; 6 studies), any CNS tumors (n = 62 patients; 3 studies), and supratentorial high-grade gliomas (n = 10 patients; 1 study). The median interval between initial and reirradiation was 2.3 years (range, 1.2-4.75 years). The median cumulative prescription dose in equivalent dose in 2-Gy fractions (EQD22; assuming α/β value = 2 Gy) was 103.8 Gy (range, 55.8-141.3 Gy). Among 449 reirradiated children/AYA, 22 (4.9%; 95% CI, 3.1%-7.3%) developed brain necrosis and 14 (3.1%; 95% CI, 1.7%-5.2%) developed brain stem necrosis with a weighted median follow-up of 1.6 years (range, 0.5-7.4 years). The median cumulative prescription EQD22 was 111.4 Gy (range, 55.8-141.3 Gy) for development of any necrosis, 107.7 Gy (range, 55.8-141.3 Gy) for brain necrosis, and 112.1 Gy (range, 100.2-117 Gy) for brain stem necrosis. The median latent period between reirradiation and the development of necrosis was 5.7 months (range, 4.3-24 months). Though there were more events among children/AYA undergoing hypofractionated versus conventionally fractionated reirradiation, the differences were not statistically significant (P = .46). CONCLUSIONS Existing reports suggest that in children/AYA with recurrent brain tumors, reirradiation with a total EQD22 of about 112 Gy is associated with an approximate 5% to 7% incidence of brain/brain stem necrosis after a median follow-up of 1.6 years (with the initial course of radiation therapy being given with conventional prescription doses of ≤2 Gy per fraction and the second course with variable fractionations). We recommend a uniform approach for reporting dosimetric endpoints to derive robust predictive models of late toxicities following reirradiation.
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Affiliation(s)
- Thankamma Ajithkumar
- Department of Oncology, Cambridge University Hospitals, Cambridge, United Kingdom.
| | - Michele Avanzo
- Division of Medical Physics, Centro di Riferimento Oncologico Aviano IRCCS, Aviano, Italy
| | - Ellen Yorke
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Derek S Tsang
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Michael T Milano
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York
| | - Arthur J Olch
- Department of Radiation Oncology and Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Karin Dieckmann
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Hiroshi Fuji
- National Center for Child Health and Development, Tokyo, Japan
| | - Arnold C Paulino
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Beate Timmermann
- Department of Particle Therapy, University Hospital Essen, West German Proton Therapy Centre Essen, West German Cancer Center, Essen, Germany
| | - Lawrence B Marks
- Department of Radiation Oncology and Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Soren M Bentzen
- Division of Biostatistics and Bioinformatics, Department of Radiation Oncology, and University of Maryland Greenebaum Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Andrew Jackson
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Louis S Constine
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York; Department of Pediatrics, University of Rochester Medical Center, Rochester, New York
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3
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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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4
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Eichkorn T, Lischalk JW, Schwarz R, Bauer L, Deng M, Regnery S, Jungk C, Hörner-Rieber J, Herfarth K, König L, Debus J. Radiation-Induced Cerebral Contrast Enhancements Strongly Share Ischemic Stroke Risk Factors. Int J Radiat Oncol Biol Phys 2024; 118:1192-1205. [PMID: 38237810 DOI: 10.1016/j.ijrobp.2023.12.044] [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: 07/16/2023] [Revised: 12/12/2023] [Accepted: 12/31/2023] [Indexed: 03/18/2024]
Abstract
PURPOSE Radiation-induced cerebral contrast enhancements (RICE) are frequent after photon and particularly proton radiation therapy and are associated with a significant risk for neurologic morbidity. Nevertheless, risk factors are poorly understood. A more robust understanding of RICE risk factors is crucial to improve management and offer adaptive therapy at the outset and during follow-up. METHODS AND MATERIALS We analyzed the comorbidities in detail of 190 consecutive adult patients treated at a single European national comprehensive cancer center with proton radiation therapy (54 Gy relative biological effectiveness) for LGG from 2010 to 2020 who were followed with serial clinical examinations and magnetic resonance imaging for a median 5.6 years. RESULTS Classical vascular risk factors including age (≥50 vs <50 years: 1.6-fold; P = .0024), hypertension (2.7-fold; P = .00012), and diabetes (11.7-fold; P = .0066) were observed more frequently in the cohort that developed RICE. Dyslipidemia (2.1-fold), being overweight (2.0-fold), and smoking (2.6-fold), as well as history of previous stroke (1.7-fold), were also more frequently observed in the RICE cohort, although these factors did not reach the threshold for significance. Multivariable regression modeling supported the influence of age (P = .05), arterial hypertension (P = .01), and potentially male sex (P = .02), diabetes (P = .0008), and smoking (P = .001) on RICE occurrence over time, independent of each other and further vascular risk factors. If RICE occurred, bevacizumab treatment was 2-fold more frequently needed in the cohort with vascular risk factors, but RICE long-term prognosis did not differ between the RICE subcohorts with and without vascular risk factors. CONCLUSIONS This is the first report in the literature demonstrating that RICE strongly shares vascular risk factors with ischemic stroke, which further enhances the nebulous understanding of the multifactorial pathophysiology of RICE. Classical vascular risk factors, especially age, hypertension, and diabetes, clearly correlated independently with RICE risk. Risk-adapted screening and management for RICE can be directly derived from these data to assist in clinical management.
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Affiliation(s)
- Tanja Eichkorn
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.
| | - Jonathan W Lischalk
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Health at Long Island, New York, New York
| | - Robert Schwarz
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Lena Bauer
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Maximilian Deng
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian Regnery
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christine Jungk
- National Center for Tumor Diseases (NCT), Heidelberg, Germany; Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Klaus Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; German Cancer Consortium (DKTK), Partner Site Heidelberg, Heidelberg, Germany
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5
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Lütgendorf-Caucig C, Pelak M, Hug E, Flechl B, Surböck B, Marosi C, Mock U, Zach L, Mardor Y, Furman O, Hentschel H, Gora J, Fossati P, Stock M, Graichen U, Klee S, Georg P. Prospective Analysis of Radiation-Induced Contrast Enhancement and Health-Related Quality of Life After Proton Therapy for Central Nervous System and Skull Base Tumors. Int J Radiat Oncol Biol Phys 2024; 118:1206-1216. [PMID: 38244874 DOI: 10.1016/j.ijrobp.2024.01.007] [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: 10/15/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/22/2024]
Abstract
PURPOSE Intracerebral radiation-induced contrast enhancement (RICE) can occur after photon as well as proton beam therapy (PBT). This study evaluated the incidence, characteristics, and risk factors of RICE after PBT delivered to, or in direct proximity to, the brain and its effect on health-related quality of life (HRQoL). METHODS AND MATERIALS Four hundred twenty-one patients treated with pencil beam scanning PBT between 2017 and 2021 were included. Follow-up included clinical evaluation and contrast-enhanced magnetic resonance imaging at 3, 6, and 12 months after treatment completion and annually thereafter. RICE was graded according to Common Terminology Criteria for Adverse Events version 4, and HRQoL parameters were assessed via European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ)-C30 questionnaires. RESULTS The median follow-up was 24 months (range, 6-54), and median dose to 1% relative volume of noninvolved central nervous system (D1%CNS) was 54.3 Gy relative biologic effectiveness (RBE; range, 30-76 Gy RBE). The cumulative RICE incidence was 15% (n = 63), of which 10.5% (n = 44) were grade 1, 3.1% (n = 13) were grade 2, and 1.4% (n = 6) were grade 3. No grade 4 or 5 events were observed. Twenty-six of 63 RICE (41.3%) had resolved at the latest follow-up. The median onset after PBT and duration of RICE in patients in whom the lesions resolved were 11.8 and 9.0 months, respectively. On multivariable analysis, D1%CNS > 57.6 Gy RBE, previous in-field radiation, and diabetes mellitus were identified as significant risk factors for RICE development. Previous radiation was the only factor influencing the risk of symptomatic RICE. After PBT, general HRQoL parameters were not compromised. In a matched cohort analysis of 54/50 patients with and without RICE, no differences in global health score or functional and symptom scales were seen. CONCLUSIONS The overall incidence of clinically relevant RICE after PBT is very low and has no significant negative effect on long-term patient QoL.
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Affiliation(s)
| | - Maciej Pelak
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria; University Clinic for Radiotherapy and Radiation Oncology, Uniklinikum Salzburg, Salzburg, Austria.
| | - Eugen Hug
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - Birgit Flechl
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - Birgit Surböck
- Department of Neurology, Klinikum Favoriten, Vienna, Austria
| | - Christine Marosi
- Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Ulrike Mock
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - Leor Zach
- Department of Radiation Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Yael Mardor
- Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel; Advanced Technology Center, Sheba Medical Center, Ramat Gan, Israel
| | - Orit Furman
- Department of Radiation Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Joanna Gora
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - Piero Fossati
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - Markus Stock
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - Uwe Graichen
- Department of General Health Studies, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Sascha Klee
- Department of General Health Studies, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Petra Georg
- Department of Radiotherapy, Karl Landsteiner University of Health Sciences, University Hospital Krems, Krems, Austria
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6
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Mattke M, Ohlinger M, Bougatf N, Wolf R, Welzel T, Roeder F, Gerum S, Fussl C, Annon-Eberharter N, Ellerbrock M, Jäkel O, Haberer T, Herfarth K, Uhl M, Debus J, Seidensaal K, Harrabi S. Patterns of Temporal Lobe Reaction and Radiation Necrosis after Particle Radiotherapy in Patients with Skull Base Chordoma and Chondrosarcoma-A Single-Center Experience. Cancers (Basel) 2024; 16:718. [PMID: 38398109 PMCID: PMC10886807 DOI: 10.3390/cancers16040718] [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: 12/28/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The current study aims to evaluate the occurrence of temporal lobe reactions and identify possible risk factors for patients who underwent particle therapy of the skull base. METHODS 244 patients treated for skull base chordoma (n = 144) or chondrosarcoma (n = 100) at the Heidelberg Ion Beam Therapy Center (HIT) using a raster scan technique, were analyzed. Follow-up MRI-scans were matched with the initial planning images. Radiogenic reactions were contoured and analyzed based on volume and dose of treatment. RESULTS 51 patients with chordoma (35.4%) and 30 patients (30%) with chondrosarcoma experienced at least one temporal lobe reaction within the follow-up period (median 49 months for chondrosarcoma, 62 months for chordoma). Age, irradiated volume, and dose values were significant risk factors for the development of temporal lobe reactions with the highest significance for the value of DMax-7 being defined as the dose maximum in the temporal lobe minus the 7cc with the highest dose (p = 0.000000000019; OR 1.087). CONCLUSION Temporal lobe reactions are a common side effect after particle therapy of the skull base. We were able to develop a multivariate model, which predicted radiation reactions with a specificity of 99% and a sensitivity of 52.2%.
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Affiliation(s)
- Matthias Mattke
- Department of Radiation Oncology, Paracelsus Medical University, Salzburger Landesklinikum (SALK), 5020 Salzburg, Austria; (F.R.); (S.G.); (C.F.)
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (N.B.); (R.W.); (T.W.); (O.J.); (K.H.); (J.D.); (S.H.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany; (M.E.); (T.H.)
| | - Matteo Ohlinger
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (N.B.); (R.W.); (T.W.); (O.J.); (K.H.); (J.D.); (S.H.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany; (M.E.); (T.H.)
| | - Nina Bougatf
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (N.B.); (R.W.); (T.W.); (O.J.); (K.H.); (J.D.); (S.H.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany; (M.E.); (T.H.)
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Robert Wolf
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (N.B.); (R.W.); (T.W.); (O.J.); (K.H.); (J.D.); (S.H.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany; (M.E.); (T.H.)
| | - Thomas Welzel
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (N.B.); (R.W.); (T.W.); (O.J.); (K.H.); (J.D.); (S.H.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany; (M.E.); (T.H.)
| | - Falk Roeder
- Department of Radiation Oncology, Paracelsus Medical University, Salzburger Landesklinikum (SALK), 5020 Salzburg, Austria; (F.R.); (S.G.); (C.F.)
- Institute of Research and Development of Advanced Radiation Technologies (radART), Paracelsus Medical University, 5020 Salzburg, Austria
| | - Sabine Gerum
- Department of Radiation Oncology, Paracelsus Medical University, Salzburger Landesklinikum (SALK), 5020 Salzburg, Austria; (F.R.); (S.G.); (C.F.)
| | - Christoph Fussl
- Department of Radiation Oncology, Paracelsus Medical University, Salzburger Landesklinikum (SALK), 5020 Salzburg, Austria; (F.R.); (S.G.); (C.F.)
| | - Natalee Annon-Eberharter
- Department of Radiation Oncology, Paracelsus Medical University, Salzburger Landesklinikum (SALK), 5020 Salzburg, Austria; (F.R.); (S.G.); (C.F.)
| | - Malte Ellerbrock
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany; (M.E.); (T.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Oliver Jäkel
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (N.B.); (R.W.); (T.W.); (O.J.); (K.H.); (J.D.); (S.H.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany; (M.E.); (T.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Division for Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Thomas Haberer
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany; (M.E.); (T.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Klaus Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (N.B.); (R.W.); (T.W.); (O.J.); (K.H.); (J.D.); (S.H.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany; (M.E.); (T.H.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Matthias Uhl
- Department of Radiation Oncology, Ludwigshafen Hospital, 67063 Ludwigshafen, Germany;
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (N.B.); (R.W.); (T.W.); (O.J.); (K.H.); (J.D.); (S.H.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany; (M.E.); (T.H.)
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), 69120 Heidelberg, Germany
- German Cancer Consortium (DKTK), Partner Site Heidelberg, 69120 Heidelberg, Germany
| | - Katharina Seidensaal
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (N.B.); (R.W.); (T.W.); (O.J.); (K.H.); (J.D.); (S.H.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany; (M.E.); (T.H.)
| | - Semi Harrabi
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany (N.B.); (R.W.); (T.W.); (O.J.); (K.H.); (J.D.); (S.H.)
- Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany; (M.E.); (T.H.)
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Malbari F. Pediatric Neuro-oncology. Continuum (Minneap Minn) 2023; 29:1680-1709. [PMID: 38085894 DOI: 10.1212/con.0000000000001360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVE This article reviews the most common pediatric brain tumors, neurocutaneous syndromes, treatment-related neurotoxicities, and the long-term outcomes of survivors. LATEST DEVELOPMENTS In the era of molecular diagnostics, the classification, management, and prognostication of pediatric brain tumors and neurocutaneous syndromes has been refined, resulting in advancements in patient management. Molecular diagnostics have been incorporated into the most recent World Health Organization 2021 classification. This knowledge has allowed for novel therapeutic approaches targeting the biology of these tumors with the intent to improve overall survival, decrease treatment-related morbidity, and improve quality of life. Advances in management have led to better survival, but mortality remains high and significant morbidity persists. Current clinical trials focus on tumor biology targeted therapy, deescalation of therapy, and multimodal intensified approaches with targeted therapy in more high-risk tumors. ESSENTIAL POINTS Molecular diagnostics for pediatric brain tumors and neurocutaneous syndromes have led to novel therapeutic approaches targeting the biology of these tumors with the goals of improving overall survival and decreasing treatment-related morbidity. Further understanding will lead to continued refinement and improvement of tumor classification, management, and prognostication.
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Berlin E, Eisenberg R, Hill-Kayser C, Lustig RA, Kurtz G, Cummings E, LaRiviere M. Delivery of re-irradiation and complex palliative radiotherapy using proton therapy in pediatric cancer patients. Pediatr Blood Cancer 2023; 70:e30708. [PMID: 37794575 DOI: 10.1002/pbc.30708] [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] [Received: 05/01/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND The intent of this study is to characterize indications for pediatric palliative-intent proton radiation therapy (PIPRT). PROCEDURE We retrospectively reviewed patients 21 years and younger who received PIPRT. We defined PIPRT as radiotherapy (RT) aimed to improve cancer-related symptoms/provide durable local control in the non-curative setting. Mixed proton/photon plans were included. Adjacent re-irradiation (reRT) was defined as a reRT volume within the incidental dose cloud of a prior RT target, whereas direct reRT was defined as in-field overlap with prior RT target. Acute toxicity during RT until first inspection visit was graded according to the Common Terminology Criteria for Adverse Events. The Kaplan-Meier method, measured from last PIPRT fraction, was used to assess progression-free survival (PFS) and overall survival (OS). RESULTS Eighteen patients underwent PIPRT between 2014 and 2020. Median age at treatment start was 10 years [2-21]. Median follow-up was 8.2 months [0-48]. Treatment sites included: brain/spine [10], abdomen/pelvis [3], thorax [3], and head/neck [2]. Indications for palliation included: durable tumor control [18], neurologic symptoms [4], pain [3], airway compromise [2], and great vessel compression [1]. Indications for protons included: reRT [15] (three adjacent, 12 direct), craniospinal irradiation [4], reduction of dose to normal tissues [3]. Sixteen experienced grade (G) 1-2 toxicity; two G3. There were no reports of radionecrosis. Median PFS was 5.3 months [95% confidence interval (CI): 2.7-16.3]. Median OS was 8.3 months [95% CI: 5.5-26.3]. CONCLUSIONS The most common indication for PIPRT was reRT to provide durable tumor control. PIPRT appears to be safe, with no cases of high-grade toxicity.
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Affiliation(s)
- Eva Berlin
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rachel Eisenberg
- Albany Medical College, Albany Medical Center, Albany, New York, USA
| | - Christine Hill-Kayser
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert A Lustig
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Goldie Kurtz
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elizabeth Cummings
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michael LaRiviere
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Eichkorn T, Lischalk JW, Sandrini E, Meixner E, Regnery S, Held T, Bauer J, Bahn E, Harrabi S, Hörner-Rieber J, Herfarth K, Debus J, König L. Iatrogenic Influence on Prognosis of Radiation-Induced Contrast Enhancements in Patients with Glioma WHO 1-3 following Photon and Proton Radiotherapy. Radiother Oncol 2022; 175:133-143. [PMID: 36041565 DOI: 10.1016/j.radonc.2022.08.025] [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: 03/17/2022] [Revised: 07/20/2022] [Accepted: 08/23/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Radiation-induced contrast enhancement (RICE) is a common side effect following radiotherapy for glioma, but both diagnosis and handling are challenging. Due to the potential risks associated with RICE and its challenges in differentiating RICE from tumor progression, it is critical to better understand how RICE prognosis depends on iatrogenic influence. MATERIALS AND METHODS We identified 99 patients diagnosed with RICE who were previously treated with either photon or proton therapy for World Health Organization (WHO) grade 1-3 primary gliomas. Post-treatment brain MRI-based volumetric analysis and clinical data collection was performed at multiple time points. RESULTS The most common histologic subtypes were astrocytoma (50%) and oligodendroglioma (46%). In 67%, it was graded WHO grade 2 and in 86% an IDH mutation was present. RICE first occurred after 16 months (range: 1 - 160) in median. At initial RICE occurrence, 39% were misinterpreted as tumor progression. A tumor-specific therapy including chemotherapy or re-irradiation led to a RICE size progression in 86% and 92% of cases, respectively and RICE symptom progression in 57% and 65% of cases, respectively. A RICE-specific therapy such as corticosteroids or Bevacizumab for larger or symptomatic RICE led to a RICE size regression in 81% of cases with symptom stability or regression in 62% of cases. CONCLUSIONS While with chemotherapy and re-irradiation a RICE progression was frequently observed, anti-edematous or anti-VEGF treatment frequently went along with a RICE regression. For RICE, correct diagnosis and treatment decisions are challenging and critical and should be made interdisciplinarily.
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Affiliation(s)
- Tanja Eichkorn
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany; National Center for Tumor diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.
| | - Jonathan W Lischalk
- Department of Radiation Oncology, Perlmutter Cancer Center at New York University Langone Health at Long Island, New York, NY, USA.
| | - Elisabetta Sandrini
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany; National Center for Tumor diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.
| | - Eva Meixner
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany; National Center for Tumor diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.
| | - Sebastian Regnery
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany; National Center for Tumor diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.
| | - Thomas Held
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany; National Center for Tumor diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.
| | - Julia Bauer
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.
| | - Emanuel Bahn
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - Semi Harrabi
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany; National Center for Tumor diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany; National Center for Tumor diseases (NCT), Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; German Cancer Consortium (DKTK), partner site Heidelberg, Germany.
| | - Klaus Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany; National Center for Tumor diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany; National Center for Tumor diseases (NCT), Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; German Cancer Consortium (DKTK), partner site Heidelberg, Germany.
| | - Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany; National Center for Tumor diseases (NCT), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.
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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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Infants and Newborns with Atypical Teratoid Rhabdoid Tumors (ATRT) and Extracranial Malignant Rhabdoid Tumors (eMRT) in the EU-RHAB Registry: A Unique and Challenging Population. Cancers (Basel) 2022; 14:cancers14092185. [PMID: 35565313 PMCID: PMC9100752 DOI: 10.3390/cancers14092185] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/23/2022] [Accepted: 04/24/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Malignant rhabdoid tumors (MRT) are deadly tumors that predominantly affect infants and young children. Even when considering the generally young age of these patients, the treatment of infants below the age of six months represents a particular challenge due to the vulnerability of this patient population. The aim of our retrospective study was to assess the available information on prognostic factors, genetics, toxicity of treatment and long-term outcomes of MRT. We confirmed that, in a cohort of homogenously treated infants with MRT, significant predictors of outcome were female sex, localized stage, absence of a GLM and maintenance therapy, and these significantly favorably influence prognosis. Stratification-based biomarker-driven tailored trials may be a key option to improve survival rates. Abstract Introduction: Malignant rhabdoid tumors (MRT) predominantly affect infants and young children. Patients below six months of age represent a particularly therapeutically challenging group. Toxicity to developing organ sites limits intensity of treatment. Information on prognostic factors, genetics, toxicity of treatment and long-term outcomes is sparse. Methods: Clinical, genetic, and treatment data of 100 patients (aged below 6 months at diagnosis) from 13 European countries were analyzed (2005–2020). Tumors and matching blood samples were examined for SMARCB1 mutations using FISH, MLPA and Sanger sequencing. DNA methylation subgroups (ATRT-TYR, ATRT-SHH, and ATRT-MYC) were determined using 450 k / 850 k-profiling. Results: A total of 45 patients presented with ATRT, 29 with extracranial, extrarenal (eMRT) and 9 with renal rhabdoid tumors (RTK). Seventeen patients demonstrated synchronous tumors (SYN). Metastases (M+) were present in 27% (26/97) at diagnosis. A germline mutation (GLM) was detected in 55% (47/86). DNA methylation subgrouping was available in 50% (31 / 62) with ATRT or SYN; for eMRT, methylation-based subgrouping was not performed. The 5-year overall (OS) and event free survival (EFS) rates were 23.5 ± 4.6% and 19 ± 4.1%, respectively. Male sex (11 ± 5% vs. 35.8 ± 7.4%), M+ stage (6.1 ± 5.4% vs. 36.2 ± 7.4%), presence of SYN (7.1 ± 6.9% vs. 26.6 ± 5.3%) and GLM (7.7 ± 4.2% vs. 45.7 ± 8.6%) were significant prognostic factors for 5-year OS. Molecular subgrouping and survival analyses confirm a previously described survival advantage for ATRT-TYR. In an adjusted multivariate model, clinical factors that favorably influence the prognosis were female sex, localized stage, absence of a GLM and maintenance therapy. Conclusions: In this cohort of homogenously treated infants with MRT, significant predictors of outcome were sex, M-stage, GLM and maintenance therapy. We confirm the need to stratify which patient groups benefit from multimodal treatment, and which need novel therapeutic strategies. Biomarker-driven tailored trials may be a key option.
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Paganetti H. Mechanisms and Review of Clinical Evidence of Variations in Relative Biological Effectiveness in Proton Therapy. Int J Radiat Oncol Biol Phys 2022; 112:222-236. [PMID: 34407443 PMCID: PMC8688199 DOI: 10.1016/j.ijrobp.2021.08.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/14/2021] [Accepted: 08/10/2021] [Indexed: 01/03/2023]
Abstract
Proton therapy is increasingly being used as a radiation therapy modality. There is uncertainty about the biological effectiveness of protons relative to photon therapies as it depends on several physical and biological parameters. Radiation oncology currently applies a constant and generic value for the relative biological effectiveness (RBE) of 1.1, which was chosen conservatively to ensure tumor coverage. The use of a constant value has been challenged particularly when considering normal tissue constraints. Potential variations in RBE have been assessed in several published reviews but have mostly focused on data from clonogenic cell survival experiments with unclear relevance for clinical proton therapy. The goal of this review is to put in vitro findings in relation to clinical observations. Relevant in vivo pathways determining RBE for tumors and normal tissues are outlined, including not only damage to tumor cells and parenchyma but also vascular damage and immune response. Furthermore, the current clinical evidence of varying RBE is reviewed. The assessment can serve as guidance for treatment planning, personalized dose prescriptions, and outcome analysis.
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Affiliation(s)
- Harald Paganetti
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
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13
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Radiation induced contrast enhancement after proton beam therapy in patients with low grade glioma - How safe are protons? Radiother Oncol 2021; 167:211-218. [PMID: 34973277 DOI: 10.1016/j.radonc.2021.12.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/30/2021] [Accepted: 12/22/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE The optimal treatment strategy for low-grade glioma (LGG) is still a matter of controversy. Considering that the prognosis is typically favorable, the prevention of late sequelae is of particular importance. Proton beam therapy (PRT) has the potential to further reduce the burden of treatment related side effects. We set out to evaluate the clinical outcome of proton irradiation with a particular focus on morphologic features on magnetic resonance imaging (MRI). METHODS We assessed prospectively 110 patients who received radiotherapy with protons for histologically proven LGG. Clinical and radiological information were analyzed resulting in more than 1200 available MRI examinations with a median follow-up of 39 months. Newly diagnosed contrast-enhancing lesions on MRI were delineated and correlated with parameters of the corresponding treatment plan. A voxel-based dose-matched paired analysis of the linear energy transfer (LET) inside vs outside lesions was performed. RESULTS Proton beam irradiation of patients with low-grade glioma results in overall survival (OS) of 90% after seven years. Median progression free survival had not yet been reached with surviving fraction of 54% after seven years. The incidence of temporary or clinically silent radiation induced contrast enhancement was significantly higher than previously assumed, however, symptomatic radiation necrosis was only detected in one patient. These radiation-induced contrast-enhancing lesions were almost exclusively seen at the distal beam end of the proton beam. In 22 out of 23 patients, the average LET of voxels inside contrast-enhancing lesions was significantly increased, compared to dose-matched voxels outside the lesions. CONCLUSION Symptomatic radiation necrosis following PRT was as rare as conventional photon-based treatment series suggest. However, the increased incidence of asymptomatic radiation-induced brain injuries with an increased average LET observed in this cohort provides strong clinical evidence to support the hypothesis that the relative biological effectiveness of protons is variable and different to the fixed factor of 1.1 currently used worldwide.
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14
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On dose cube pixel spacing pre-processing for features extraction stability in dosiomic studies. Phys Med 2021; 90:108-114. [PMID: 34600351 DOI: 10.1016/j.ejmp.2021.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 09/06/2021] [Accepted: 09/17/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE Dosiomics allows to parameterize regions of interest (ROIs) and to produce quantitative dose features encoding the spatial and statistical distribution of radiotherapy dose. The stability of dosiomics features extraction on dose cube pixel spacing variation has been investigated in this study. MATERIAL AND METHODS Based on 17 clinical delivered dose distributions (Pn), dataset has been generated considering all the possible combinations of four dose grid resolutions and two calculation algorithms. Each dose voxel cube has been post-processed considering 4 different dose cube pixel spacing values: 1x1x1, 2x2x2, 3x3x3 mm3 and the one equal to the planning CT. Dosiomics features extraction has been performed from four different ROIs. The stability of each extracted dosiomic feature has been analyzed in terms of coefficient of variation (CV) intraclass correlation coefficient (ICC). RESULTS The highest CV mean values were observed for PTV ROI and for the grey level size zone matrix features family. On the other hand, the lowest CV mean values have been found for RING ROI for the grey level co-occurrence matrix features family. P3 showed the highest percentage of CV >1 (1.14%) followed by P15 (0.41%), P1 (0.29%) and P13 (0.19%). ICC analysis leads to identify features with an ICC >0.95 that could be considered stable to use in dosiomic studies when different dose cube pixel spacing are considered, especially the features in common among the seventeen plans. CONCLUSION Considering the observed variability, dosiomic studies should always provide a report not only on grid resolution and algorithm dose calculation, but also on dose cube pixel spacing.
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15
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Radiation-induced brain injury in patients with meningioma treated with proton or photon therapy. J Neurooncol 2021; 153:169-180. [PMID: 33886111 DOI: 10.1007/s11060-021-03758-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Radiation therapy is often used to treat meningioma with adverse features or when unresectable. Proton therapy has advantages over photon therapy in reducing integral dose to the brain. This study compared the incidence of radiological and clinical adverse events after photon versus proton therapy in the treatment of meningioma. METHODS A retrospective review was conducted on patients with meningioma treated with proton or photon therapy at two high-volume tertiary cancer centers. Patients with a history of prior radiation therapy (RT) or less than 3 months of follow-up were excluded. Post-RT imaging changes were categorized into abnormal T2 signal intensities (T2 changes) or abnormal T1 post-contrast and T2 signal intensities (T1c+T2 changes) on magnetic resonance imaging (MRI). Clinical outcomes of adverse events and survival were compared between the proton and photon therapies. RESULTS Among the total of 77 patients, 38 patients received proton therapy and 39 patients received photon therapy. The median age at diagnosis was 55 years and median follow-up was 2.2 years. No significant differences in symptomatic adverse events were observed between the two groups: grade ≥ 2 adverse events were seen in 4 (10.5%) patients in the proton group and 3 (7.7%) patients in the photon group (p = 0.67). The 2-year cumulative incidences of T2 changes were 38.3% after proton therapy and 47.7% after photon therapy (p = 0.53) and the 2-year cumulative incidences of T1c+T2 changes were 26.8% after proton therapy and 5.3% after photon therapy (p = 0.02). One patient experienced grade ≥ 4 adverse event in each group (p = 0.99). Estimated 2-year progression-free survival was 79.5% (proton therapy 76.0% vs. photon therapy 81.3%, p = 0.66) and 2-year overall survival was 89.7% (proton therapy 86.6% vs. photon therapy 89.3%, p = 0.65). CONCLUSIONS Following RT, high rates of T2 changes were seen in meningioma patients regardless of treatment modality. Proton therapy was associated with significantly higher rates of T1c+T2 changes compared with photon therapy, but severe adverse events were uncommon in both groups and survival outcomes were comparable between the two groups. Future studies will aim at correlating the MRI changes with models that can be incorporated into RT planning to avoid toxicity.
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Ni C, Qin D, Cheng H, Zhou M, Luo D. Effect Evaluation of Combined Application of Magnetic Resonance Diffusion Tensor Imaging and Brain Function Imaging in Radiation Therapy of Brain Tumours Involving Motor Pathways. JOURNAL OF MEDICAL IMAGING AND HEALTH INFORMATICS 2021. [DOI: 10.1166/jmihi.2021.3329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
This study is an attempt to find a way for functional imaging information to be applied clinically in radiation therapy. The basal nucleus is a collective term for a group of neural nucleus in the central nervous system that connects the pontine, brainstem, and cerebral cortex, including
the caudate nucleus, the bean-shaped nucleus, the screen-shaped nucleus, and the amygdala. It is difficult to find the exact position of these neural nuclei on the computed tomography (CT) image or the T1 or T2 sequence of magnetic resonance. However, the development of neurosurgery has partially
confirmed that these functional nuclei are involved in advanced cognitive functions such as memory, emotion, and learning. Neurosurgery has tried to avoid damaging these nucleus groups during surgery to improve the quality of life of patients, and there is currently no clear strategy for this
in radiotherapy. Because CT and magnetic resonance spin echo (SE) sequences are difficult to find the anatomical location of the nucleus, it is difficult to have any strategy to protect these functions in radiotherapy planning. This article uses diffusion tensor imaging (DTI) images and fiber
bundle tracking to obtain a more accurate anatomical position of the nerve nucleus on the image, and provides some available strategies for radiotherapy to protect patients’ brain function. The conclusion of this paper is that the combined application of DTI and functional magnetic resonance
imaging (fMRI) can better observe the relationship among tumours, functional areas and white matter fibers, and guide the designation of radiotherapy plans.
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Affiliation(s)
- Cheng Ni
- The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, En Shi 445000, China
| | - Daming Qin
- The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, En Shi 445000, China
| | - Hong Cheng
- The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, En Shi 445000, China
| | - Meng Zhou
- The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, En Shi 445000, China
| | - Dandan Luo
- The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, En Shi 445000, China
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Niemierko A, Schuemann J, Niyazi M, Giantsoudi D, Maquilan G, Shih HA, Paganetti H. Brain Necrosis in Adult Patients After Proton Therapy: Is There Evidence for Dependency on Linear Energy Transfer? Int J Radiat Oncol Biol Phys 2021; 109:109-119. [PMID: 32911019 PMCID: PMC7736370 DOI: 10.1016/j.ijrobp.2020.08.058] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 08/26/2020] [Accepted: 08/27/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To investigate if radiographic imaging changes defined as necrosis correlate with regions in the brain with elevated linear energy transfer (LET) for proton radiation therapy treatments with partial brain involvement in central nervous system and patients with head and neck cancer. METHODS AND MATERIALS Fifty patients with head and neck, skull base, or intracranial tumors who underwent proton therapy between 2004 to 2016 with a minimum prescription dose of 59.4 Gy (relative biological effectiveness) and with magnetic resonance imaging changes indicative of brain necrosis after radiation therapy were retrospectively reviewed. Each treatment plan was recalculated using Monte Carlo simulations to provide accurate dose distributions as well as 3-dimensional distributions of LET. To assess the effect of LET on radiographic imaging changes several voxel-based analyses were performed. RESULTS In this patient cohort, LET adjusted for dose was not found to be associated with risk of brain necrosis. CONCLUSIONS A voxel-based analysis of brain necrosis as an endpoint is difficult owing to uncertainties in the origin of necrosis, timing of imaging, variability in patient specific radiosensitivity, and the simultaneous effect of dose and LET. Even though it is expected that the LET and thus relative biological effectiveness increases at the end of range, effects in patients might be small compared with interpatient variability of radiosensitivity and might be obscured by other confounding factors.
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Affiliation(s)
- Andrzej Niemierko
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | - Jan Schuemann
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Maximilian Niyazi
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium, partner site Munich, Heidelberg, Germany; German Cancer Research Center, Heidelberg, Germany
| | - Drosoula Giantsoudi
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Genevieve Maquilan
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Helen A Shih
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Harald Paganetti
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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18
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Tran S, Lim PS, Bojaxhiu B, Teske C, Baust K, Zepter S, Kliebsch U, Timmermann B, Calaminus G, Weber DC. Clinical outcomes and quality of life in children and adolescents with primary brain tumors treated with pencil beam scanning proton therapy. Pediatr Blood Cancer 2020; 67:e28465. [PMID: 32902137 DOI: 10.1002/pbc.28465] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/01/2020] [Accepted: 05/15/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Long-term treatment-related toxicity may substantially impact well-being, quality of life (QoL), and health of children/adolescents with brain tumors (CBTs). Strategies to reduce toxicity include pencil beam scanning (PBS) proton therapy (PT). This study aims to report clinical outcomes and QoL in PBS-treated CBTs. PROCEDURE We retrospectively reviewed 221 PBS-treated CBTs aged <18 years. Overall-free (OS), disease-free (DFS), and late-toxicity-free survivals (TFS), local control (LC) and distant (DC) brain/spinal control were calculated using Kaplan-Meier estimates. Prospective QoL reports from 206 patients (proxies only ≤4 years old [yo], proxies and patients ≥5 yo) were descriptively analyzed. Median follow-up was 51 months (range, 4-222). RESULTS Median age at diagnosis was 3.1 years (range, 0.3-17.7). The main histologies were ependymoma (n = 88; 39.8%), glioma (n = 37; 16.7%), craniopharyngioma (n = 22; 10.0%), atypical teratoid/rhabdoid tumor (ATRT) (n = 21; 9.5%) and medulloblastoma (n = 15; 6.8%). One hundred sixty (72.4%) patients received chemotherapy. Median PT dose was 54 Gy(relative biological effectiveness) (range, 18.0-64.8). The 5-year OS, DFS, LC, and DC (95% CI) were 79.9% (74-85.8), 65.2% (59.8-70.6), 72.1% (65.4-78.8), and 81.8% (76.3-87.3), respectively. Late PT-related ≥G3 toxicity occurred in 19 (8.6%) patients. The 5-year ≥G3 TFS was 91.0% (86.3-95.7). Three (1.4%) secondary malignancies were observed. Patients aged ≤3 years at PT (P = .044) or receiving chemotherapy (P = .043) experienced more ≥G3 toxicity. ATRT histology independently predicted distant brain failure (P = .046) and death (P = .01). Patients aged ≥5 years self-rated QoL higher than their parents (proxy assessment). Both reported lower social functioning and cognition after PT than at baseline, but near-normal long-term global well-being. QoL was well below normal before and after PT in children ≤4 years. CONCLUSIONS The outcome of CBTs was excellent after PBS. Few patients had late ≥G3 toxicity. Patients aged <5 years showed worse QoL and toxicity outcomes.
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Affiliation(s)
- Sebastien Tran
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Pei S Lim
- Department of Radiation Oncology, University College London Hospitals, London, United Kingdom
| | - Beat Bojaxhiu
- Department of Radiation Oncology, Triemli Hospital, Zurich, Switzerland.,Department of Radiation Oncology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Carmen Teske
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Katja Baust
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Stefan Zepter
- Center for Proton Therapy (CPT), Paul Scherrer Institute (PSI), ETH Domain, Villigen, Switzerland
| | - Ulrike Kliebsch
- Center for Proton Therapy (CPT), Paul Scherrer Institute (PSI), ETH Domain, Villigen, Switzerland
| | - Beate Timmermann
- Department of Particle Therapy, West German Proton Therapy Centre Essen (WPE), West German Cancer Center (WTZ), German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Gabriele Calaminus
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Bonn, Germany
| | - Damien Charles Weber
- Department of Radiation Oncology, Inselspital, University Hospital Bern, Bern, Switzerland.,Center for Proton Therapy (CPT), Paul Scherrer Institute (PSI), ETH Domain, Villigen, Switzerland.,Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
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19
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Jin MC, Shi S, Wu A, Sandhu N, Xiang M, Soltys SG, Hiniker S, Li G, Pollom EL. Impact of proton radiotherapy on treatment timing in pediatric and adult patients with CNS tumors. Neurooncol Pract 2020; 7:626-635. [PMID: 33312677 PMCID: PMC7716142 DOI: 10.1093/nop/npaa034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite putative benefits associated with proton radiotherapy in the setting of CNS tumors, numerous barriers limit treatment accessibility. Given these challenges, we explored the association of proton use with variations in treatment timing. METHODS Pediatric and adult patients with histologically confirmed CNS tumors were identified from the National Cancer Database (2004-2015). Univariable and multivariable regression models were constructed to assess factors impacting radiation timing. Multivariable Cox regression was used to evaluate the effect of treatment delay on survival. RESULTS A total of 76 157 patients received photon or proton radiotherapy. Compared to photons, time to proton administration was longer in multiple pediatric (embryonal, ependymal, nonependymal glial, and other) and adult (ependymal, nonependymal glial, meningeal, other) tumor histologies. On adjusted analysis, proton radiotherapy was associated with longer delays in radiotherapy administration in pediatric embryonal tumors (+3.00 weeks, P = .024) and in all adult tumors (embryonal [+1.36 weeks, P = .018], ependymal [+3.15 weeks, P < .001], germ cell [+2.65 weeks, P = .024], glial [+2.15 weeks, P < .001], meningeal [+5.05 weeks, P < .001], and other [+3.06 weeks, P < .001]). In patients with high-risk tumors receiving protons, delays in adjuvant radiotherapy were independently associated with poorer survival (continuous [weeks], adjusted hazard ratio = 1.09, 95% CI = 1.02-1.16). CONCLUSIONS Proton radiotherapy is associated with later radiation initiation in pediatric and adult patients with CNS tumors. In patients with high-risk CNS malignancies receiving protons, delayed adjuvant radiotherapy is associated with poorer survival. Further studies are needed to understand this discrepancy to maximize the potential of proton radiotherapy for CNS malignancies.
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Affiliation(s)
- Michael C Jin
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Siyu Shi
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Adela Wu
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Navjot Sandhu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Michael Xiang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Scott G Soltys
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Susan Hiniker
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Gordon Li
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Erqi L Pollom
- Palo Alto Veterans Affairs Health Care System, Palo Alto, California
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20
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Boria AJ, Perez-Torres CJ. Impact of mouse strain and sex when modeling radiation necrosis. Radiat Oncol 2020; 15:141. [PMID: 32493371 PMCID: PMC7268332 DOI: 10.1186/s13014-020-01585-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background Murine models are among the most common type of preclinical animal models used to study the human condition, but a wide selection of different mice is currently in use with these differences potentially compromising study results and impairing the ability to reconcile interstudy results. Our goal was to determine how the strain and sex of the mice selection would affect the development of radiation necrosis in our murine model of radiation-induced cerebral necrosis. Methods We generated this model by using a preclinical irradiator to irradiate a sub-hemispheric portion of the brain of mice with single-fraction doses of 80 Gy. Eight possible combinations of mice made up of two different with two substrains each (BALB/cN, BALB/cJ, C57BL/6 N, and C57BL/6 J) and both sexes were irradiated in this study. Radiation necrosis development was tracked up to 8 weeks with a 7 T Bruker MRI utilizing T2-weighted and post-contrast T1-weighted imaging. MRI results were compared to and validated with the use of histology which utilized a scale from 0 to 3 in ascending order of damage. Results Both time post-irradiation and strain (BALB/c vs C57BL/6) were significant factors affecting radiation necrosis development. Sex was in general not a statistically significant parameter in terms of radiation necrosis development. Conclusion Mouse strain thus needs to be considered when evaluating the results of necrosis models. However, sex does not appear to be a variable needing major consideration.
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Affiliation(s)
- Andrew J Boria
- School of Health Sciences, Purdue University, 550 Stadium Mall Drive, Hampton Hall 1263A, West Lafayette, IN, USA
| | - Carlos J Perez-Torres
- School of Health Sciences, Purdue University, 550 Stadium Mall Drive, Hampton Hall 1263A, West Lafayette, IN, USA. .,Purdue University Center for Cancer Research, Purdue University, West Lafayette, IN, USA.
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21
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Colloca G, Tagliaferri L, Capua BD, Gambacorta MA, Lanzotti V, Bellieni A, Monfardini S, Balducci L, Bernabei R, Cho WC, Valentini V. Management of The Elderly Cancer Patients Complexity: The Radiation Oncology Potential. Aging Dis 2020; 11:649-657. [PMID: 32489709 PMCID: PMC7220284 DOI: 10.14336/ad.2019.0616] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 06/16/2019] [Indexed: 12/30/2022] Open
Abstract
Radiation oncology has the potential to be an excellent option for the frail elderly cancer patients because of its limited systemic toxicities. It can be effective for curative, prophylactic, disease control or palliative purposes. Currently about 60% of all cancer patients undergoing active treatment at some point receive radiation treatment. However, though widely used, there are limited clinical trials strictly designed for the elderly. This paper will review the key points in the assessment and treatment of elderly cancer patient including quality of life, active life expectancy, cognitive performance, frailty, sarcopenia and how the new technologies can help to reach the key goal of maintaining autonomy and independence for the elderly cancer patient.
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Affiliation(s)
- Giuseppe Colloca
- 1Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Roma, Italy.,3GIOGER Gruppo italiano di Oncologia Geriatrica, Italy
| | - Luca Tagliaferri
- 1Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Roma, Italy
| | - Beatrice Di Capua
- 1Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Roma, Italy.,3GIOGER Gruppo italiano di Oncologia Geriatrica, Italy
| | - Maria Antonietta Gambacorta
- 1Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Roma, Italy
| | - Vito Lanzotti
- 1Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Roma, Italy
| | - Andrea Bellieni
- 2Istituto di Medicina Interna e Geriatria, Università Cattolica Sacro Cuore, Roma, Italy.,3GIOGER Gruppo italiano di Oncologia Geriatrica, Italy
| | | | | | - Roberto Bernabei
- 2Istituto di Medicina Interna e Geriatria, Università Cattolica Sacro Cuore, Roma, Italy
| | - William C Cho
- 6Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong
| | - Vincenzo Valentini
- 1Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC di Radioterapia, Dipartimento di Scienze Radiologiche, Radioterapiche ed Ematologiche, Roma, Italy
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22
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Seidel C, Dietzsch S, Kortmann RD, Schackert G, Hau P. Radiation Therapy in Ependymal Tumors. Radiat Oncol 2020. [DOI: 10.1007/978-3-319-52619-5_4-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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23
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Quantifying effects of radiotherapy-induced microvascular injury; review of established and emerging brain MRI techniques. Radiother Oncol 2019; 140:41-53. [PMID: 31176207 DOI: 10.1016/j.radonc.2019.05.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/16/2019] [Accepted: 05/17/2019] [Indexed: 12/17/2022]
Abstract
Microvascular changes are increasingly recognised not only as primary drivers of radiotherapy treatment response in brain tumours, but also as an important contributor to short- and long-term (cognitive) side effects arising from irradiation of otherwise healthy brain tissue. As overall survival of patients with brain tumours is increasing, monitoring long-term sequels of radiotherapy-induced microvascular changes in the context of their potential predictive power for outcome, such as cognitive disability, has become increasingly relevant. Ideally, radiotherapy-induced significant microvascular changes in otherwise healthy brain tissue should be identified as early as possible to facilitate adaptive radiotherapy and to proactively start treatment to minimise the influence on these side-effects on the final outcome. Although MRI is already known to be able to detect significant long-term radiotherapy induced microvascular effects, more recently advanced MR imaging biomarkers reflecting microvascular integrity and function have been reported and might provide a more accurate and earlier detection of microvascular changes. However, the use and validation of both established and new techniques in the context of monitoring early and late radiotherapy-induced microvascular changes in both target-tissue and healthy tissue currently are minimal at best. This review aims to summarise the performance and limitations of existing methods and future opportunities for detection and quantification of radiotherapy-induced microvascular changes, as well as the relation of these findings with key clinical parameters.
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24
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Weber DC, Lim PS, Tran S, Walser M, Bolsi A, Kliebsch U, Beer J, Bachtiary B, Lomax T, Pica A. Proton therapy for brain tumours in the area of evidence-based medicine. Br J Radiol 2019; 93:20190237. [PMID: 31067074 DOI: 10.1259/bjr.20190237] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
ADVANCES IN KNOWLEDGE This review details the indication of brain tumors for proton therapy and give a list of the open prospective trials for these challenging tumors.
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Affiliation(s)
- Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland.,University of Bern, Bern, Switzerland.,University of Zürich, Zürich, Switzerland
| | - Pei S Lim
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Sebastien Tran
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Marc Walser
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Alessandra Bolsi
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Ulrike Kliebsch
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Jürgen Beer
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Barbara Bachtiary
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Tony Lomax
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland.,Department of Physics, ETH, Zürich, Switzerland
| | - Alessia Pica
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
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