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Youssef I, Mohamed N, Kallini D, Zakeri K, Lin H, Han D, Qi H, Nosov A, Riaz N, Chen L, Yu Y, Dunn LA, Sherman EJ, Wray R, Schöder H, Lee NY. An Analysis of Positron Emission Tomography Maximum Standard Uptake Value Among Patients With Head and Neck Cancer Receiving Photon and Proton Radiation. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00428-0. [PMID: 38499254 DOI: 10.1016/j.ijrobp.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 02/23/2024] [Accepted: 03/07/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE One main advantage of proton therapy versus photon therapy is its precise radiation delivery to targets without exit dose, resulting in lower dose to surrounding healthy tissues. This is critical, given the proximity of head and neck tumors to normal structures. However, proton planning requires careful consideration of factors, including air-tissue interface, anatomic uncertainties, surgical artifacts, weight fluctuations, rapid tumor response, and daily variations in setup and anatomy, as these heterogeneities can lead to inaccuracies in targeting and creating unwarranted hotspots to a greater extent than photon radiation. In addition, the elevated relative biological effectiveness at the Bragg peak's distal end can also increase hot spots within and outside the target area. METHODS AND MATERIALS The purpose of this study was to evaluate for a difference in positron emission tomography (PET) standard uptake value (SUV) after definitive treatment, between intensity modulated proton therapy (IMPT) and intensity modulated photon therapy (IMRT). In addition, we compared the biologic dose between PET areas of high and low uptake within the clinical target volume-primary of patients treated with IMPT. This work is assuming that the greater SUV may potentially result in greater toxicities. For the purposes of this short communication, we are strictly focusing on the SUV and do not have correlation with toxicity outcomes. To accomplish this, we compared the 3- and 6-month posttreatment fluorodeoxyglucose PET scans for 100 matched patients with oropharyngeal cancer treated definitively without surgery using either IMPT (n = 50) or IMRT (n = 50). RESULTS Our study found a significant difference in biologic dose between the high- and low-uptake regions on 3-month posttreatment scans of IMPT. However, this difference did not translate to a significant difference in PET uptake in the clinical target volume-primary at 3 and 6 months' follow-up between patients who received IMPT versus IMRT. CONCLUSIONS Studies have proposed that proton's greater relative biological effectiveness at the Bragg peak could lead to tissue inflammation. Our study did not corroborate these findings. This study's conclusion underscores the need for further investigations with ultimate correlation with clinical toxicity outcomes.
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Affiliation(s)
- Irini Youssef
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York; New York Proton Center, New York, New York
| | - Nader Mohamed
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Daniel Kallini
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kaveh Zakeri
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Haibo Lin
- New York Proton Center, New York, New York
| | - Dong Han
- New York Proton Center, New York, New York
| | - Hang Qi
- New York Proton Center, New York, New York
| | - Anton Nosov
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nadeem Riaz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Linda Chen
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yao Yu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lara Ann Dunn
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Eric J Sherman
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Rick Wray
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Heiko Schöder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York; New York Proton Center, New York, New York.
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Simard M, Robertson DG, Fullarton R, Royle G, Beddar S, Collins-Fekete CA. Integrated-mode proton radiography with 2D lateral projections. Phys Med Biol 2024; 69:054001. [PMID: 38241716 DOI: 10.1088/1361-6560/ad209d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 01/19/2024] [Indexed: 01/21/2024]
Abstract
Integrated-mode proton radiography leading to water equivalent thickness (WET) maps is an avenue of interest for motion management, patient positioning, andin vivorange verification. Radiographs can be obtained using a pencil beam scanning setup with a large 3D monolithic scintillator coupled with optical cameras. Established reconstruction methods either (1) involve a camera at the distal end of the scintillator, or (2) use a lateral view camera as a range telescope. Both approaches lead to limited image quality. The purpose of this work is to propose a third, novel reconstruction framework that exploits the 2D information provided by two lateral view cameras, to improve image quality achievable using lateral views. The three methods are first compared in a simulated Geant4 Monte Carlo framework using an extended cardiac torso (XCAT) phantom and a slanted edge. The proposed method with 2D lateral views is also compared with the range telescope approach using experimental data acquired with a plastic volumetric scintillator. Scanned phantoms include a Las Vegas (contrast), 9 tissue-substitute inserts (WET accuracy), and a paediatric head phantom. Resolution increases from 0.24 (distal) to 0.33 lp mm-1(proposed method) on the simulated slanted edge phantom, and the mean absolute error on WET maps of the XCAT phantom is reduced from 3.4 to 2.7 mm with the same methods. Experimental data from the proposed 2D lateral views indicate a 36% increase in contrast relative to the range telescope method. High WET accuracy is obtained, with a mean absolute error of 0.4 mm over 9 inserts. Results are presented for various pencil beam spacing ranging from 2 to 6 mm. This work illustrates that high quality proton radiographs can be obtained with clinical beam settings and the proposed reconstruction framework with 2D lateral views, with potential applications in adaptive proton therapy.
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Affiliation(s)
- Mikaël Simard
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Daniel G Robertson
- Division of Medical Physics, Department of Radiation Oncology, Mayo Clinic Arizona, 5881 E Mayo Blvd, Phoenix, AZ, United States of America
| | - Ryan Fullarton
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Gary Royle
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Sam Beddar
- The University of Texas MD Anderson UTHealth Graduate School of Biomedical Sciences, Houston, TX, United States of America
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Chang L, Shaaban SG, Gogineni E, Page B, Quon H, Li H, Ger R. Daily Head and Neck Treatment Assessment for Optimal Proton Therapy Planning Robustness. Cancers (Basel) 2023; 15:3719. [PMID: 37509380 PMCID: PMC10378634 DOI: 10.3390/cancers15143719] [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: 05/11/2023] [Revised: 07/20/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
Robust optimization in proton therapy ensures adequate target coverage; however, validation of fractional plan quality and setup uncertainty in patients has not been performed. We aimed to assess plan robustness on delivered head and neck proton plans classified into two categories: (1) primary only (PO) and (2) primary and neck nodal (PNN) coverage. Registration at the machine was utilized for daily CBCT to generate a synthetic CT. The dose for the clinical target volume (CTV) and organs at risk (OAR) was compared to the expected robustness bands using 3.5% range uncertainty and 3 mm vs. 5 mm setup uncertainty. The fractional deviation was defined as D95% and V100% outside of uncertainty constraints. About 203 daily fractions from 6 patients were included for analysis. The percentage of fractions that exceeded robustness calculations was greater in 3 mm as compared to 5 mm setup uncertainty for both CTV and OAR volumes. PO plans had clinically insignificant average fractional deviation, less than 1%, in delivered D95% and V100%. In comparison, PNN plans had up to 2.2% average fractional deviation in delivered V100% using 3 mm robustness. Given the need to balance dose accuracy with OAR sparing, we recommend the utilization of 3 mm setup uncertainty as an acceptable simulation of the dose delivered.
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Affiliation(s)
- Leslie Chang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21202, USA
| | - Sherif G Shaaban
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21202, USA
| | - Emile Gogineni
- Department of Radiation Oncology, Ohio State University, Columbus, OH 43210, USA
| | - Brandi Page
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21202, USA
| | - Harry Quon
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21202, USA
| | - Heng Li
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21202, USA
| | - Rachel Ger
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21202, USA
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Carsuzaa F, Favier V, Ferrari M, Turri-Zanoni M, Ingargiola R, Camarda AM, Seguin L, Contro G, Orlandi E, Thariat J. Need for close interdisciplinary communication after endoscopic endonasal surgery to further personalize postoperative radiotherapy in sinonasal malignancies. Front Oncol 2023; 13:1130040. [PMID: 36925924 PMCID: PMC10012420 DOI: 10.3389/fonc.2023.1130040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/20/2023] [Indexed: 03/08/2023] Open
Affiliation(s)
- Florent Carsuzaa
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Poitiers, Poitiers, France
| | - Valentin Favier
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Montpellier, Montpellier, France
| | - Marco Ferrari
- Section of Otorhinolaryngology - Head and Neck Surgery, University of Padova, "Azienda Ospedale Università di Padova", Padova, Italy
| | - Mario Turri-Zanoni
- Division of Otorhinolaryngology - Head and neck surgery, Department of Biotechnology and Life Sciences, University of Insubria, ASST Sette Laghi University Hospital, Varese, Italy
| | - Rossana Ingargiola
- Radiation Oncology, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Anna Maria Camarda
- Radiation Oncology, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Lise Seguin
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Poitiers, Poitiers, France
| | - Giacomo Contro
- Section of Otorhinolaryngology - Head and Neck Surgery, University of Padova, "Azienda Ospedale Università di Padova", Padova, Italy
| | - Ester Orlandi
- Radiation Oncology, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Juliette Thariat
- Radiation Oncology, Centre François Baclesse: ARCHADE, Caen, France
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An online adaptive plan library approach for intensity modulated proton therapy for head and neck cancer. Radiother Oncol 2022; 176:68-75. [PMID: 36150418 DOI: 10.1016/j.radonc.2022.09.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 08/25/2022] [Accepted: 09/13/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE In intensity modulated proton therapy (IMPT), the impact of setup errors and anatomical changes is commonly mitigated by robust optimization with population-based setup robustness (SR) settings and offline replanning. In this study we propose and evaluate an alternative approach based on daily plan selection from patient-specific pre-treatment established plan libraries (PLs). Clinical implementation of the PL strategy would be rather straightforward compared to daily online re-planning. MATERIALS AND METHODS For 15 head-and-neck cancer patients, the planning CT was used to generate a PL with 5 plans, robustly optimized for increasing SR: 0, 1, 2, 3, 5 mm, and 3% range robustness. Repeat CTs (rCTs) and realistic setup and range uncertainty distributions were used for simulation of treatment courses for the PL approach, treatments with fixed SR (fSR3) and a trigger-based offline adaptive schedule for 3 mm SR (fSR3OfA). Daily plan selection in the PL approach was based only on recomputed dose to the CTV on the rCT. RESULTS Compared to using fSR3 and fSR3OfA, the risk of xerostomia grade ≥ II & III and dysphagia ≥ grade III were significantly reduced with the PL. For 6/15 patients the risk of xerostomia and/or dysphagia ≥ grade II could be reduced by > 2% by using PL. For the other patients, adherence to target coverage constraints was often improved. fSR3OfA resulted in significantly improved coverage compared to PL for selected patients. CONCLUSION The proposed PL approach resulted in overall reduced NTCPs compared to fSR3 and fSR3OfA at limited cost in target coverage.
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Mohamed N, Lee A, Lee NY. Proton beam radiation therapy treatment for head and neck cancer. PRECISION RADIATION ONCOLOGY 2021. [DOI: 10.1002/pro6.1135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Nader Mohamed
- Department of Radiation Oncology Memorial Sloan Kettering Cancer Center New York NY USA
| | - Anna Lee
- Department of Radiation Oncology The University of Texas MD Anderson Cancer Center Houston TX USA
| | - Nancy Y. Lee
- Department of Radiation Oncology Memorial Sloan Kettering Cancer Center New York NY USA
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Zhou Y, Li Y, Kubota Y, Sakai M, Ohno T. Robust Angle Selection in Particle Therapy. Front Oncol 2021; 11:715025. [PMID: 34621672 PMCID: PMC8490826 DOI: 10.3389/fonc.2021.715025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/19/2021] [Indexed: 11/13/2022] Open
Abstract
The popularity of particle radiotherapy has grown exponentially over recent years owing to the marked advantage of the depth–dose curve and its unique biological property. However, particle therapy is sensitive to changes in anatomical structure, and the dose distribution may deteriorate. In particle therapy, robust beam angle selection plays a crucial role in mitigating inter- and intrafractional variation, including daily patient setup uncertainties and tumor motion. With the development of a rotating gantry, angle optimization has gained increasing attention. Currently, several studies use the variation in the water equivalent thickness to quantify anatomical changes during treatment. This method seems helpful in determining better beam angles and improving the robustness of planning. Therefore, this review will discuss and summarize the robust beam angles at different tumor sites in particle radiotherapy.
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Affiliation(s)
- Yuan Zhou
- Department of Radiation Oncology, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Yang Li
- Gunma University Heavy Ion Medical Center, Gunma University, Maebashi, Japan.,Department of Radiation Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yoshiki Kubota
- Gunma University Heavy Ion Medical Center, Gunma University, Maebashi, Japan
| | - Makoto Sakai
- Gunma University Heavy Ion Medical Center, Gunma University, Maebashi, Japan
| | - Tatsuya Ohno
- Department of Radiation Oncology, Graduate School of Medicine, Gunma University, Maebashi, Japan.,Gunma University Heavy Ion Medical Center, Gunma University, Maebashi, Japan
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Gordon KB, Smyk DI, Gulidov IA. Proton Therapy in Head and Neck Cancer Treatment: State of the Problem and Development Prospects (Review). Sovrem Tekhnologii Med 2021; 13:70-80. [PMID: 34603766 PMCID: PMC8482826 DOI: 10.17691/stm2021.13.4.08] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Indexed: 11/24/2022] Open
Abstract
Proton therapy (PT) due to dosimetric characteristics (Bragg peak formation, sharp dose slowdown) is currently one of the most high-tech techniques of radiation therapy exceeding the standards of photon methods. In recent decades, PT has traditionally been used, primarily, for head and neck cancers (HNC) including skull base tumors. Regardless of the fact that recently PT application area has significantly expanded, HNC still remain a leading indication for proton radiation since PT’s physic-dosimetric and radiobiological advantages enable to achieve the best treatment results in these tumors. The present review is devoted to PT usage in HNC treatment in the world and Russian medicine, the prospects for further technique development, the assessment of PT’s radiobiological features, a physical and dosimetric comparison of protons photons distribution. The paper shows PT’s capabilities in the treatment of skull base tumors, HNC (nasal cavity, paranasal sinuses, nasopharynx, oropharynx, and laryngopharynx, etc.), eye tumors, sialomas. The authors analyze the studies on repeated radiation and provide recent experimental data on favorable profile of proton radiation compared to the conventional radiation therapy. The review enables to conclude that currently PT is a dynamic radiation technique opening up new opportunities for improving therapy of oncology patients, especially those with HNC.
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Affiliation(s)
- K B Gordon
- Senior Researcher, Proton Therapy Department; A. Tsyb Medical Radiological Research Centre - Branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, 4 Koroleva St., Kaluga Region, Obninsk, 249036, Russia
| | - D I Smyk
- Junior Researcher, Proton Therapy Department; A. Tsyb Medical Radiological Research Centre - Branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, 4 Koroleva St., Kaluga Region, Obninsk, 249036, Russia
| | - I A Gulidov
- Professor, Head of the Proton Therapy Department; A. Tsyb Medical Radiological Research Centre - Branch of the National Medical Research Radiological Centre of the Ministry of Health of the Russian Federation, 4 Koroleva St., Kaluga Region, Obninsk, 249036, Russia
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Narita Y, Kato T, Ono T, Oyama S, Yamazaki Y, Ouchi H, Takemasa K, Murakami M. Trend analysis of the dosimetric impact of anatomical changes during proton therapy for maxillary sinus carcinoma. J Appl Clin Med Phys 2021; 22:298-306. [PMID: 34402579 PMCID: PMC8425936 DOI: 10.1002/acm2.13391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/25/2021] [Accepted: 07/28/2021] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Anatomical changes, such as shrinkage and aeration, can affect dose distribution in proton therapy (PT) for maxillary sinus carcinoma (MSC). These changes can affect the dose to the target and organs at risk (OARs); however, when these changes occur during PT is unclear. This study aimed to investigate the dosimetric impact of anatomical changes during PT. MATERIALS AND METHODS Fifteen patients with MSC were enrolled in this study. Initial PT plans were generated based on initial computed tomography (CT) images. Several repeat CT images were obtained to confirm anatomical changes during PT. Evaluation PT plans were generated by copying initial PT plans to repeat CT images. The dose differences of the target and OARs were evaluated by comparing both the plans. RESULTS At 3-4 weeks after the initiation of PT, the target volume reduced by approximately 10% as compared with the initial volume. Consequently, the target volumes gradually varied until the end of treatment. The value of V95 (volume that received 95% of the prescription dose) in the clinical target volume of the evaluation PT plan was similar to that of the initial PT plan. However, the dose to OARs, such as the contralateral optic nerve, contralateral eyeball, brainstem, and optic chiasm, increased significantly from the middle to the later phases of the treatment course. In contrast, there was a slight dose difference in the ipsilateral optic apparatus. CONCLUSION The trend analysis in this study showed that anatomical changes appeared 3-4 weeks after the start of PT, and the dose to the OARs tended to increase. Therefore, it is recommended to check the status of tumor 3-4 weeks after the start of treatment to avoid the deterioration of dose distribution due to these changes.
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Affiliation(s)
- Yuki Narita
- Department of Radiation Physics and Technology, Southern TOHOKU Proton Therapy Center, Koriyama, Japan
| | - Takahiro Kato
- Department of Radiation Physics and Technology, Southern TOHOKU Proton Therapy Center, Koriyama, Japan.,School of Health Sciences, Fukushima Medical University, Fukushima, Japan
| | - Takashi Ono
- Department of Radiation Oncology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Sho Oyama
- Department of Radiation Physics and Technology, Southern TOHOKU Proton Therapy Center, Koriyama, Japan
| | - Yuhei Yamazaki
- Department of Radiation Physics and Technology, Southern TOHOKU Proton Therapy Center, Koriyama, Japan
| | - Hisao Ouchi
- Department of Radiation Physics and Technology, Southern TOHOKU Proton Therapy Center, Koriyama, Japan
| | - Kimihiro Takemasa
- Department of Radiation Physics and Technology, Southern TOHOKU Proton Therapy Center, Koriyama, Japan
| | - Masao Murakami
- Department of Radiation Oncology, Southern TOHOKU Proton Therapy Center, Koriyama, Japan
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Damico NJ, Wu AK, Kharouta MZ, Eitan T, Pidikiti R, Jesseph FB, Smith M, Langmack C, Mattson DL, Dobbins D, Mansur DB, Machtay MX, Dorth JA, Choi S, Yao M, Bhatt AD. Proton Beam Therapy in the Treatment of Periorbital Malignancies. Int J Part Ther 2021; 7:42-51. [PMID: 33829072 PMCID: PMC8019573 DOI: 10.14338/ijpt-20-00025.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 01/05/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose Periorbital tumor location presents a significant challenge with 3-dimensional conformal radiation therapy or intensity modulated radiation therapy due to high tumor dose needed in the setting of close proximity to orbital structures with lower tolerance. Proton beam therapy (PBT) is felt to be an effective modality in such cases due to its sharp dose gradient. Materials and Methods We reviewed our institutional PBT registry and identified 17 patients with tumor epicenters within 2 cm of the eye and optic apparatus treated with passive scatter PBT with comparison volumetric arc therapy plans available. Maximum and mean doses to organs at risk of interest, including optic nerves, optic chiasm, lens, eye ball, pituitary, cochlea, lacrimal gland, and surrounding brain, were compared using the paired Wilcoxon signed rank test. Overall survival was determined using the Kaplan-Meier method. Results Median age was 67. Median follow-up was 19.7 months. Fourteen patients underwent upfront resection and received postoperative radiation and 3 received definitive radiation. One patient received elective neck radiation, 2 underwent reirradiation, and 3 had concurrent chemotherapy. There was a statistically significant reduction in mean dose to the optic nerves and chiasm, brain, pituitary gland, lacrimal glands, and cochlea as well as in the maximum dose to the optic nerves and chiasm, pituitary gland, lacrimal glands, and cochlea with PBT. The 18-month cumulative incidence of local failure was 19.1% and 1-year overall survival was 80.9%. Conclusion Proton beam therapy resulted in significant dose reductions to several periorbital and optic structures compared with volumetric arc therapy. Proton beam therapy appears to be the optimal radiation modality in such cases to minimize risk of toxicity to periorbital organs at risk.
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Affiliation(s)
- Nicholas J Damico
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Anna K Wu
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Michael Z Kharouta
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Tal Eitan
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Rajesh Pidikiti
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Frederick B Jesseph
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Mark Smith
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Christian Langmack
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Diana L Mattson
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Donald Dobbins
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - David B Mansur
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Mitchell X Machtay
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Jennifer A Dorth
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Serah Choi
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Min Yao
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH, USA
| | - Aashish D Bhatt
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH, USA
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11
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Sharma M, Argota Perez R, Holm A, Korreman S, Jensen K, Elstrøm U, Grau C. Air variability in maxillary sinus during radiotherapy for sinonasal carcinoma. Clin Transl Radiat Oncol 2021; 27:36-43. [PMID: 33490653 PMCID: PMC7809099 DOI: 10.1016/j.ctro.2020.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/26/2020] [Accepted: 12/28/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The aim was to characterise patterns and predictability of aeration changes in the ipsilateral maxillary sinus during intensity-modulated radiotherapy (IMRT) for sinonasal cancer (SNC), and in a sample evaluate the dosimetric effects of aeration changes for both photon and proton therapy. MATERIALS AND METHODS The study included patients treated with IMRT for SNC in a single institution in 2009-2017. The volume of air in the ipsilateral maxillary sinus was recorded in 1578 daily cone beam computer tomography (CBCT) from 53 patients. Patterns of changing air volumes were categorised as 'stable', increasing', 'decreasing', or 'erratic'. For the prediction analysis, categorisation was performed based both on the entire treatment course and the first five fractions (F1-5). Photon and proton therapy plans were generated for four patients, the one from each category with the largest aeration variation. Synthetic CT images were generated for each CBCT and all plans were recalculated on the daily synthetic CTs. RESULTS The absolute volume of air varied considerably during the treatment course, ranging from 0 to 25.9 cm3. Changes within a single participant varied in the range of 0-18.7 cm3. In the categorisation of patterns, most patients had increasing aeration of the sinus. Generally, patterns of aeration could not be predicted from F1-5. Patients categorised as increasing in F1-5 had the best prediction, with 78% predicted correctly as increasing for the entire treatment course. The numeric correlation coefficients for target coverage and air volume were low for 3/4 scenarios (photons 0.03-0.23, protons 0.26-0.48). No straightforward correlation between the dosimetric effect and the volume changes could be detected in the sample test of four patients for neither photon nor proton therapy. CONCLUSION The variation of aeration was large and unpredictable. No clear dosimetric consequences of the aeration variation were evident for neither IMRT nor proton therapy for the patients investigated.
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Affiliation(s)
- M.B. Sharma
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - R. Argota Perez
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - A.I.S. Holm
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - S.S. Korreman
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - K. Jensen
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - U.V. Elstrøm
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - C. Grau
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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12
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Li X, Lee A, Cohen MA, Sherman EJ, Lee NY. Past, present and future of proton therapy for head and neck cancer. Oral Oncol 2020; 110:104879. [PMID: 32650256 DOI: 10.1016/j.oraloncology.2020.104879] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 06/22/2020] [Indexed: 12/17/2022]
Abstract
Proton therapy has recently gained substantial momentum worldwide due to improved accessibility to the technology and sustained interests in its advantage of better tissue sparing compared to traditional photon radiation. Proton therapy in head and neck cancer has a unique advantage given the complex anatomy and proximity of targets to vital organs. As head and neck cancer patients are living longer due to epidemiological shifts and advances in treatment options, long-term toxicity from radiation treatment has become a major concern that may be better mitigated by proton therapy. With increased utilization of proton therapy, new proton centers breaking ground, and as excitement about the technology continue to increase, we aim to comprehensively review the evidence of proton therapy in major subsites within the head and neck, hoping to facilitate a greater understanding of the full risks and benefits of proton therapy for head and neck cancer.
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Affiliation(s)
- Xingzhe Li
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, United States
| | - Anna Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, United States
| | - Marc A Cohen
- Department of Surgery, Memorial Sloan Kettering Cancer Center, United States
| | - Eric J Sherman
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, United States
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, United States.
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13
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Li G, Qiu B, Huang YX, Doyen J, Bondiau PY, Benezery K, Xia YF, Qian CN. Cost-effectiveness analysis of proton beam therapy for treatment decision making in paranasal sinus and nasal cavity cancers in China. BMC Cancer 2020; 20:599. [PMID: 32590957 PMCID: PMC7320568 DOI: 10.1186/s12885-020-07083-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/16/2020] [Indexed: 02/03/2023] Open
Abstract
Background Cost-effectiveness is a pivotal consideration for clinical decision making of high-tech cancer treatment in developing countries. Intensity-modulated proton radiation therapy (IMPT, the advanced form of proton beam therapy) has been found to improve the prognosis of the patients with paranasal sinus and nasal cavity cancers compared with intensity-modulated photon-radiation therapy (IMRT). However, the cost-effectiveness of IMPT has not yet been fully evaluated. This study aimed at evaluating the cost-effectiveness of IMPT versus IMRT for treatment decision making of paranasal sinus and nasal cavity cancers in Chinese settings. Methods A 3-state Markov model was designed for cost-effectiveness analysis. A base case evaluation was performed on a patient of 47-year-old (median age of patients with paranasal sinus and nasal cavity cancers in China). Model robustness was examined by probabilistic sensitivity analysis, Markov cohort analysis and Tornado diagram. Cost-effective scenarios of IMPT were further identified by one-way sensitivity analyses and stratified analyses were performed for different age levels. The outcome measure of the model was the incremental cost-effectiveness ratio (ICER). A strategy was defined as cost-effective if the ICER was below the societal willingness-to-pay (WTP) threshold of China (30,828 US dollars ($) / quality-adjusted life year (QALY)). Results IMPT was identified as being cost-effective for the base case at the WTP of China, providing an extra 1.65 QALYs at an additional cost of $38,928.7 compared with IMRT, and had an ICER of $23,611.2 / QALY. Of note, cost-effective scenarios of IMPT only existed in the following independent conditions: probability of IMPT eradicating cancer ≥0.867; probability of IMRT eradicating cancer ≤0.764; or cost of IMPT ≤ $52,163.9. Stratified analyses for different age levels demonstrated that IMPT was more cost-effective in younger patients than older patients, and was cost-effective only in patients ≤56-year-old. Conclusions Despite initially regarded as bearing high treatment cost, IMPT could still be cost-effective for patients with paranasal sinus and nasal cavity cancers in China. The tumor control superiority of IMPT over IMRT and the patient’s age should be the principal considerations for clinical decision of prescribing this new irradiation technique.
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Affiliation(s)
- Guo Li
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, Guangdong, 510095, P. R. China
| | - Bo Qiu
- State Key Laboratory of Oncology in South China, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P. R. China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China
| | - Yi-Xiang Huang
- Department of Health Management, Public Health Institute of Sun Yat-sen University, Guangzhou, Guangdong, 510000, P. R. China
| | - Jerome Doyen
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, 06189, Nice, France.,Mediterranean Institute of Proton Therapy, Antoine Lacassagne Cancer Center, University of Nice-Sophia, 06200, Nice, France
| | - Pierre-Yves Bondiau
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, 06189, Nice, France.,Mediterranean Institute of Proton Therapy, Antoine Lacassagne Cancer Center, University of Nice-Sophia, 06200, Nice, France
| | - Karen Benezery
- Department of Radiation Oncology, Antoine Lacassagne Cancer Center, University of Nice-Sophia, 06189, Nice, France.,Mediterranean Institute of Proton Therapy, Antoine Lacassagne Cancer Center, University of Nice-Sophia, 06200, Nice, France
| | - Yun-Fei Xia
- State Key Laboratory of Oncology in South China, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P. R. China.,Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, P. R. China
| | - Chao-Nan Qian
- State Key Laboratory of Oncology in South China, 651 Dongfeng East Road, Guangzhou, Guangdong, 510060, P. R. China. .,Department of Radiation Oncology, Guangzhou Concord Cancer Center, Guangzhou, Guangdong, 510045, P. R. China.
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14
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Shusharina N, Fullerton B, Adams JA, Sharp GC, Chan AW. Impact of aeration change and beam arrangement on the robustness of proton plans. J Appl Clin Med Phys 2019; 20:14-21. [PMID: 30756466 PMCID: PMC6414139 DOI: 10.1002/acm2.12503] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 09/10/2018] [Accepted: 10/18/2018] [Indexed: 11/16/2022] Open
Abstract
This study determines the impact of change in aeration in sinonasal cavities on the robustness of passive‐scattering proton therapy plans in patients with sinonasal and nasopharyngeal malignancies. Fourteen patients, each with one planning CT and one CT acquired during radiotherapy were studied. Repeat and planning CTs were rigidly aligned and contours were transferred using deformable registration. The amount of air, tumor, and fluid within the cavity containing the tumor were measured on both CTs. The original plans were recalculated on the repeat CT. Dosimetric changes were measured for the targets and critical structures. Median decrease in gross tumor volume (GTV) was 19.8% and correlated with the time of rescan. The median change in air content was 7.1% and correlated with the tumor shrinkage. The median of the mean dose Dmean change was +0.4% for GTV and +0.3% for clinical target volume. Median change in the maximum dose Dmax of the critical structures were as follows: optic chiasm +0.66%, left optic nerve +0.12%, right optic nerve +0.38%, brainstem +0.6%. The dose to the GTV decreased by more than 5% in 1 case, and the dose to critical structure(s) increased by more than 5% in three cases. These four patients had sinonasal cancers and were treated with anterior proton fields that directly transversed through the involved sinus cavities. The change in dose in the replanning was strongly correlated with the change in aeration (P = 0.02). We found that the change in aeration in the vicinity of the target and the arrangement of proton beams affected the robustness of proton plan.
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Affiliation(s)
- Nadya Shusharina
- Department of Radiation OncologyMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
| | - Barbara Fullerton
- Department of Radiation OncologyMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
- Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryHarvard Medical SchoolBostonMAUSA
| | - Judy A. Adams
- Department of Radiation OncologyMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
| | - Gregory C. Sharp
- Department of Radiation OncologyMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
| | - Annie W. Chan
- Department of Radiation OncologyMassachusetts General HospitalHarvard Medical SchoolBostonMAUSA
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15
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Narita Y, Kato T, Ono T, Oyama S, Komori S, Arai K, Abe Y, Harada T, Nakamura T, Wada H, Kikuchi Y, Murakami M, Hosokawa Y. Effect of anatomical change on dose distribution during radiotherapy for maxillary sinus carcinoma: passive scattering proton therapy versus volumetric-modulated arc therapy. Br J Radiol 2019; 92:20180273. [PMID: 30281327 PMCID: PMC6435060 DOI: 10.1259/bjr.20180273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 09/14/2018] [Accepted: 10/01/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Maxillary sinus carcinomas are anatomically situated next to many organs at risk (OARs), and anatomical change is often observed during radiotherapy. We analyzed the effect of anatomical change on dose distribution of passive scattering proton therapy (PSPT) and volumetric-modulated arc therapy (VMAT) for 20 patients. METHODS The first plans were generated based on the first CT images. The second CT images were acquired after 3 weeks, and the second plans were generated by copying the first plans to the second CT images. The effect of anatomical change was estimated by comparing both plans. RESULTS Target volume change was observed in all cases, however, the influence on dose coverage of clinical target volume tended to be small. Alternatively, the doses to almost all OARs were increased. In particular, the increase in the dose to brainstem (p < 0.001) and optic chiasm (p < 0.001) was significantly higher in the second PSPT plan than in the first PSPT plan. Although PSPT is sensitive to anatomical change, the dose to OARs remained significantly lower in PSPT plans than that in VMAT plans. CONCLUSION PSPT was confirmed to be more effective than VMAT even the effect of anatomical change was taken into account. Therefore, it is expected that the contralateral vision can be preserved reliably while optimal target coverage is provided. ADVANCES IN KNOWLEDGE PSPT allowed significant sparing of OARs even in the result of the second plans affected by the anatomical change. PSPT offers benefits over VMAT in reducing dose to several OARs.
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Affiliation(s)
| | | | - Takashi Ono
- Departmentof Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Sho Oyama
- Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Shinya Komori
- Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Kazuhiro Arai
- Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Yoshitomo Abe
- Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Takaomi Harada
- Department of Radiation Physics and Technology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Tatsuya Nakamura
- Departmentof Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Hitoshi Wada
- Departmentof Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Yasuhiro Kikuchi
- Departmentof Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Masao Murakami
- Departmentof Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Japan
| | - Yoichiro Hosokawa
- Department of Radiological Life Sciences, Division of Medical Life Sciences, Hirosaki University Graduate School of Health Sciences, Hirosaki, Aomori, Japan
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16
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Busch K, Muren LP, Thörnqvist S, Andersen AG, Pedersen J, Dong L, Petersen JBB. On-line dose-guidance to account for inter-fractional motion during proton therapy. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2018; 9:7-13. [PMID: 33458420 PMCID: PMC7807653 DOI: 10.1016/j.phro.2018.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 11/26/2018] [Indexed: 11/13/2022]
Abstract
Background and purpose Proton therapy (PT) of extra-cranial tumour sites is challenged by density changes caused by inter-fractional organ motion. In this study we investigate on-line dose-guided PT (DGPT) to account inter-fractional target motion, exemplified by internal motion in the pelvis. Materials and methods On-line DGPT involved re-calculating dose distributions with the isocenter shifted up to 15 mm from the position corresponding to conventional soft-tissue based image-guided PT (IGPT). The method was applied to patient models with simulated prostate/seminal vesicle target motion of ±3, ±5 and ±10 mm along the three cardinal axes. Treatment plans were created using either two lateral (gantry angles of 90°/270°) or two lateral oblique fields (gantry angles of 35°/325°). Target coverage and normal tissue doses from DGPT were compared to both soft-tissue and bony anatomy based IGPT. Results DGPT improved the dose distributions relative to soft-tissue based IGPT for 39 of 90 simulation scenarios using lateral fields and for 50 of 90 scenarios using lateral oblique fields. The greatest benefits of DGPT were seen for large motion, e.g. a median target coverage improvement of 13% was found for 10 mm anterior motion with lateral fields. DGPT also improved the dose distribution in comparison to bony anatomy IGPT in all cases. The best strategy was often to move the fields back towards the original target position prior to the simulated target motion. Conclusion DGPT has the potential to better account for large inter-fractional organ motion in the pelvis than IGPT.
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Affiliation(s)
- Kia Busch
- Department of Medical Physics, Aarhus University Hospital/Aarhus University, Aarhus, Denmark
| | - Ludvig P Muren
- Department of Medical Physics, Aarhus University Hospital/Aarhus University, Aarhus, Denmark
| | - Sara Thörnqvist
- Department of Physics and Technology, University of Bergen, Norway.,Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | - Andreas G Andersen
- Department of Medical Physics, Aarhus University Hospital/Aarhus University, Aarhus, Denmark
| | - Jesper Pedersen
- Department of Medical Physics, Aarhus University Hospital/Aarhus University, Aarhus, Denmark
| | - Lei Dong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, USA
| | - Jørgen B B Petersen
- Department of Medical Physics, Aarhus University Hospital/Aarhus University, Aarhus, Denmark
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17
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Blanchard P, Gunn GB, Lin A, Foote RL, Lee NY, Frank SJ. Proton Therapy for Head and Neck Cancers. Semin Radiat Oncol 2018; 28:53-63. [PMID: 29173756 DOI: 10.1016/j.semradonc.2017.08.004] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Because of its sharp lateral penumbra and steep distal fall-off, proton therapy offers dosimetric advantages over photon therapy. In head and neck cancer, proton therapy has been used for decades in the treatment of skull-base tumors. In recent years the use of proton therapy has been extended to numerous other disease sites, including nasopharynx, oropharynx, nasal cavity and paranasal sinuses, periorbital tumors, skin, and salivary gland, or to reirradiation. The aim of this review is to present the physical properties and dosimetric benefit of proton therapy over advanced photon therapy; to summarize the clinical benefit described for each disease site; and to discuss issues of patient selection and cost-effectiveness.
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Affiliation(s)
- Pierre Blanchard
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Gary Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Alexander Lin
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
| | - Robert L Foote
- Departments of Radiation Oncology, Mayo Clinic, Rochester, MN
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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18
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van de Water S, Albertini F, Weber DC, Heijmen BJM, Hoogeman MS, Lomax AJ. Anatomical robust optimization to account for nasal cavity filling variation during intensity-modulated proton therapy: a comparison with conventional and adaptive planning strategies. Phys Med Biol 2018; 63:025020. [PMID: 29160775 DOI: 10.1088/1361-6560/aa9c1c] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The aim of this study is to develop an anatomical robust optimization method for intensity-modulated proton therapy (IMPT) that accounts for interfraction variations in nasal cavity filling, and to compare it with conventional single-field uniform dose (SFUD) optimization and online plan adaptation. We included CT data of five patients with tumors in the sinonasal region. Using the planning CT, we generated for each patient 25 'synthetic' CTs with varying nasal cavity filling. The robust optimization method available in our treatment planning system 'Erasmus-iCycle' was extended to also account for anatomical uncertainties by including (synthetic) CTs with varying patient anatomy as error scenarios in the inverse optimization. For each patient, we generated treatment plans using anatomical robust optimization and, for benchmarking, using SFUD optimization and online plan adaptation. Clinical target volume (CTV) and organ-at-risk (OAR) doses were assessed by recalculating the treatment plans on the synthetic CTs, evaluating dose distributions individually and accumulated over an entire fractionated 50 GyRBE treatment, assuming each synthetic CT to correspond to a 2 GyRBE fraction. Treatment plans were also evaluated using actual repeat CTs. Anatomical robust optimization resulted in adequate CTV doses (V95% ⩾ 98% and V107% ⩽ 2%) if at least three synthetic CTs were included in addition to the planning CT. These CTV requirements were also fulfilled for online plan adaptation, but not for the SFUD approach, even when applying a margin of 5 mm. Compared with anatomical robust optimization, OAR dose parameters for the accumulated dose distributions were on average 5.9 GyRBE (20%) higher when using SFUD optimization and on average 3.6 GyRBE (18%) lower for online plan adaptation. In conclusion, anatomical robust optimization effectively accounted for changes in nasal cavity filling during IMPT, providing substantially improved CTV and OAR doses compared with conventional SFUD optimization. OAR doses can be further reduced by using online plan adaptation.
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Affiliation(s)
- Steven van de Water
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Groene Hilledijk 301, 3075 EA Rotterdam, Netherlands. Author to whom any correspondence should be addressed
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19
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Blanchard P, Frank SJ. [Proton therapy for head and neck cancers]. Cancer Radiother 2017; 21:515-520. [PMID: 28869195 DOI: 10.1016/j.canrad.2017.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/27/2017] [Accepted: 06/30/2017] [Indexed: 12/23/2022]
Abstract
The absence of exit dose and the sharp lateral penumbra are key assets for proton therapy, which are responsible for its dosimetric superiority over advanced photon radiotherapy. Dosimetric comparisons have consistently shown a reduction of the integral dose and the dose to organs at risk favouring intensity-modulated proton therapy (IMPT) over intensity-modulated radiotherapy (IMRT). The structures that benefit the most of these dosimetric improvements in head and neck cancers are the anterior oral cavity, the posterior fossa, the visual apparatus and swallowing structures. A number of publications have concluded that these dosimetric differences actually translate into reduced toxicities with IMPT, for example with regards to reduced weight loss or need for feeding tube. Patient survival is usually similar to IMRT series, except in base of skull or sinonasal malignancies, where a survival advantage of IMPT could exist. The goals of the present review is to describe the major characteristics of proton therapy, to analyse the clinical data with regards to head and neck cancer patients, and to highlight the issue of patient selection and physical and biological uncertainties.
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Affiliation(s)
- P Blanchard
- Department of radiation oncology, MD Anderson cancer center, the university of Texas, Houston, Texas, États-Unis; Département de radiothérapie, Gustave-Roussy cancer campus, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
| | - S J Frank
- Department of radiation oncology, MD Anderson cancer center, the university of Texas, Houston, Texas, États-Unis
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20
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Dionisi F, Amichetti M, Algranati C, Giacomelli I, Barbareschi M, Recla M, Grandi C. Unresectable Ameloblastoma Successfully Treated with Definitive Proton Therapy. Int J Part Ther 2017; 4:7-13. [PMID: 31773001 DOI: 10.14338/ijpt-17-00008.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 07/06/2017] [Indexed: 11/21/2022] Open
Abstract
We report the case of an 87-year-old man affected by an unresectable ameloblastoma of the right jaw that was successfully treated by definitive proton therapy up to a dose of 66 Gy in 33 fractions. Treatment was well tolerated, and there were no interruptions due to toxicity. At follow-up visits, the patient experienced complete response to treatment with no evidence of disease and complete recovery from acute side effects. In this report, we discuss the potential and possible pitfalls of proton therapy in the treatment of specific settings.
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Affiliation(s)
- Francesco Dionisi
- Proton Therapy Unit, Department of Oncology, Ospedale di Trento, Trento, Italy
| | - Maurizio Amichetti
- Proton Therapy Unit, Department of Oncology, Ospedale di Trento, Trento, Italy
| | - Carlo Algranati
- Proton Therapy Unit, Department of Medical Physics, Ospedale di Trento, Trento, Italy
| | - Irene Giacomelli
- Proton Therapy Unit, Department of Oncology, Ospedale di Trento, Trento, Italy
| | | | - Mauro Recla
- Department of Radiology Ospedale di Trento, Trento, Italy
| | - Cesare Grandi
- Department of Otolaryngology, Ospedale di Trento, Trento, Italy
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21
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Nasal cavity reirradiation: a challenging case for comparison between proton therapy and volumetric modulated arc therapy. TUMORI JOURNAL 2016; 102:A6DF1426-AF24-4888-B649-D36586F88FA5. [PMID: 26166226 DOI: 10.5301/tj.5000375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND The aim of this case report is to report on a dosimetric comparison between volumetric modulated arc therapy (RapidArc technique and active scanning proton therapy (single-field (SFO) and multifield (MFO) techniques) in a case of nasal cavity cancer recurrence. CASE REPORT A 72-year-old man, who received adjuvant radiotherapy for a carcinoma of the nasal cavity, experienced an unresectable local recurrence in the previous surgical bed. Hence, the patient was evaluated for reirradiation by comparing different modalities, with a total prescribed dose of 50 Gy in standard fractionation. RA plan was revealed to be equivalent to the MFO plan in terms of target dose coverage and conformity index. SFO plan was not able to respect a maximum dose of 9 Gy to nervous structures, in contrast to RA and MFO plans. CONCLUSIONS In this challenging scenario, although a clear preference would be given to the MFO proton plan, the RA plan was revealed to be adequate for the clinical goal of target coverage and sparing of organs at risk.
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22
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Russo AL, Adams JA, Weyman EA, Busse PM, Goldberg SI, Varvares M, Deschler DD, Lin DT, Delaney TF, Chan AW. Long-Term Outcomes After Proton Beam Therapy for Sinonasal Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2016; 95:368-376. [PMID: 27084654 DOI: 10.1016/j.ijrobp.2016.02.042] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 02/10/2016] [Accepted: 02/11/2016] [Indexed: 01/09/2023]
Abstract
PURPOSE Squamous cell carcinoma (SCC) is the most common sinonasal cancer and is associated with one of the poor outcomes. Proton therapy allows excellent target coverage with maximal sparing of adjacent normal tissues. We evaluated the long-term outcomes in patients with sinonasal SCC treated with proton therapy. METHODS AND MATERIALS Between 1991 and 2008, 54 patients with Stage III and IV SCC of the nasal cavity and paranasal sinus received proton beam therapy at our institution to a median dose of 72.8 Gy(RBE). Sixty-nine percent underwent prior surgical resection, and 74% received elective nodal radiation. Locoregional control and survival probabilities were estimated with the Kaplan-Meier method. Multivariate analyses were performed using the Cox proportional-hazards model. Treatment toxicity was scored using the Common Terminology Criteria for Adverse Events version 4.0. RESULTS With a median follow-up time of 82 months in surviving patients, there were 10 local, 7 regional, and 11 distant failures. The 2-year and 5-year actuarial local control rate was 80%. The 2-year and 5-year rates of overall survival were 67% and 47%, respectively. Only smoking status was predictive for worse locoregional control, with current smokers having a 5-year rate of 23% compared with 83% for noncurrent smokers (P=.004). Karnofsky performance status ≤80 was the most significant factor predictive for worse overall survival in multivariate analysis (adjusted hazard ratio 4.5, 95% confidence interval 1.6-12.5, P=.004). There were nine grade 3 and six grade 4 toxicities, and no grade 5 toxicity. Wound adverse events constituted the most common grade 3-4 toxicity. CONCLUSIONS Our long-term results show that proton radiation therapy is well tolerated and yields good locoregional control for SCC of the nasal cavity and paranasal sinus. Current smokers and patients with poor performance status had inferior outcomes. Prospective study is necessary to compare IMRT with proton therapy in the treatment of sinonasal malignancy.
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Affiliation(s)
- Andrea L Russo
- Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Judith A Adams
- Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Elizabeth A Weyman
- Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Paul M Busse
- Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Saveli I Goldberg
- Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Mark Varvares
- Head and Neck Surgical Oncology, Massachusetts Eye and Ear Infirmary; Harvard Medical School, Boston, Massachusetts
| | - Daniel D Deschler
- Head and Neck Surgical Oncology, Massachusetts Eye and Ear Infirmary; Harvard Medical School, Boston, Massachusetts
| | - Derrick T Lin
- Head and Neck Surgical Oncology, Massachusetts Eye and Ear Infirmary; Harvard Medical School, Boston, Massachusetts
| | - Thomas F Delaney
- Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Annie W Chan
- Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
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23
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Thomson DJ, Teo BKK, Ong A, Ang KW, Kirk M, Ahn PH, Lukens JN, Swisher-McClure S, Liptrot T, Solberg TD, Slevin NJ, Lin A. The Impact of Anatomic Change on Pencil Beam Scanning in the Treatment of Oropharynx Cancer. Int J Part Ther 2015. [DOI: 10.14338/ijpt-15-00002.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- David J. Thomson
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- University of Manchester, Institute of Cancer Sciences, Manchester, United Kingdom
| | - Boon-Keng Kevin Teo
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ashley Ong
- National Cancer Centre Singapore, Singapore
| | | | - Maura Kirk
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter H. Ahn
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - John N. Lukens
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Tom Liptrot
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Timothy D. Solberg
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Nick J. Slevin
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Alexander Lin
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| |
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