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Fossati P, Perpar A, Stock M, Georg P, Carlino A, Gora J, Martino G, Hug EB. Carbon Ion Dose Constraints in the Head and Neck and Skull Base: Review of MedAustron Institutional Protocols. Int J Part Ther 2021; 8:25-35. [PMID: 34285933 PMCID: PMC8270085 DOI: 10.14338/ijpt-20-00093.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/16/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Dose constraints are of paramount importance for the outcome of any radiotherapy treatment. In this article, we report dose-volume constraints as well as currently used fractionation schedules for carbon ion radiotherapy as applied in MedAustron (Wiener Neustadt, Austria). MATERIALS AND METHODS For fractionation schedules, both German and Japanese regimes were used. From the clinical experience of National Institute of Radiological Sciences (Chiba, Japan) and Heidelberg Ion Therapy (Heidelberg, Germany; formerly GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany) and the work by colleagues in Centro Nazionale Adroterapia Oncologica (Pavia, Italy) recalculating the dose from the microdosimetric kinetic model to the local effect model, we have set the dose constraints for critical organs of the head and neck area. Where no clinical data was available, an educated guess was made, based on data available from photon and proton series. RESULTS We report the constraints for the optic nerve and chiasm, brainstem, spinal cord, cochlea, brain parenchyma, salivary gland, eye and adnexa, and mandibular/maxillary bone; constraints are grouped based on a fractionation scheme (German versus Japanese) and the risk of toxicity (safe, low to middle, and middle to high). CONCLUSION We think validation of dose constraints should present a relevant part of the activity of any carbon ion radiotherapy facility, and we anticipate future multicentric, joint evaluations.
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Affiliation(s)
- Piero Fossati
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - Ana Perpar
- Oncology Institute Ljubljana, Ljubljana, Slovenia
| | - Markus Stock
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | - Petra Georg
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | | | - Joanna Gora
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | | | - Eugen B. Hug
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
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Abolfath R, Helo Y, Bronk L, Carabe A, Grosshans D, Mohan R. Renormalization of radiobiological response functions by energy loss fluctuations and complexities in chromosome aberration induction: deactivation theory for proton therapy from cells to tumor control. THE EUROPEAN PHYSICAL JOURNAL. D, ATOMIC, MOLECULAR, AND OPTICAL PHYSICS 2019; 73:64. [PMID: 39148557 PMCID: PMC11325099 DOI: 10.1140/epjd/e2019-90263-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 08/21/2018] [Indexed: 08/17/2024]
Abstract
We employ a multi-scale mechanistic approach built upon our recent phenomenological/computational methodologies [R. Abolfath et al., Sci. Rep. 7, 8340 (2017)] to investigate radiation induced cell toxicities and deactivation mechanisms as a function of linear energy transfer in hadron therapy. Our theoretical model consists of a system of Markov chains in microscopic and macroscopic spatio-temporal landscapes, i.e., stochastic birth-death processes of cells in millimeter-scale colonies that incorporates a coarse-grained driving force to account for microscopic radiation induced damage. The coupling, hence the driving force in this process, stems from a nano-meter scale radiation induced DNA damage that incorporates the enzymatic end-joining repair and mis-repair mechanisms. We use this model for global fitting of the high-throughput and high accuracy clonogenic cell-survival data acquired under exposure of the therapeutic scanned proton beams, the experimental design that considers γ-H2AX as the biological endpoint and exhibits maximum observed achievable dose and LET, beyond which the majority of the cells undergo collective biological deactivation processes. An estimate to optimal dose and LET calculated from tumor control probability by extension to ~106 cells per mm-size voxels is presented. We attribute the increase in degree of complexity in chromosome aberration to variabilities in the observed biological responses as the beam linear energy transfer (LET) increases, and verify consistency of the predicted cell death probability with the in vitro cell survival assay of approximately 100 non-small cell lung cancer (NSCLC) cells. The present model provides an interesting interpretation to variabilities in α and β indices via perturbative expansion of the cell survival fraction (SF) in terms of specific and lineal energies, z and y, corresponding to continuous transitions in pair-wise to ternary, quaternary and more complex recombination of broken chromosomes from the entrance to the end of the range of proton beam.
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Affiliation(s)
- Ramin Abolfath
- Department of Radiation Physics and Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 75031, USA
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Yusuf Helo
- Invicro, A Konica Minolta Company, London, UK
- Centre for Medical Image Computing and Department of Computer Science, University College London, London, UK
| | - Lawrence Bronk
- Department of Radiation Physics and Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 75031, USA
| | - Alejandro Carabe
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David Grosshans
- Department of Radiation Physics and Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 75031, USA
| | - Radhe Mohan
- Department of Radiation Physics and Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 75031, USA
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Vogin G, Wambersie A, Koto M, Ohno T, Uhl M, Fossati P, Balosso J. A step towards international prospective trials in carbon ion radiotherapy: investigation of factors influencing dose distribution in the facilities in operation based on a case of skull base chordoma. Radiat Oncol 2019; 14:24. [PMID: 30709366 PMCID: PMC6359776 DOI: 10.1186/s13014-019-1224-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 01/20/2019] [Indexed: 12/23/2022] Open
Abstract
Background Carbon ion radiotherapy (CIRT) has been delivered to more than 20,000 patients worldwide. International trials have been recommended in order to emphasize the actual benefits. The ULICE program (Union of Light Ion Centers in Europe) addressed the need for harmonization of CIRT practices. A comparative knowledge of the sources and magnitudes of uncertainties altering dose distribution and clinical effects during the whole CIRT procedure is required in that aim. Methods As part of ULICE WP2 task group, we sent a centrally reviewed questionnaire exploring candidate sources of uncertainties in dose deposition to the ten CIRT facilities in operation by February 2017. We aimed to explore native beam characterization, immobilization, anatomic data acquisition, target volumes and organs at risks delineation, treatment planning, dose delivery, quality assurance prior and during treatment. The responders had to consider the clinical case of a clival chordoma eligible for postoperative CIRT according to their clinical practice. With the results, our task group discussed ways to harmonize CIRT practices. Results We received 5 surveys from facilities that have treated 77% of the patients worldwide per November 2017. We pointed out the singularity of the facilities and beam delivery systems, a divergent definition of target volumes, the multiplicity of TPS and equieffective dose calculation approximations. Conclusion Multiple uncertainties affect equieffective dose definition, deposition and calculation in CIRT. Although it is not possible to harmonize all the steps of the CIRT planning between the centers, our working group proposed counter-measures addressing the improvable limitations.
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Affiliation(s)
- G Vogin
- Department of Radiation Oncology, Institut de Cancérologie de Lorraine, 6 avenue de bourgogne - CS 30519, 54519, Nancy, Vandoeuvre-les-Nancy Cedex, France. .,UMR 7365 CNRS-UL, IMoPA, Nancy, Vandoeuvre-les-Nancy Cedex, France.
| | - A Wambersie
- Institut de Recherche Expérimentale et Clinique (IREC), Molecular Imaging, Radiotherapy and Oncology (MIRO), University Clinics St Luc, Brussels, Belgium.,Université catholique de Louvain (UCL), Louvain-la-Neuve, Belgium
| | - M Koto
- Hospital of the National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Sciences and Technology, Chiba, Japan
| | - T Ohno
- Gunma University Heavy Ion Medical Center, Gunma University, Maebashi, Gunma, Japan
| | - M Uhl
- Universitätsklinik Heidelberg, Abteilung für Radioonkologie und Strahlentherapie, Heidelberg, Germany
| | - P Fossati
- EBG GmbH MedAustron, Wiener Neustadt, Austria.,Fondazione CNAO (Centro Nazionale di Adroterapia Oncologica), Pavia, Italy
| | - J Balosso
- Service de Cancérologie-Radiothérapie, Hôpital A.Michallon, CHU de Grenoble, Grenoble, France.,Université Grenoble Alpes, Grenoble, France.,Département de radiothérapie, Centre François Baclesse, Caen, France
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Grün R, Friedrich T, Traneus E, Scholz M. Is the dose‐averaged
LET
a reliable predictor for the relative biological effectiveness? Med Phys 2019; 46:1064-1074. [DOI: 10.1002/mp.13347] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/30/2018] [Accepted: 11/30/2018] [Indexed: 11/06/2022] Open
Affiliation(s)
- Rebecca Grün
- Department of Biophysics GSI Helmholtzzentrum für Schwerionenforschung GmbH Planckstr. 1 Darmstadt 64291 Germany
| | - Thomas Friedrich
- Department of Biophysics GSI Helmholtzzentrum für Schwerionenforschung GmbH Planckstr. 1 Darmstadt 64291 Germany
| | - Erik Traneus
- RaySearch Laboratories AB Sveavägen 44 Stockholm 111 34 Sweden
| | - Michael Scholz
- Department of Biophysics GSI Helmholtzzentrum für Schwerionenforschung GmbH Planckstr. 1 Darmstadt 64291 Germany
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Stewart RD, Carlson DJ, Butkus MP, Hawkins R, Friedrich T, Scholz M. A comparison of mechanism-inspired models for particle relative biological effectiveness (RBE). Med Phys 2018; 45:e925-e952. [PMID: 30421808 DOI: 10.1002/mp.13207] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 09/05/2018] [Accepted: 09/13/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND SIGNIFICANCE The application of heavy ion beams in cancer therapy must account for the increasing relative biological effectiveness (RBE) with increasing penetration depth when determining dose prescriptions and organ at risk (OAR) constraints in treatment planning. Because RBE depends in a complex manner on factors such as the ion type, energy, cell and tissue radiosensitivity, physical dose, biological endpoint, and position within and outside treatment fields, biophysical models reflecting these dependencies are required for the personalization and optimization of treatment plans. AIM To review and compare three mechanism-inspired models which predict the complexities of particle RBE for various ion types, energies, linear energy transfer (LET) values and tissue radiation sensitivities. METHODS The review of models and mechanisms focuses on the Local Effect Model (LEM), the Microdosimetric-Kinetic (MK) model, and the Repair-Misrepair-Fixation (RMF) model in combination with the Monte Carlo Damage Simulation (MCDS). These models relate the induction of potentially lethal double strand breaks (DSBs) to the subsequent interactions and biological processing of DSB into more lethal forms of damage. A key element to explain the increased biological effectiveness of high LET ions compared to MV x rays is the characterization of the number and local complexity (clustering) of the initial DSB produced within a cell. For high LET ions, the spatial density of DSB induction along an ion's trajectory is much greater than along the path of a low LET electron, such as the secondary electrons produced by the megavoltage (MV) x rays used in conventional radiation therapy. The main aspects of the three models are introduced and the conceptual similarities and differences are critiqued and highlighted. Model predictions are compared in terms of the RBE for DSB induction and for reproductive cell survival. RESULTS AND CONCLUSIONS Comparisons of the RBE for DSB induction and for cell survival are presented for proton (1 H), helium (4 He), and carbon (12 C) ions for the therapeutically most relevant range of ion beam energies. The reviewed models embody mechanisms of action acting over the spatial scales underlying the biological processing of potentially lethal DSB into more lethal forms of damage. Differences among the number and types of input parameters, relevant biological targets, and the computational approaches among the LEM, MK and RMF models are summarized and critiqued. Potential experiments to test some of the seemingly contradictory aspects of the models are discussed.
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Affiliation(s)
- Robert D Stewart
- Department of Radiation Oncology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356043, Seattle, WA, 98195, USA
| | - David J Carlson
- Department of Therapeutic Radiology, Yale University, New Haven, CT, USA
| | - Michael P Butkus
- Department of Therapeutic Radiology, Yale University, New Haven, CT, USA
| | - Roland Hawkins
- Radiation Oncology Center, Ochsner Clinic Foundation, New Orleans, LA, 70121, USA
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Vogin G, Wambersie A, Pötter R, Beuve M, Combs SE, Magrin G, Mayer R, Mock U, Sarrut D, Schreiner T, Fossati P, Balosso J. Concepts and terms for dose/volume parameters in carbon-ion radiotherapy: Conclusions of the ULICE taskforce. Cancer Radiother 2018; 22:802-809. [PMID: 30327228 DOI: 10.1016/j.canrad.2017.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 11/24/2017] [Accepted: 11/29/2017] [Indexed: 01/24/2023]
Abstract
PURPOSE The Union of Light Ion Centers in Europe (ULICE) program addressed the need for uniting scientific results for carbon-ion radiation therapy obtained by several institutions worldwide in different fields of excellence, and translating them into a real benefit to the community. Particularly, the concepts for dose/volume parameters developed in photon radiotherapy cannot be extrapolated to high linear energy transfer particles. METHODS AND MATERIALS The ULICE-WP2 taskforce included radiation oncologists involved in carbon-ion radiation therapy and International Commission on Radiation Units and Measurements, radiation biologists, expert physicists in the fields of carbon-ion radiation therapy, microdosimetry, biological modeling and image-guided radiotherapy. Consensual reports emerged from multiple discussions within both the restricted group and the wider ULICE community. Public deliverables were produced and disseminated to the European Commission. RESULTS Here we highlight the disparity in practices between treating centers, then address the main topics to finally elaborate specific recommendations. Although it appears relatively simple to add geometrical margins around the clinical target volume to obtain the planning target volume as performed in photon radiotherapy, this procedure is not appropriate for carbon-ion radiation therapy. Due to the variation of the radiation quality in depth, there is no generic relative biological effectiveness value for carbon-ions outside of an isolated point, for a given fractionation and specific experimental conditions. Absorbed dose and "equieffective dose" for specified conditions must always be reported. CONCLUSIONS This work contributed to the development of standard operating procedures for carbon-ion radiation therapy clinical trials. These procedures are now being applied, particularly in the first phase III international, multicenter trial (PHRC Étoile).
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Affiliation(s)
- G Vogin
- Département de radiothérapie, institut de cancérologie de Lorraine Alexis-Vautrin, 54519 Vandœuvre-lès-Nancy cedex, France; CNRS, UMR 7365, ingénierie moléculaire et physiopathologie articulaire (Imopa), 54505 Vandœuvre-lès-Nancy cedex, France; Université de Lorraine, 54505 Vandoeuvre-lès-Nancy, France.
| | - A Wambersie
- Institut de recherche expérimentale et clinique (Irec), Molecular Imaging, Radiotherapy and Oncology (MIRO), cliniques universitaires Saint-Luc, 1200 Brussels, Belgium; Université catholique de Louvain (UCL), 1348 Louvain-la-Neuve, Belgium
| | - R Pötter
- Department of Radiotherapy, Comprehensive Cancer Center, Vienna, Austria; Medical University of Vienna, Vienna, Austria
| | - M Beuve
- Université Lyon 1, 69100 Villeurbanne, France; Institut de physique nucléaire de Lyon, 69622 Villeurbanne cedex, France
| | - S E Combs
- Klinik und Poliklinik für RadioOnkologie und Strahlentherapie, Technische Universität München (TUM), 81675 München, Germany; Instituts für Innovative Radiotherapie (iRT), Helmholtz Zentrum München, 85764 Oberschleißheim, Germany
| | - G Magrin
- EBG MedAustron GmbH, 2700 Wiener-Neustadt, Austria
| | - R Mayer
- EBG MedAustron GmbH, 2700 Wiener-Neustadt, Austria
| | - U Mock
- EBG MedAustron GmbH, 2700 Wiener-Neustadt, Austria
| | - D Sarrut
- Université Lyon 1, 69100 Villeurbanne, France; CNRS, UMR 5220 Laboratoire Creatis, 69100 Villeurbanne, France; Inserm, U1044 Laboratoire Creatis, 69100 Villeurbanne, France
| | - T Schreiner
- EBG MedAustron GmbH, 2700 Wiener-Neustadt, Austria
| | - P Fossati
- Università di Milano-Medicina e Chirurgia, Milano, Italy; Fondazione CNAO (Centro Nazionale di Adroterapia Oncologica), Pavia, Italy
| | - J Balosso
- Service de cancérologie-radiothérapie, hôpital Albert-Michallon, CHU Grenoble Alpes, 38043 Grenoble cedex 09, France; IPNL, France Hadron national research infrastructure, 69000 Lyon, France; Université Grenoble Alpes, 38400 Saint-Martin-d'Hères, France
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A model for relative biological effectiveness of therapeutic proton beams based on a global fit of cell survival data. Sci Rep 2017; 7:8340. [PMID: 28827691 PMCID: PMC5567137 DOI: 10.1038/s41598-017-08622-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 07/17/2017] [Indexed: 12/14/2022] Open
Abstract
We introduce an approach for global fitting of the recently published high-throughput and high accuracy clonogenic cell-survival data for therapeutic scanned proton beams. Our fitting procedure accounts for the correlation between the cell-survival, the absorbed (physical) dose and the proton linear energy transfer (LET). The fitting polynomials and constraints have been constructed upon generalization of the microdosimetric kinetic model (gMKM) adapted to account for the low energy and high lineal-energy spectrum of the beam where the current radiobiological models may underestimate the reported relative biological effectiveness (RBE). The parameters (α, β) of the linear-quadratic (LQ) model calculated by the presented method reveal a smooth transition from low to high LETs which is an advantage of the current method over methods previously employed to fit the same clonogenic data. Finally, the presented approach provides insight into underlying microscopic mechanisms which, with future study, may help to elucidate radiobiological responses along the Bragg curve and resolve discrepancies between experimental data and current RBE models.
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Walenta S, Mueller-Klieser W. Differential Superiority of Heavy Charged-Particle Irradiation to X-Rays: Studies on Biological Effectiveness and Side Effect Mechanisms in Multicellular Tumor and Normal Tissue Models. Front Oncol 2016; 6:30. [PMID: 26942125 PMCID: PMC4766872 DOI: 10.3389/fonc.2016.00030] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 01/28/2016] [Indexed: 01/31/2023] Open
Abstract
This review is focused on the radiobiology of carbon ions compared to X-rays using multicellular models of tumors and normal mucosa. The first part summarizes basic radiobiological effects, as observed in cancer cells. The second, more clinically oriented part of the review, deals with radiation-induced cell migration and mucositis. Multicellular spheroids from V79 hamster cells were irradiated with X-rays or carbon ions under ambient or restricted oxygen supply conditions. Reliable oxygen enhancement ratios could be derived to be 2.9, 2.8, and 1.4 for irradiation with photons, 12C+6 in the plateau region, and 12C+6 in the Bragg peak, respectively. Similarly, a relative biological effectiveness of 4.3 and 2.1 for ambient pO2 and hypoxia was obtained, respectively. The high effectiveness of carbon ions was reflected by an enhanced accumulation of cells in G2/M and a dose-dependent massive induction of apoptosis. These data clearly show that heavy charged particles are more efficient in sterilizing tumor cells than conventional irradiation even under hypoxic conditions. Clinically relevant doses (3 Gy) of X-rays induced an increase in migratory activity of U87 but not of LN229 or HCT116 tumor cells. Such an increase in cell motility following irradiation in situ could be the source of recurrence. In contrast, carbon ion treatment was associated with a dose-dependent decrease in migration with all cell lines and under all conditions investigated. The radiation-induced loss of cell motility was correlated, in most cases, with corresponding changes in β1 integrin expression. The photon-induced increase in cell migration was paralleled by an elevated phosphorylation status of the epidermal growth factor receptor and AKT-ERK1/2 pathway. Such a hyperphosphorylation did not occur during 12C+6 irradiation under all conditions registered. Comparing the gene toxicity of X-rays with that of particles using the γH2AX technique in organotypic cultures of the oral mucosa, the superior effectiveness of heavy ions was confirmed by a twofold higher number of foci per nucleus. However, proinflammatory signs were similar for both treatment modalities, e.g., the activation of NFκB and the release of IL6 and IL8. The presence of peripheral blood mononuclear cell increased the radiation-induced release of the proinflammatory cytokines by factors of 2–3. Carbon ions are part of the cosmic radiation. Long-term exposure to such particles during extended space flights, as planned by international space agencies, may thus impose a medical and safety risk on the astronauts by a potential induction of mucositis. In summary, particle irradiation is superior to gamma-rays due to a higher radiobiological effectiveness, a reduced hypoxia-induced radioresistance, a multicellular radiosensitization, and the absence of a radiation-induced cell motility. However, the potential of inducing mucositis is similar for both radiation types.
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Affiliation(s)
- Stefan Walenta
- Institute of Pathophysiology, University Medical Center, University of Mainz , Mainz , Germany
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Held KD, Kawamura H, Kaminuma T, Paz AES, Yoshida Y, Liu Q, Willers H, Takahashi A. Effects of Charged Particles on Human Tumor Cells. Front Oncol 2016; 6:23. [PMID: 26904502 PMCID: PMC4751258 DOI: 10.3389/fonc.2016.00023] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 01/21/2016] [Indexed: 12/22/2022] Open
Abstract
The use of charged particle therapy in cancer treatment is growing rapidly, in large part because the exquisite dose localization of charged particles allows for higher radiation doses to be given to tumor tissue while normal tissues are exposed to lower doses and decreased volumes of normal tissues are irradiated. In addition, charged particles heavier than protons have substantial potential clinical advantages because of their additional biological effects, including greater cell killing effectiveness, decreased radiation resistance of hypoxic cells in tumors, and reduced cell cycle dependence of radiation response. These biological advantages depend on many factors, such as endpoint, cell or tissue type, dose, dose rate or fractionation, charged particle type and energy, and oxygen concentration. This review summarizes the unique biological advantages of charged particle therapy and highlights recent research and areas of particular research needs, such as quantification of relative biological effectiveness (RBE) for various tumor types and radiation qualities, role of genetic background of tumor cells in determining response to charged particles, sensitivity of cancer stem-like cells to charged particles, role of charged particles in tumors with hypoxic fractions, and importance of fractionation, including use of hypofractionation, with charged particles.
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Affiliation(s)
- Kathryn D Held
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
| | - Hidemasa Kawamura
- Gunma University Heavy Ion Medical Center, Gunma, Japan; Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Takuya Kaminuma
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Gunma University Heavy Ion Medical Center, Gunma, Japan; Department of Radiation Oncology, Gunma University Graduate School of Medicine, Gunma, Japan
| | | | - Yukari Yoshida
- Gunma University Heavy Ion Medical Center , Gunma , Japan
| | - Qi Liu
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
| | - Henning Willers
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
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