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Sommat K, Tong AKT, Ong ALK, Hu J, Sin SY, Lam WWC, Xie W, Khor YM, Lim C, Lim TW, Selvarajan S, Wang F, Tan TWK, Wee JTS, Soong YL, Fong KW, Hennedige T, Hua TC. 18F-FMISO PET-guided dose escalation with multifield optimization intensity-modulated proton therapy in nasopharyngeal carcinoma. Asia Pac J Clin Oncol 2023. [PMID: 37157884 DOI: 10.1111/ajco.13953] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/13/2023] [Accepted: 03/22/2023] [Indexed: 05/10/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the radiotherapy planning feasibility of dose escalation with intensity-modulated proton therapy (IMPT) to hypoxic tumor regions identified on 18F-Fluoromisonidazole (FMISO) positron emission tomography and computed tomography (PET-CT) in NPC. MATERIALS AND METHODS Nine patients with stages T3-4N0-3M0 NPC underwent 18F-FMISO PET-CT before and during week 3 of radiotherapy. The hypoxic volume (GTVhypo) is automatically generated by applying a subthresholding algorithm within the gross tumor volume (GTV) with a tumor to muscle standardized uptake value (SUV) ratio of 1.3 on the 18F-FMISO PET-CT scan. Two proton plans were generated for each patient, a standard plan to 70 Gy and dose escalation plan with upfront boost followed by standard 70GyE plan. The stereotactic boost was planned with single-field uniform dose optimization using two fields to deliver 10 GyE in two fractions to GTVhypo. The standard plan was generated with IMPT with robust optimization to deliver 70GyE, 60GyE in 33 fractions using simultaneous integrated boost technique. A plan sum was generated for assessment. RESULTS Eight of nine patients showed tumor hypoxia on the baseline 18F-FMISO PET-CT scan. The mean hypoxic tumor volume was 3.9 cm3 (range .9-11.9cm3 ). The average SUVmax of the hypoxic volume was 2.2 (range 1.44-2.98). All the dose-volume parameters met the planning objectives for target coverage. Dose escalation was not feasible in three of eight patients as the D0.03cc of temporal lobe was greater than 75GyE. CONCLUSIONS The utility of boost to the hypoxic volume before standard course of radiotherapy with IMPT is dosimetrically feasible in selected patients. Clinical trials are warranted to determine the clinical outcomes of this approach.
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Affiliation(s)
- Kiattisa Sommat
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Aaron Kian Ti Tong
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore, Singapore
| | - Ashley Li Kuan Ong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Jing Hu
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Sze Yarn Sin
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Winnie Wing Chuen Lam
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore, Singapore
| | - Wanying Xie
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore, Singapore
| | - Yiu Ming Khor
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore, Singapore
| | - Cindy Lim
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | - Tze Wei Lim
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | - Sathiyamoorthy Selvarajan
- Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, Singapore, Singapore
| | - Fuqiang Wang
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Terence Wee Kiat Tan
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Joseph Tien Seng Wee
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Yoke Lim Soong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Kam Weng Fong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Tiffany Hennedige
- Division of Oncologic Imaging, National Cancer Centre Singapore, Singapore, Singapore
| | - Thng Choon Hua
- Division of Oncologic Imaging, National Cancer Centre Singapore, Singapore, Singapore
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Chevli N, Grosshans DR, McAleer MF, Foster JH, Harrison D, McGovern SL, Paulino AC. Renal function in abdominal neuroblastoma patients undergoing proton radiotherapy. Pediatr Blood Cancer 2023; 70:e29981. [PMID: 36129239 DOI: 10.1002/pbc.29981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/05/2022] [Accepted: 08/18/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND The purpose of this study is to analyze renal function outcomes in abdominal neuroblastoma patients undergoing proton therapy (PT). PROCEDURE From 2011 to 2019, two single-institution Institutional Review Board-approved protocols prospectively enrolled neuroblastoma patients for data collection. To assess renal function, serum creatinine (Cr), blood urea nitrogen (BUN), and creatinine clearance (CrCl) before proton therapy (pre-PT) were compared with the values at last follow-up. RESULTS A total of 30 children with abdominal neuroblastoma with median age 3.5 years (range, 0.9-9.1) at time of PT were included in this study. All patients underwent chemotherapy and resection of primary tumor prior to PT. Two patients required radical nephrectomy. Median follow-up after PT was 35 months. Mean dose to ipsilateral and contralateral kidney was 13.9 and 5.4 Gy, respectively. No patients developed hypertension or renal dysfunction during follow-up. There was no statistically significant change in serum BUN (p = .508), CrCl (p = .280), or eGFR (p = .246) between pre-PT and last follow-up. CONCLUSION At a median follow-up of almost 3 years, renal toxicity was uncommon after PT. Longer follow-up and larger patient cohort data are needed to further assess impact of PT on renal function in this population.
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Affiliation(s)
- Neil Chevli
- Department of Radiation Oncology, University of Texas Medical Branch, Galveston, TX, USA
| | - David R Grosshans
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mary Frances McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jennifer H Foster
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Douglas Harrison
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan L McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Arnold C Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Toumia Y, Pullia M, Domenici F, Facoetti A, Ferrarini M, Heymans SV, Carlier B, Van Den Abeele K, Sterpin E, D'hooge J, D'Agostino E, Paradossi G. Ultrasound-assisted carbon ion dosimetry and range measurement using injectable polymer-shelled phase-change nanodroplets: in vitro study. Sci Rep 2022; 12:8012. [PMID: 35568710 PMCID: PMC9107472 DOI: 10.1038/s41598-022-11524-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/20/2022] [Indexed: 11/09/2022] Open
Abstract
Methods allowing for in situ dosimetry and range verification are essential in radiotherapy to reduce the safety margins required to account for uncertainties introduced in the entire treatment workflow. This study suggests a non-invasive dosimetry concept for carbon ion radiotherapy based on phase-change ultrasound contrast agents. Injectable nanodroplets made of a metastable perfluorobutane (PFB) liquid core, stabilized with a crosslinked poly(vinylalcohol) shell, are vaporized at physiological temperature when exposed to carbon ion radiation (C-ions), converting them into echogenic microbubbles. Nanodroplets, embedded in tissue-mimicking phantoms, are exposed at 37 °C to a 312 MeV/u clinical C-ions beam at different doses between 0.1 and 4 Gy. The evaluation of the contrast enhancement from ultrasound imaging of the phantoms, pre- and post-irradiation, reveals a significant radiation-triggered nanodroplets vaporization occurring at the C-ions Bragg peak with sub-millimeter shift reproducibility and dose dependency. The specific response of the nanodroplets to C-ions is further confirmed by varying the phantom position, the beam range, and by performing spread-out Bragg peak irradiation. The nanodroplets' response to C-ions is influenced by their concentration and is dose rate independent. These early findings show the ground-breaking potential of polymer-shelled PFB nanodroplets to enable in vivo carbon ion dosimetry and range verification.
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Affiliation(s)
- Yosra Toumia
- Department of Chemical Science and Technologies, University of Rome Tor Vergata, 00133, Rome, Italy.
- National Institute for Nuclear Physics, INFN Sez. Roma Tor Vergata, 00133, Rome, Italy.
| | - Marco Pullia
- Fondazione CNAO, The National Center of Oncological Hadrontherapy, 27100, Pavia, Italy
| | - Fabio Domenici
- Department of Chemical Science and Technologies, University of Rome Tor Vergata, 00133, Rome, Italy
- National Institute for Nuclear Physics, INFN Sez. Roma Tor Vergata, 00133, Rome, Italy
| | - Angelica Facoetti
- Fondazione CNAO, The National Center of Oncological Hadrontherapy, 27100, Pavia, Italy
| | - Michele Ferrarini
- Fondazione CNAO, The National Center of Oncological Hadrontherapy, 27100, Pavia, Italy
| | - Sophie V Heymans
- Department of Physics, KU Leuven Campus Kulak, Kortrijk, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Biomedical Engineering, Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Bram Carlier
- Department of Oncology, KU Leuven, Leuven, Belgium
| | | | | | - Jan D'hooge
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | | | - Gaio Paradossi
- Department of Chemical Science and Technologies, University of Rome Tor Vergata, 00133, Rome, Italy
- National Institute for Nuclear Physics, INFN Sez. Roma Tor Vergata, 00133, Rome, Italy
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Lykowski T, Jhagra R, Bennett C. Evaluation of proton beam therapy pedagogy within the UK's pre-registration radiotherapy and oncology higher education setting. Radiography (Lond) 2022; 28:267-275. [DOI: 10.1016/j.radi.2022.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/13/2021] [Accepted: 01/21/2022] [Indexed: 11/25/2022]
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Cunningham C, de Kock M, Engelbrecht M, Miles X, Slabbert J, Vandevoorde C. Radiosensitization Effect of Gold Nanoparticles in Proton Therapy. Front Public Health 2021; 9:699822. [PMID: 34395371 PMCID: PMC8358148 DOI: 10.3389/fpubh.2021.699822] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 06/30/2021] [Indexed: 01/02/2023] Open
Abstract
The number of proton therapy facilities and the clinical usage of high energy proton beams for cancer treatment has substantially increased over the last decade. This is mainly due to the superior dose distribution of proton beams resulting in a reduction of side effects and a lower integral dose compared to conventional X-ray radiotherapy. More recently, the usage of metallic nanoparticles as radiosensitizers to enhance radiotherapy is receiving growing attention. While this strategy was originally intended for X-ray radiotherapy, there is currently a small number of experimental studies indicating promising results for proton therapy. However, most of these studies used low proton energies, which are less applicable to clinical practice; and very small gold nanoparticles (AuNPs). Therefore, this proof of principle study evaluates the radiosensitization effect of larger AuNPs in combination with a 200 MeV proton beam. CHO-K1 cells were exposed to a concentration of 10 μg/ml of 50 nm AuNPs for 4 hours before irradiation with a clinical proton beam at NRF iThemba LABS. AuNP internalization was confirmed by inductively coupled mass spectrometry and transmission electron microscopy, showing a random distribution of AuNPs throughout the cytoplasm of the cells and even some close localization to the nuclear membrane. The combined exposure to AuNPs and protons resulted in an increase in cell killing, which was 27.1% at 2 Gy and 43.8% at 6 Gy, compared to proton irradiation alone, illustrating the radiosensitizing potential of AuNPs. Additionally, cells were irradiated at different positions along the proton depth-dose curve to investigate the LET-dependence of AuNP radiosensitization. An increase in cytogenetic damage was observed at all depths for the combined treatment compared to protons alone, but no incremental increase with LET could be determined. In conclusion, this study confirms the potential of 50 nm AuNPs to increase the therapeutic efficacy of proton therapy.
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Affiliation(s)
- Charnay Cunningham
- Radiation Biophysics Division, Nuclear Medicine Department, iThemba LABS, National Research Foundation, Cape Town, South Africa.,Department of Medical Biosciences, Faculty of Natural Sciences, University of the Western Cape, Cape Town, South Africa
| | - Maryna de Kock
- Department of Medical Biosciences, Faculty of Natural Sciences, University of the Western Cape, Cape Town, South Africa
| | - Monique Engelbrecht
- Radiation Biophysics Division, Nuclear Medicine Department, iThemba LABS, National Research Foundation, Cape Town, South Africa.,Department of Medical Biosciences, Faculty of Natural Sciences, University of the Western Cape, Cape Town, South Africa
| | - Xanthene Miles
- Radiation Biophysics Division, Nuclear Medicine Department, iThemba LABS, National Research Foundation, Cape Town, South Africa
| | - Jacobus Slabbert
- Radiation Biophysics Division, Nuclear Medicine Department, iThemba LABS, National Research Foundation, Cape Town, South Africa
| | - Charlot Vandevoorde
- Radiation Biophysics Division, Nuclear Medicine Department, iThemba LABS, National Research Foundation, Cape Town, South Africa
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Ostermayr TM, Kreuzer C, Englbrecht FS, Gebhard J, Hartmann J, Huebl A, Haffa D, Hilz P, Parodi K, Wenz J, Donovan ME, Dyer G, Gaul E, Gordon J, Martinez M, Mccary E, Spinks M, Tiwari G, Hegelich BM, Schreiber J. Laser-driven x-ray and proton micro-source and application to simultaneous single-shot bi-modal radiographic imaging. Nat Commun 2020; 11:6174. [PMID: 33268784 PMCID: PMC7710721 DOI: 10.1038/s41467-020-19838-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 10/29/2020] [Indexed: 11/16/2022] Open
Abstract
Radiographic imaging with x-rays and protons is an omnipresent tool in basic research and applications in industry, material science and medical diagnostics. The information contained in both modalities can often be valuable in principle, but difficult to access simultaneously. Laser-driven solid-density plasma-sources deliver both kinds of radiation, but mostly single modalities have been explored for applications. Their potential for bi-modal radiographic imaging has never been fully realized, due to problems in generating appropriate sources and separating image modalities. Here, we report on the generation of proton and x-ray micro-sources in laser-plasma interactions of the focused Texas Petawatt laser with solid-density, micrometer-sized tungsten needles. We apply them for bi-modal radiographic imaging of biological and technological objects in a single laser shot. Thereby, advantages of laser-driven sources could be enriched beyond their small footprint by embracing their additional unique properties, including the spectral bandwidth, small source size and multi-mode emission. Here the authors show a synchronized single-shot bi-modal x-ray and proton source based on laser-generated plasma. This source can be useful for radiographic and tomographic imaging.
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Affiliation(s)
- T M Ostermayr
- Ludwig-Maximilians-Universität München, Fakultät für Physik, 85748, Garching, Germany. .,Max-Planck-Institut für Quantenoptik, 85748, Garching, Germany. .,Lawrence Berkeley National Laboratory, Berkeley, CA, 94720, USA.
| | - C Kreuzer
- Ludwig-Maximilians-Universität München, Fakultät für Physik, 85748, Garching, Germany
| | - F S Englbrecht
- Ludwig-Maximilians-Universität München, Fakultät für Physik, 85748, Garching, Germany
| | - J Gebhard
- Ludwig-Maximilians-Universität München, Fakultät für Physik, 85748, Garching, Germany
| | - J Hartmann
- Ludwig-Maximilians-Universität München, Fakultät für Physik, 85748, Garching, Germany
| | - A Huebl
- Lawrence Berkeley National Laboratory, Berkeley, CA, 94720, USA
| | - D Haffa
- Ludwig-Maximilians-Universität München, Fakultät für Physik, 85748, Garching, Germany
| | - P Hilz
- Ludwig-Maximilians-Universität München, Fakultät für Physik, 85748, Garching, Germany.,Helmholtz Institute Jena, 07743, Jena, Germany
| | - K Parodi
- Ludwig-Maximilians-Universität München, Fakultät für Physik, 85748, Garching, Germany
| | - J Wenz
- Ludwig-Maximilians-Universität München, Fakultät für Physik, 85748, Garching, Germany
| | - M E Donovan
- Center for High Energy Density Science, University of Texas at Austin, Austin, TX, 78712, USA
| | - G Dyer
- Center for High Energy Density Science, University of Texas at Austin, Austin, TX, 78712, USA
| | - E Gaul
- Center for High Energy Density Science, University of Texas at Austin, Austin, TX, 78712, USA
| | - J Gordon
- Center for High Energy Density Science, University of Texas at Austin, Austin, TX, 78712, USA
| | - M Martinez
- Center for High Energy Density Science, University of Texas at Austin, Austin, TX, 78712, USA
| | - E Mccary
- Center for High Energy Density Science, University of Texas at Austin, Austin, TX, 78712, USA
| | - M Spinks
- Center for High Energy Density Science, University of Texas at Austin, Austin, TX, 78712, USA
| | - G Tiwari
- Center for High Energy Density Science, University of Texas at Austin, Austin, TX, 78712, USA
| | - B M Hegelich
- Center for High Energy Density Science, University of Texas at Austin, Austin, TX, 78712, USA
| | - J Schreiber
- Ludwig-Maximilians-Universität München, Fakultät für Physik, 85748, Garching, Germany. .,Max-Planck-Institut für Quantenoptik, 85748, Garching, Germany.
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Goossens ME, Van den Bulcke M, Gevaert T, Meheus L, Verellen D, Cosset JM, Storme G. Is there any benefit to particles over photon radiotherapy? Ecancermedicalscience 2019; 13:982. [PMID: 32010206 PMCID: PMC6974365 DOI: 10.3332/ecancer.2019.982] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Indexed: 12/18/2022] Open
Abstract
Particle, essentially, proton radiotherapy (RT) could provide some benefits over photon RT, especially in reducing the side effects of RT. We performed a systematic review to identify the performed randomised clinical trials (RCTs) and ongoing RCTs comparing particle RT with photon therapy. So far, there are no results available from phase 3 RCTs comparing particle RT with photon therapy. Furthermore, the results on side effects comparing proton and carbon ion beam RT with photon RT do vary. The introduction of new techniques in photon RT, such as image-guided RT (IGRT), intensity-modulated RT (IMRT), volumetric arc therapy (VMAT) and stereotactic body RT (SBRT) was already effective in reducing side effects. At present, the lack of evidence limits the indications for proton and carbon ion beam RTs and makes the particle RT still experimental.
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Affiliation(s)
- Maria E Goossens
- Cancer Centre, Sciensano (Scientific Institute of Public Health), 1050 Brussels, Belgium
| | - Marc Van den Bulcke
- Cancer Centre, Sciensano (Scientific Institute of Public Health), 1050 Brussels, Belgium
| | - Thierry Gevaert
- Department of Radiotherapy, University Hospital Brussels, Vrije Universiteit Brussel, 1050 Brussel, Belgium
| | - Lydie Meheus
- The Anticancer Fund, Reliable Cancer Therapies, Strombeek-Bever, 1853, Belgium
| | - Dirk Verellen
- Department of Radiotherapy, University Hospital Brussels, Vrije Universiteit Brussel, 1050 Brussel, Belgium
- Iridium Kankernetwerk Antwerp, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, 1050 Brussel, Belgium
| | - Jean-Marc Cosset
- Centre de Radiothérapie Charlebourg, Groupe Amethyst, 65, Avenue Foch, 92250 La Garenne-Colombes, France
| | - Guy Storme
- Department of Radiotherapy, University Hospital Brussels, Vrije Universiteit Brussel, 1050 Brussel, Belgium
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Ray S, Cekanaviciute E, Lima IP, Sørensen BS, Costes SV. Comparing Photon and Charged Particle Therapy Using DNA Damage Biomarkers. Int J Part Ther 2018; 5:15-24. [PMID: 31773017 DOI: 10.14338/ijpt-18-00018.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 07/05/2018] [Indexed: 11/21/2022] Open
Abstract
Treatment modalities for cancer radiation therapy have become increasingly diversified given the growing number of facilities providing proton and carbon-ion therapy in addition to the more historically accepted photon therapy. An understanding of high-LET radiobiology is critical for optimization of charged particle radiation therapy and potential DNA damage response. In this review, we present a comprehensive summary and comparison of these types of therapy monitored primarily by using DNA damage biomarkers. We focus on their relative profiles of dose distribution and mechanisms of action from the level of nucleic acid to tumor cell death.
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Affiliation(s)
- Shayoni Ray
- USRA/NASA Ames Research Center, Moffett Field, CA, USA
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Sørensen BS, Bassler N, Nielsen S, Horsman MR, Grzanka L, Spejlborg H, Swakoń J, Olko P, Overgaard J. Relative biological effectiveness (RBE) and distal edge effects of proton radiation on early damage in vivo. Acta Oncol 2017; 56:1387-1391. [PMID: 28830292 DOI: 10.1080/0284186x.2017.1351621] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The aim of the present study was to examine the RBE for early damage in an in vivo mouse model, and the effect of the increased linear energy transfer (LET) towards the distal edge of the spread-out Bragg peak (SOBP). METHOD The lower part of the right hind limb of CDF1 mice was irradiated with single fractions of either 6 MV photons, 240 kV photons or scanning beam protons and graded doses were applied. For the proton irradiation, the leg was either placed in the middle of a 30-mm SOBP, or to assess the effect in different positions, irradiated in 4 mm intervals from the middle of the SOBP to behind the distal dose fall-off. Irradiations were performed with the same dose plan at all positions, corresponding to a dose of 31.25 Gy in the middle of the SOBP. Endpoint of the study was early skin damage of the foot, assessed by a mouse foot skin scoring system. RESULTS The MDD50 values with 95% confidence intervals were 36.1 (34.2-38.1) Gy for protons in the middle of the SOBP for score 3.5. For 6 MV photons, it was 35.9 (34.5-37.5) Gy and 32.6 (30.7-34.7) Gy for 240 kV photons for score 3.5. The corresponding RBE was 1.00 (0.94-1.05), relative to 6 MV photons and 0.9 (0.85-0.97) relative to 240 kV photons. In the mice group positioned at the SOBP distal dose fall-off, 25% of the mice developed early skin damage compared with 0-8% in other groups. LETd,z = 1 was 8.4 keV/μm at the distal dose fall-off and the physical dose delivered was 7% lower than in the central SOBP position, where LETd,z =1 was 3.3 keV/μm. CONCLUSIONS Although there is a need to expand the current study to be able to calculate an exact enhancement ratio, an enhanced biological effect in vivo for early skin damage in the distal edge was demonstrated.
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Affiliation(s)
- Brita Singers Sørensen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Bassler
- Medical Radiation Physics, Department of Physics, Stockholm University, Stockholm, Sweden
| | - Steffen Nielsen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael R. Horsman
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Leszek Grzanka
- Institute of Nuclear Physics Polish Academy of Sciences, Krakow, Poland
| | - Harald Spejlborg
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Jan Swakoń
- Institute of Nuclear Physics Polish Academy of Sciences, Krakow, Poland
| | - Paweł Olko
- Institute of Nuclear Physics Polish Academy of Sciences, Krakow, Poland
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
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Mishra MV, Aggarwal S, Bentzen SM, Knight N, Mehta MP, Regine WF. Establishing Evidence-Based Indications for Proton Therapy: An Overview of Current Clinical Trials. Int J Radiat Oncol Biol Phys 2017; 97:228-235. [DOI: 10.1016/j.ijrobp.2016.10.045] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/18/2016] [Accepted: 10/31/2016] [Indexed: 11/30/2022]
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Marshall TI, Chaudhary P, Michaelidesová A, Vachelová J, Davídková M, Vondráček V, Schettino G, Prise KM. Investigating the Implications of a Variable RBE on Proton Dose Fractionation Across a Clinical Pencil Beam Scanned Spread-Out Bragg Peak. Int J Radiat Oncol Biol Phys 2016; 95:70-77. [PMID: 27084630 PMCID: PMC4838672 DOI: 10.1016/j.ijrobp.2016.02.029] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 01/27/2016] [Accepted: 02/08/2016] [Indexed: 01/19/2023]
Abstract
Purpose To investigate the clinical implications of a variable relative biological effectiveness (RBE) on proton dose fractionation. Using acute exposures, the current clinical adoption of a generic, constant cell killing RBE has been shown to underestimate the effect of the sharp increase in linear energy transfer (LET) in the distal regions of the spread-out Bragg peak (SOBP). However, experimental data for the impact of dose fractionation in such scenarios are still limited. Methods and Materials Human fibroblasts (AG01522) at 4 key depth positions on a clinical SOBP of maximum energy 219.65 MeV were subjected to various fractionation regimens with an interfraction period of 24 hours at Proton Therapy Center in Prague, Czech Republic. Cell killing RBE variations were measured using standard clonogenic assays and were further validated using Monte Carlo simulations and parameterized using a linear quadratic formalism. Results Significant variations in the cell killing RBE for fractionated exposures along the proton dose profile were observed. RBE increased sharply toward the distal position, corresponding to a reduction in cell sparing effectiveness of fractionated proton exposures at higher LET. The effect was more pronounced at smaller doses per fraction. Experimental survival fractions were adequately predicted using a linear quadratic formalism assuming full repair between fractions. Data were also used to validate a parameterized variable RBE model based on linear α parameter response with LET that showed considerable deviations from clinically predicted isoeffective fractionation regimens. Conclusions The RBE-weighted absorbed dose calculated using the clinically adopted generic RBE of 1.1 significantly underestimates the biological effective dose from variable RBE, particularly in fractionation regimens with low doses per fraction. Coupled with an increase in effective range in fractionated exposures, our study provides an RBE dataset that can be used by the modeling community for the optimization of fractionated proton therapy.
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Affiliation(s)
- Thomas I Marshall
- Centre for Cancer Research and Cell Biology, Queen's University, Belfast, UK
| | - Pankaj Chaudhary
- Centre for Cancer Research and Cell Biology, Queen's University, Belfast, UK
| | - Anna Michaelidesová
- Department of Radiation Dosimetry, Nuclear Physics Institute CAS, Prague, Czech Republic; Proton Therapy Center Czech, Prague, Czech Republic; Department of Dosimetry and Application of Ionizing Radiation, Faculty of Nuclear Sciences and Physical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Jana Vachelová
- Department of Radiation Dosimetry, Nuclear Physics Institute CAS, Prague, Czech Republic
| | - Marie Davídková
- Department of Radiation Dosimetry, Nuclear Physics Institute CAS, Prague, Czech Republic
| | | | | | - Kevin M Prise
- Centre for Cancer Research and Cell Biology, Queen's University, Belfast, UK
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Dosimetric Comparison and Potential for Improved Clinical Outcomes of Paediatric CNS Patients Treated with Protons or IMRT. Cancers (Basel) 2015; 7:706-22. [PMID: 25927402 PMCID: PMC4491680 DOI: 10.3390/cancers7020706] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 04/16/2015] [Accepted: 04/20/2015] [Indexed: 12/24/2022] Open
Abstract
Background: We compare clinical outcomes of paediatric patients with CNS tumours treated with protons or IMRT. CNS tumours form the second most common group of cancers in children. Radiotherapy plays a major role in the treatment of many of these patients but also contributes to late side effects in long term survivors. Radiation dose inevitably deposited in healthy tissues outside the clinical target has been linked to detrimental late effects such as neurocognitive, behavioural and vascular effects in addition to endocrine abnormalities and second tumours. Methods: A literature search was performed using keywords: protons, IMRT, CNS and paediatric. Of 189 papers retrieved, 10 were deemed relevant based on title and abstract screening. All papers directly compared outcomes from protons with photons, five papers included medulloblastoma, four papers each included craniopharyngioma and low grade gliomas and three papers included ependymoma. Results: This review found that while proton beam therapy offered similar clinical target coverage, there was a demonstrable reduction in integral dose to normal structures. Conclusions: This in turn suggests the potential for superior long term outcomes for paediatric patients with CNS tumours both in terms of radiogenic second cancers and out-of-field adverse effects.
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Yock TI, Constine LS, Mahajan A. Protons, the brainstem, and toxicity: ingredients for an emerging dialectic. Acta Oncol 2014; 53:1279-82. [PMID: 25327262 DOI: 10.3109/0284186x.2014.957415] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Torunn I Yock
- Massachusetts General Hospital, Francis H. Burr Proton Therapy Center , Boston , USA
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15
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16
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Chaudhary P, Marshall TI, Perozziello FM, Manti L, Currell FJ, Hanton F, McMahon SJ, Kavanagh JN, Cirrone GAP, Romano F, Prise KM, Schettino G. Relative biological effectiveness variation along monoenergetic and modulated Bragg peaks of a 62-MeV therapeutic proton beam: a preclinical assessment. Int J Radiat Oncol Biol Phys 2014; 90:27-35. [PMID: 24986743 DOI: 10.1016/j.ijrobp.2014.05.010] [Citation(s) in RCA: 159] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 03/29/2014] [Accepted: 05/06/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE The biological optimization of proton therapy can be achieved only through a detailed evaluation of relative biological effectiveness (RBE) variations along the full range of the Bragg curve. The clinically used RBE value of 1.1 represents a broad average, which disregards the steep rise of linear energy transfer (LET) at the distal end of the spread-out Bragg peak (SOBP). With particular attention to the key endpoint of cell survival, our work presents a comparative investigation of cell killing RBE variations along monoenergetic (pristine) and modulated (SOBP) beams using human normal and radioresistant cells with the aim to investigate the RBE dependence on LET and intrinsic radiosensitvity. METHODS AND MATERIALS Human fibroblasts (AG01522) and glioma (U87) cells were irradiated at 6 depth positions along pristine and modulated 62-MeV proton beams at the INFN-LNS (Catania, Italy). Cell killing RBE variations were measured using standard clonogenic assays and were further validated using Monte Carlo simulations and the local effect model (LEM). RESULTS We observed significant cell killing RBE variations along the proton beam path, particularly in the distal region showing strong dose dependence. Experimental RBE values were in excellent agreement with the LEM predicted values, indicating dose-averaged LET as a suitable predictor of proton biological effectiveness. Data were also used to validate a parameterized RBE model. CONCLUSIONS The predicted biological dose delivered to a tumor region, based on the variable RBE inferred from the data, varies significantly with respect to the clinically used constant RBE of 1.1. The significant RBE increase at the distal end suggests also a potential to enhance optimization of treatment modalities such as LET painting of hypoxic tumors. The study highlights the limitation of adoption of a constant RBE for proton therapy and suggests approaches for fast implementation of RBE models in treatment planning.
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Affiliation(s)
- Pankaj Chaudhary
- Centre for Cancer Research and Cell Biology, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Thomas I Marshall
- Centre for Cancer Research and Cell Biology, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Francesca M Perozziello
- Department of Physics, University of Naples Federico II and INFN Naples Section University of Naples, Naples, Italy
| | - Lorenzo Manti
- Department of Physics, University of Naples Federico II and INFN Naples Section University of Naples, Naples, Italy
| | - Frederick J Currell
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, UK
| | - Fiona Hanton
- Centre for Plasma Physics, School of Mathematics and Physics, Queen's University Belfast, Belfast, UK
| | - Stephen J McMahon
- Centre for Cancer Research and Cell Biology, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Joy N Kavanagh
- Centre for Cancer Research and Cell Biology, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | | | | | - Kevin M Prise
- Centre for Cancer Research and Cell Biology, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK.
| | - Giuseppe Schettino
- Centre for Cancer Research and Cell Biology, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK; National Physical Laboratory, Teddington, UK
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Tarasevych S, Lauwers P, Vandaele F, van Meerbeeck JP. Novel treatment options in stage I non-small-cell lung cancer. Expert Rev Anticancer Ther 2014; 14:1007-20. [PMID: 24930519 DOI: 10.1586/14737140.2014.929500] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In the last 5 years, the current management of stage I non-small-cell lung cancer has been challenged due to novel surgical approaches and advances in radiation technology. The outcome after a sublobar resection is promising, especially for tumors less than 2 cm. Other treatment opportunities are available for high risk patients with comorbidity and impaired pulmonary function. Stereotactic ablative body radiotherapy is a good alternative treatment to surgery, especially in elderly and comorbid patients. However, randomized evidence comparing sublobar resection and stereotactic radiotherapy is presently lacking. The most recent development in radiotherapy is hadron therapy with a presumed reduced toxicity because of its peculiar physical and biological effects. Promising thermal and microwave ablative techniques are in development and have specific niche indications.
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Affiliation(s)
- Svitlana Tarasevych
- Department of Thoracic Oncology, Multidisciplinary Oncology Center Antwerp University Hospital, Antwerp, Belgium
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