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Loap P, De Marzi L, Almeida CE, Barcellini A, Bradley J, de Santis MC, Dendale R, Jimenez R, Orlandi E, Kirova Y. Hadrontherapy techniques for breast cancer. Crit Rev Oncol Hematol 2021; 169:103574. [PMID: 34958916 DOI: 10.1016/j.critrevonc.2021.103574] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/22/2021] [Accepted: 12/22/2021] [Indexed: 12/31/2022] Open
Abstract
Radiotherapy plays a key role in breast cancer treatment, and recent technical advances have been made to improve the therapeutic window by limiting the risk of radiation-induced toxicity or by increasing tumor control. Hadrontherapy is a form a radiotherapy relying on particle beams; compared with photon beams, particle beams have specific physical, radiobiological and immunological properties, which can be valuable in diverse clinical situations. To date, available hadrontherapy techniques for breast cancer irradiation include proton therapy, carbon ion radiation therapy, fast neutron therapy and boron neutron capture therapy. This review analyzes the current rationale and level of evidence for each hadrontherapy technique for breast cancer.
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Affiliation(s)
- Pierre Loap
- Proton Therapy Center, Institut Curie, Orsay, France.
| | | | - Carlos Eduardo Almeida
- Department of Radiological Sciences, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | - Julie Bradley
- University of Florida Health Proton Therapy Institute, Jacksonville, FL, United States
| | | | - Remi Dendale
- Proton Therapy Center, Institut Curie, Orsay, France
| | - Rachel Jimenez
- Massachusetts General Hospital, Boston, MA, United States
| | - Ester Orlandi
- National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Youlia Kirova
- Proton Therapy Center, Institut Curie, Orsay, France
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Shahmohammadi Beni M, Krstic D, Nikezic D, Yu KN. A comparative study on dispersed doses during photon and proton radiation therapy in pediatric applications. PLoS One 2021; 16:e0248300. [PMID: 33690664 PMCID: PMC7946309 DOI: 10.1371/journal.pone.0248300] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 02/23/2021] [Indexed: 12/05/2022] Open
Abstract
The Monte Carlo method was employed to simulate realistic treatment situations for photon and proton radiation therapy for a set of Oak Ridge National Laboratory (ORNL) pediatric phantoms for 15, 10, 5 and 1-year olds as well as newborns. Complete radiotherapy situations were simulated using the previously developed NRUrad input code for Monte Carlo N-Particle (MCNP) code package. Each pediatric phantom was irradiated at five different positions, namely, the testes, colon, liver, left lung and brain, and the doses in targeted organs (Dt) were determined using the track length estimate of energy. The dispersed photon and proton doses in non-targeted organs (Dd), namely, the skeleton, skin, brain, spine, left and right lungs were computed. The conversion coefficients (F = Dd/Dt) of the dispersed doses were used to study the dose dispersion in different non-targeted organs for phantoms for 15, 10, 5 and 1-year olds as well as newborns. In general, the F values were larger for younger patients. The F values for non-targeted organs for phantoms for 1-year olds and newborns were significantly larger compared to those for other phantoms. The dispersed doses from proton radiation therapy were also found to be significantly lower than those from conventional photon radiation therapy. For example, the largest F values for the brain were 65.6% and 0.206% of the dose delivered to the left lung (P4) for newborns during photon and proton radiation therapy, respectively. The present results demonstrated that dispersion of photons and generated electrons significantly affected the absorbed doses in non-targeted organs during pediatric photon therapy, and illustrated that proton therapy could in general bring benefits for treatment of pediatric cancer patients.
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Affiliation(s)
| | - Dragana Krstic
- Faculty of Science, University of Kragujevac, Kragujevac, Serbia
| | - Dragoslav Nikezic
- Department of Physics, City University of Hong Kong, Kowloon Tong, Hong Kong
- Faculty of Science, University of Kragujevac, Kragujevac, Serbia
| | - Kwan Ngok Yu
- Department of Physics, City University of Hong Kong, Kowloon Tong, Hong Kong
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Proton Radiotherapy to Preserve Fertility and Endocrine Function: A Translational Investigation. Int J Radiat Oncol Biol Phys 2021; 109:84-94. [PMID: 32758642 DOI: 10.1016/j.ijrobp.2020.07.2320] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 07/20/2020] [Accepted: 07/29/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE Photon radiation therapy (x-ray radiation therapy [XRT] and gamma-ray radiation therapy [GRT]) of tumors close to ovaries causes reproductive and endocrine sequelae due to ovarian primordial follicle depletion. Given its finite range, proton radiation therapy (PRT) can preserve ovarian function when ovaries are positioned distal to the spread-out Bragg peak (SOBP) in tumors of the abdominopelvic region. This study compared anti-Müllerian hormone (AMH) levels (a biomarker of ovarian function) and primordial follicle survival after in vivo mouse pelvic GRT versus PRT. METHODS AND MATERIALS One hundred twenty-four female prepubertal mice received sham, GRT, or PRT with ovaries positioned at various depth with respect to the proton SOBP, with single doses of 1.8 or 0.2 Gy. AMH was measured at baseline, 1, 3, and 8 weeks after treatment, and the total number of surviving primordial follicles was counted. Multivariable linear mixed-effects modeling was used to assess the relationship between radiation therapy modality and dose on AMH and primordial follicle survival. RESULTS For ovaries beyond the SOBP, ovarian function (P = .5) and ovarian primordial follicle (OPF; P = 1.0) were spared relative to sham controls. For ovaries in the SOBP plateau, ovarian function and primordial follicle reserve 8 weeks after treatment were reduced for all groups: 1.8 Gy GRT (βAMH = -4.9 ng/mL; βOPF = -728.2/animal), 1.8 Gy (relative biological effectiveness [RBE] = 1.1) PRT (βAMH = -5.1 ng/mL; βOPF = -728.2/animal), 0.2 Gy GRT (βAMH = -2.5 ng/mL; βOPF = -595.1/animal), and 0.2 Gy (RBE = 1.1) PRT (βAMH = -3.0 ng/mL; βOPF = -555.4/animal) relative to sham controls (all differences P < .001). CONCLUSIONS This study uses an animal model to demonstrate the safety of proton therapy in sparing fertility. Ovaries positioned beyond the SOBP during PRT maintain ovarian reserve, suggesting that a proton beam has no energy and exit dose beyond SOBP. This study proposes that proton therapy is much safer than photon radiation therapy to protect ovarian follicles with the same dose, and it supports further testing of proton therapy for abdominopelvic tumors in young women.
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Liu KX, Ioakeim-Ioannidou M, Susko MS, Rao AD, Yeap BY, Snijders AM, Ladra MM, Vogel J, Zaslowe-Dude C, Marcus KJ, Yock TI, Grassberger C, Braunstein SE, Haas-Kogan DA, Terezakis SA, MacDonald SM. A Multi-institutional Comparative Analysis of Proton and Photon Therapy-Induced Hematologic Toxicity in Patients With Medulloblastoma. Int J Radiat Oncol Biol Phys 2020; 109:726-735. [PMID: 33243479 DOI: 10.1016/j.ijrobp.2020.09.049] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 09/11/2020] [Accepted: 09/22/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE This multi-institutional retrospective study sought to examine the hematologic effects of craniospinal irradiation (CSI) in pediatric patients with medulloblastoma using proton or photon therapy. METHODS AND MATERIALS Clinical and treatment characteristics were recorded for 97 pediatric patients with medulloblastoma who received CSI without concurrent chemotherapy or with concurrent single-agent vincristine from 2000 to 2017. Groups of 60 and 37 patients underwent treatment with proton-based and photon-based therapy, respectively. Overall survival was determined by Kaplan-Meier curves with log-rank test. Comparisons of blood counts at each timepoint were conducted using multiple t tests with Bonferroni corrections. Univariate and multivariate analyses of time to grade ≥3 hematologic toxicity were performed with Cox regression analyses. RESULTS Median age of patients receiving proton and photon CSI was 7.5 years (range, 3.5-22.7 years) and 9.9 years (range, 3.6-19.5 years), respectively. Most patients had a diagnosis of standard risk medulloblastoma, with 86.7% and 89.2% for the proton and photon cohorts, respectively. Median total dose to involved field or whole posterior fossa was 54.0 Gy/Gy relative biological effectiveness (RBE) and median CSI dose was 23.4 Gy/Gy(RBE) (range, 18-36 Gy/Gy[RBE]) for both cohorts. Counts were significantly higher in the proton cohort compared with the photon cohort in weeks 3 to 6 of radiation therapy (RT). Although white blood cell counts did not differ between the 2 cohorts, patients receiving proton RT had significantly higher lymphocyte counts throughout the RT course. Similar results were observed when excluding patients who received vertebral body sparing proton RT or limiting to those receiving 23.4 Gy. Only photon therapy was associated with decreased time to grade ≥3 hematologic toxicity on univariate and multivariable analyses. No difference in overall survival was observed, and lymphopenia did not predict survival. CONCLUSIONS Patients who receive CSI using proton therapy experience significantly decreased hematologic toxicity compared with those receiving photon therapy.
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Affiliation(s)
- Kevin X Liu
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Myrsini Ioakeim-Ioannidou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiation and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Matthew S Susko
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Avani D Rao
- Department of Radiation and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Beow Y Yeap
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Antoine M Snijders
- Biological Systems and Engineering Division, Lawrence Berkeley National Laboratory, Berkeley, California
| | - Matthew M Ladra
- Department of Radiation and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jennifer Vogel
- Department of Radiation and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Cierra Zaslowe-Dude
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Karen J Marcus
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Torunn I Yock
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Clemens Grassberger
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Steve E Braunstein
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
| | - Daphne A Haas-Kogan
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stephanie A Terezakis
- Department of Radiation and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Shannon M MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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Tseng YD, Hartsell W, Tsai H, Badiyan S, Wang CJ, Rossi C, Kotecha R, Vora S, Vargas C, Larson G, Halasz LM. Proton therapy patterns of care among pediatric and adult patients with CNS tumors. Neuro Oncol 2019; 20:1556-1557. [PMID: 30085163 DOI: 10.1093/neuonc/noy116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yolanda D Tseng
- Department of Radiation Oncology, University of Washington; SCCA Proton Therapy Center, Seattle, Washington
| | - William Hartsell
- Northwestern Medicine Chicago Proton Center, Warrenville, Illinois
| | - Henry Tsai
- ProCure Proton Therapy Center, Somerset, New Jersey
| | | | - Chiachien J Wang
- Willis-Knighton Cancer Center, Department of Radiation Oncology, Shreveport, Louisiana
| | - Carl Rossi
- California Protons Cancer Therapy Center, San Diego, California
| | - Rupesh Kotecha
- Division of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida
| | | | | | - Gary Larson
- ProCure Proton Therapy Center, Oklahoma City, Oklahoma
| | - Lia M Halasz
- Department of Radiation Oncology, University of Washington; SCCA Proton Therapy Center, Seattle, Washington
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Gallagher KJ, Taddei PJ. ANALYTICAL MODEL TO ESTIMATE EQUIVALENT DOSE FROM INTERNAL NEUTRONS IN PROTON THERAPY OF CHILDREN WITH INTRACRANIAL TUMORS. RADIATION PROTECTION DOSIMETRY 2019; 183:459-467. [PMID: 30272222 PMCID: PMC6596440 DOI: 10.1093/rpd/ncy166] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 08/15/2018] [Accepted: 08/27/2018] [Indexed: 06/08/2023]
Abstract
This study developed a computationally efficient and easy-to-implement analytical model to estimate the equivalent dose from secondary neutrons originating in the bodies ('internal neutrons') of children receiving intracranial proton radiotherapy. A two-term double-Gaussian mathematical model was fit to previously published internal neutron equivalent dose per therapeutic absorbed dose versus distance from the field edge calculated using Monte Carlo simulations. The model was trained using three intracranial proton fields of a 9-year-old girl. The resulting model was tested against two intracranial fields of a 10-year-old boy by comparing the mean doses in organs at risk of a radiogenic cancer estimated by the model versus those previously calculated by Monte Carlo. On average, the model reproduced the internal neutron organ doses in the 10-year-old boy within 13.5% of the Monte Carlo at 3-10 cm from the field edge and within a factor of 2 of the Monte Carlo at 10-20 cm from the field edge. Beyond 20 cm, the model poorly estimated H/DRx, however, the values were very small, at <0.03 mSv Gy-1.
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Affiliation(s)
- Kyle J Gallagher
- Oregon Health and Science University, Portland, OR, USA
- Oregon State University, Corvallis, OR, USA
| | - Phillip J Taddei
- American University of Beirut Medical Center, Beirut, Lebanon
- Department of Radiation Oncology, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356043, Seattle, WA, USA
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Galvez J, Eisenhower M, England W, Wartman E, Simpao A, Rehman M, Lustig R, Hribar M. An Interactive Virtual Reality Tour for Adolescents Receiving Proton Radiation Therapy: Proof-of-Concept Study. JMIR Perioper Med 2019; 2:e11259. [PMID: 33393932 PMCID: PMC7728405 DOI: 10.2196/11259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Child life therapists provide patient education for children undergoing radiation therapy to assist in coping with and understanding their treatment. OBJECTIVE This proof-of-concept study aimed to determine the feasibility of incorporating a 360-degree video tour via a virtual reality system for children scheduled to receive radiation therapy. The secondary objective was to qualitatively describe each subject's virtual reality experience. METHODS Children aged ≥13 years scheduled to receive proton radiation therapy were included in the study. Subjects watched the 360-degree video of the radiation therapy facility in an immersive virtual reality environment with a child life therapist experienced in coaching children receiving radiation therapy and completed a survey after the tour. RESULTS Eight subjects consented to participate in the study, and six subjects completed the 360-degree video tour and survey. All the enrolled patients completed the tour successfully. Two subjects did not complete the survey. Two subjects requested to pause the tour to ask questions about the facility. Five subjects said the tour was helpful preparation before undergoing proton radiation therapy. Subjects stated that the tour was helpful because "it showed [them] what's to come" and was helpful to see "what it's like to lay in the machine." One subject said, "it made me feel less nervous." Six subjects stated that they would like to see this type of tour available for other areas of the hospital, such as diagnostic imaging rooms. None of the subjects experienced nausea or vomiting. CONCLUSIONS The 360-degree video tour allowed patients to explore the treatment facility in a comfortable environment. Participants felt that the tour was beneficial and would appreciate seeing other parts of the hospital in this manner.
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Affiliation(s)
- Jorge Galvez
- Section of Biomedical Informatics, Department of Anesthesiology & Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Anesthesiology & Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Melanie Eisenhower
- Department of Child Life, Education and Creative Arts Therapy, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - William England
- Section of Biomedical Informatics, Department of Anesthesiology & Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Elicia Wartman
- Section of Biomedical Informatics, Department of Anesthesiology & Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Allan Simpao
- Section of Biomedical Informatics, Department of Anesthesiology & Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Anesthesiology & Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Mohamed Rehman
- Section of Biomedical Informatics, Department of Anesthesiology & Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Anesthesiology & Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Robert Lustig
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Michelle Hribar
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, OR, OR, United States
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Patterns of proton therapy use in pediatric cancer management in 2016: An international survey. Radiother Oncol 2019; 132:155-161. [DOI: 10.1016/j.radonc.2018.10.022] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/10/2018] [Accepted: 10/22/2018] [Indexed: 01/19/2023]
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Indelicato DJ, Bradley JA, Rotondo RL, Nanda RH, Logie N, Sandler ES, Aldana PR, Ranalli NJ, Beier AD, Morris CG, Mendenhall NP. Outcomes following proton therapy for pediatric ependymoma. Acta Oncol 2018; 57:644-648. [PMID: 29239262 DOI: 10.1080/0284186x.2017.1413248] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Proton therapy can reduce the low and intermediate radiation dose to uninvolved brain tissue in children with intracranial ependymomas, which may improve functional outcomes and reduce second malignancies in survivors. Accordingly, ependymoma has become the most common pediatric tumor treated with proton therapy, yet data on efficacy and toxicity are limited. MATERIAL AND METHODS Between June 2007 and February 2017, 179 children (≤21 years old) with nonmetastatic grade II/III intracranial ependymoma received proton therapy at our institution. Median age, 3.5 years (range, 0.7-21); 58% were male. Most (66%) tumors were in the posterior fossa and classified as WHO grade III (67%). 27% underwent multiple operations to maximize the extent of resection; ultimately 85% had a gross total or near total tumor resection before radiotherapy. 33% received preradiation chemotherapy. Median radiation dose in children ≤3 years old, 54 Gy(RBE). Most (>90%) children over 3 years old received 59.4 Gy(RBE). Patient and treatment variables were assessed for correlation with disease control. RESULTS Median follow-up, 3.2 years. 3-year local control, progression-free survival, and overall survival rates were 85%, 76%, and 90%, respectively. First site of progression was local, metastatic, or simultaneous in 14, 17 and 6 patients, respectively. On multivariate analysis, subtotal resection was associated with inferior local control (67% vs. 88%; p ≤ .01) and progression-free survival (59% vs. 79%; p < .05). Male sex was associated with inferior progression-free (67% vs. 87%; p< .05) and overall survival (84% vs. 99%; p < .01). The 3-year CTCAE grade 2 + brainstem toxicity rate was 5.5% (95% CI: 2.9-10.2), including 1 grade 5 toxicity. CONCLUSIONS This series of proton therapy for pediatric intracranial ependymoma demonstrates disease control comparable to photon series without unexpected toxicity. Subtotal resection and male sex were associated with inferior disease control. Additional follow-up to quantify the expected reductions in late toxicity with proton therapy is ongoing.
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Affiliation(s)
- Daniel J. Indelicato
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Julie A. Bradley
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Ronny L. Rotondo
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Ronica H. Nanda
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Natalie Logie
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Eric S. Sandler
- Department of Pediatric Hematology-Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Philipp R. Aldana
- Department of Neurosurgery, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Nathan J. Ranalli
- Department of Neurosurgery, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Alexandra D. Beier
- Department of Neurosurgery, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Christopher G. Morris
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Nancy P. Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
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Galle JO, Long DE, Lautenschlaeger T, Zellars RC, Watson GA, Ellsworth SG. Effects of Proton Center Closure on Pediatric Case Volume and Resident Education at an Academic Cancer Center. Int J Radiat Oncol Biol Phys 2018; 100:710-718. [DOI: 10.1016/j.ijrobp.2017.10.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/18/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
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Cao W, Khabazian A, Yepes PP, Lim G, Poenisch F, Grosshans DR, Mohan R. Linear energy transfer incorporated intensity modulated proton therapy optimization. Phys Med Biol 2017; 63:015013. [PMID: 29131808 PMCID: PMC5815879 DOI: 10.1088/1361-6560/aa9a2e] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The purpose of this study was to investigate the feasibility of incorporating linear energy transfer (LET) into the optimization of intensity modulated proton therapy (IMPT) plans. Because increased LET correlates with increased biological effectiveness of protons, high LETs in target volumes and low LETs in critical structures and normal tissues are preferred in an IMPT plan. However, if not explicitly incorporated into the optimization criteria, different IMPT plans may yield similar physical dose distributions but greatly different LET, specifically dose-averaged LET, distributions. Conventionally, the IMPT optimization criteria (or cost function) only includes dose-based objectives in which the relative biological effectiveness (RBE) is assumed to have a constant value of 1.1. In this study, we added LET-based objectives for maximizing LET in target volumes and minimizing LET in critical structures and normal tissues. Due to the fractional programming nature of the resulting model, we used a variable reformulation approach so that the optimization process is computationally equivalent to conventional IMPT optimization. In this study, five brain tumor patients who had been treated with proton therapy at our institution were selected. Two plans were created for each patient based on the proposed LET-incorporated optimization (LETOpt) and the conventional dose-based optimization (DoseOpt). The optimized plans were compared in terms of both dose (assuming a constant RBE of 1.1 as adopted in clinical practice) and LET. Both optimization approaches were able to generate comparable dose distributions. The LET-incorporated optimization achieved not only pronounced reduction of LET values in critical organs, such as brainstem and optic chiasm, but also increased LET in target volumes, compared to the conventional dose-based optimization. However, on occasion, there was a need to tradeoff the acceptability of dose and LET distributions. Our conclusion is that the inclusion of LET-dependent criteria in the IMPT optimization could lead to similar dose distributions as the conventional optimization but superior LET distributions in target volumes and normal tissues. This may have substantial advantages in improving tumor control and reducing normal tissue toxicities.
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Affiliation(s)
- Wenhua Cao
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States of America. Author to whom any correspondence should be addressed
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Monte Carlo-driven predictions of neurocognitive and hearing impairments following proton and photon radiotherapy for pediatric brain-tumor patients. J Neurooncol 2017; 135:521-528. [DOI: 10.1007/s11060-017-2597-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 08/14/2017] [Indexed: 10/19/2022]
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13
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Ho ESQ, Barrett SA, Mullaney LM. A review of dosimetric and toxicity modeling of proton versus photon craniospinal irradiation for pediatrics medulloblastoma. Acta Oncol 2017; 56:1031-1042. [PMID: 28509599 DOI: 10.1080/0284186x.2017.1324207] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Craniospinal irradiation (CSI) is the standard radiation therapy treatment for medulloblastoma. Conventional CSI photon therapy (Photon-CSI) delivers significant dose to surrounding normal tissue (NT). Research into pediatric CSI with proton therapy (Proton-CSI) has increased, with the aim of exploiting the potential to reduce NT dose and associated post-treatment complications. This review aims to compare treatment outcomes of pediatric medulloblastoma patients between Proton- and Photon-CSI treatments. MATERIAL AND METHODS A search and review of studies published between 1990 and 2016 comparing pediatric (2-18 years) medulloblastoma Proton- and Photon-CSI in three aspects - normal organ sparing and target coverage; normal organ dysfunction and second malignancy risks - was completed. RESULTS Fifteen studies were selected for review and the results were directly compared. Proton-CSI reported improved out-of-field organ sparing while target coverage improvements were inconsistent. Normal organ dysfunction risks were predicted to be lower following Proton-CSI. Secondary malignancy risks (SMRs) were generally lower with Proton-CSI based on several different risk models. CONCLUSIONS Proton-CSI conferred better treatment outcomes than Photon-CSI for pediatric medulloblastoma patients. This review serves to compare the current literature in the absence of long-term data from prospective studies.
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Affiliation(s)
- Evangeline S. Q. Ho
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Sarah A. Barrett
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Laura M. Mullaney
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Abstract
Ependymoma is a locally aggressive tumor with metastatic potential that arises in diverse locations throughout the brain and spine in children. Tumor and treatment may result in significant morbidity. Cure remains elusive for many patients owing to diverse biology and resistance to conventional therapy. The implementation of systematic postoperative irradiation in clinical trials during the past 20 years has increased the proportion of patients achieving durable disease control with excellent results, as measured by objective functional outcome measures. Clinical, pathologic, and molecular risk stratification should be used to refine treatment regimens for children with ependymoma to reduce the risk of complications associated with therapy and increase the rate of disease control in the setting of combined modality or more intensive therapy. This review covers standards of care and current clinical trials for children with ependymoma, emphasizing the history and evolution of treatment regimens during the past 20 years and the clinical questions they hoped to address.
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Nanda RH, Ganju RG, Schreibmann E, Chen Z, Zhang C, Jegadeesh N, Cassidy R, Deng C, Eaton BR, Esiashvili N. Correlation of Acute and Late Brainstem Toxicities With Dose-Volume Data for Pediatric Patients With Posterior Fossa Malignancies. Int J Radiat Oncol Biol Phys 2017; 98:360-366. [PMID: 28463155 DOI: 10.1016/j.ijrobp.2017.02.092] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 02/14/2017] [Accepted: 02/21/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Radiation-induced brainstem toxicity after treatment of pediatric posterior fossa malignancies is incompletely understood, especially in the era of intensity modulated radiation therapy (IMRT). The rates of, and predictive factors for, brainstem toxicity after photon RT for posterior fossa tumors were examined. METHODS AND MATERIALS After institutional review board approval, 60 pediatric patients treated at our institution for nonmetastatic infratentorial ependymoma and medulloblastoma with IMRT were included in the present analysis. Dosimetric variables, including the mean and maximum dose to the brainstem, the dose to 10% to 90% of the brainstem (in 10% increments), and the volume of the brainstem receiving 40, 45, 50, and 55 Gy were recorded for each patient. Acute (onset within 3 months) and late (>3 months of RT completion) RT-induced brainstem toxicities with clinical and radiographic correlates were scored using Common Terminology Criteria for Adverse Events, version 4.0. RESULTS Patients aged 1.4 to 21.8 years underwent IMRT or volumetric arc therapy postoperatively to the posterior fossa or tumor bed. At a median clinical follow-up period of 2.8 years, 14 patients had developed symptomatic brainstem toxicity (crude incidence 23.3%). No correlation was found between the dosimetric variables examined and brainstem toxicity. Vascular injury or ischemia showed a strong trend toward predicting brainstem toxicity (P=.054). Patients with grade 3 to 5 brainstem toxicity had undergone treatment to significant volumes of the posterior fossa. CONCLUSION The results of the present series demonstrate a low, but not negligible, risk of brainstem radiation necrosis for pediatric patients with posterior fossa malignancies treated with IMRT. No specific dose-volume correlations were identified; however, modern treatment volumes might help limit the incidence of severe toxicity. Additional work investigating inherent biologic sensitivity might also provide further insight into this clinical problem.
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Affiliation(s)
- Ronica H Nanda
- Department of Radiation Oncology, Winship Cancer Institute, Emory University College of Medicine, Atlanta, Georgia.
| | - Rohit G Ganju
- Department of Radiation Oncology, Winship Cancer Institute, Emory University College of Medicine, Atlanta, Georgia
| | - Edward Schreibmann
- Department of Radiation Oncology, Winship Cancer Institute, Emory University College of Medicine, Atlanta, Georgia
| | - Zhengjia Chen
- Department of Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Chao Zhang
- Department of Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Naresh Jegadeesh
- Department of Radiation Oncology, Winship Cancer Institute, Emory University College of Medicine, Atlanta, Georgia
| | - Richard Cassidy
- Department of Radiation Oncology, Winship Cancer Institute, Emory University College of Medicine, Atlanta, Georgia
| | - Claudia Deng
- Department of Radiation Oncology, Winship Cancer Institute, Emory University College of Medicine, Atlanta, Georgia
| | - Bree R Eaton
- Department of Radiation Oncology, Winship Cancer Institute, Emory University College of Medicine, Atlanta, Georgia
| | - Natia Esiashvili
- Department of Radiation Oncology, Winship Cancer Institute, Emory University College of Medicine, Atlanta, Georgia
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16
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Chua P, Hill-Kayser C, Ahumada LM, Jalal A, Simpao AF, Lingappan AM, Jawad A, Rehman MA, Gálvez JA. Visual analytics dashboard to explore the relationship of unscheduled treatment interruptions and variations in airway management for children undergoing external beam radiation therapy. Pract Radiat Oncol 2017; 7:e339-e344. [PMID: 28428018 DOI: 10.1016/j.prro.2017.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/23/2016] [Accepted: 01/16/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Pandora Chua
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Christine Hill-Kayser
- Department of Radiation Oncology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Luis M Ahumada
- Enterprise Reporting & Analytics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ali Jalal
- Department of Mechanical Engineering, Villanova University, Villanova, Pennsylvania; Department of Anesthesiology & Critical Care Medicine, The Children's Hospital of Philadelphia, Pennsylvania
| | - Allan F Simpao
- Department of Anesthesiology & Critical Care Medicine, The Children's Hospital of Philadelphia, Pennsylvania
| | - Arul M Lingappan
- Department of Anesthesiology & Critical Care Medicine, The Children's Hospital of Philadelphia, Pennsylvania
| | - Abbas Jawad
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mohamed A Rehman
- Department of Anesthesiology & Critical Care Medicine, The Children's Hospital of Philadelphia, Pennsylvania
| | - Jorge A Gálvez
- Department of Anesthesiology & Critical Care Medicine, The Children's Hospital of Philadelphia, Pennsylvania.
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17
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Chapman TR, Ermoian RP. Proton therapy for pediatric cancer: are we ready for prime time? Future Oncol 2017; 13:5-8. [DOI: 10.2217/fon-2016-0373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
| | - Ralph P Ermoian
- Radiation Oncology, University of Washington, Seattle, WA, USA
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18
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Innovative radiotherapy of sarcoma: Proton beam radiation. Eur J Cancer 2016; 62:112-23. [PMID: 27258968 DOI: 10.1016/j.ejca.2016.04.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 04/13/2016] [Accepted: 04/14/2016] [Indexed: 01/13/2023]
Abstract
This review on proton beam radiotherapy (PBT) focusses on an historical overview, cost-effectiveness, techniques, acute and late toxicities and clinical results of PBT for sarcoma patients. PBT has gained its place among the armamentarium of modern radiotherapy techniques. For selected patients, it can be cost-effective.
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19
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Yock TI, Yeap BY, Ebb DH, Weyman E, Eaton BR, Sherry NA, Jones RM, MacDonald SM, Pulsifer MB, Lavally B, Abrams AN, Huang MS, Marcus KJ, Tarbell NJ. Long-term toxic effects of proton radiotherapy for paediatric medulloblastoma: a phase 2 single-arm study. Lancet Oncol 2016; 17:287-298. [DOI: 10.1016/s1470-2045(15)00167-9] [Citation(s) in RCA: 226] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/10/2015] [Accepted: 07/14/2015] [Indexed: 01/12/2023]
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20
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Kristensen I, Nilsson K, Nilsson P. Comparative Proton and Photon Treatment Planning in Pediatric Patients with Various Diagnoses. Int J Part Ther 2015. [DOI: 10.14338/ijpt-14-00026.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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21
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Eaton BR, Chowdhry V, Weaver K, Liu L, Ebb D, MacDonald SM, Tarbell NJ, Yock TI. Use of proton therapy for re-irradiation in pediatric intracranial ependymoma. Radiother Oncol 2015; 116:301-8. [DOI: 10.1016/j.radonc.2015.07.023] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 07/06/2015] [Accepted: 07/16/2015] [Indexed: 10/23/2022]
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22
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Inter-Institutional Comparison of Personalized Risk Assessments for Second Malignant Neoplasms for a 13-Year-Old Girl Receiving Proton versus Photon Craniospinal Irradiation. Cancers (Basel) 2015; 7:407-26. [PMID: 25763928 PMCID: PMC4381265 DOI: 10.3390/cancers7010407] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 02/18/2015] [Accepted: 02/19/2015] [Indexed: 01/14/2023] Open
Abstract
Children receiving radiotherapy face the probability of a subsequent malignant neoplasm (SMN). In some cases, the predicted SMN risk can be reduced by proton therapy. The purpose of this study was to apply the most comprehensive dose assessment methods to estimate the reduction in SMN risk after proton therapy vs. photon therapy for a 13-year-old girl requiring craniospinal irradiation (CSI). We reconstructed the equivalent dose throughout the patient’s body from therapeutic and stray radiation and applied SMN incidence and mortality risk models for each modality. Excluding skin cancer, the risk of incidence after proton CSI was a third of that of photon CSI. The predicted absolute SMN risks were high. For photon CSI, the SMN incidence rates greater than 10% were for thyroid, non-melanoma skin, lung, colon, stomach, and other solid cancers, and for proton CSI they were non-melanoma skin, lung, and other solid cancers. In each setting, lung cancer accounted for half the risk of mortality. In conclusion, the predicted SMN risk for a 13-year-old girl undergoing proton CSI was reduced vs. photon CSI. This study demonstrates the feasibility of inter-institutional whole-body dose and risk assessments and also serves as a model for including risk estimation in personalized cancer care.
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Conroy R, Gomes L, Owen C, Buchsbaum J, Ahern V. Clinical equipoise: Protons and the child with craniopharyngioma. J Med Imaging Radiat Oncol 2014; 59:379-85. [DOI: 10.1111/1754-9485.12264] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 10/08/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Ruth Conroy
- Crown Princess Mary Cancer Centre; Westmead Hospital; Sydney New South Wales Australia
| | - Lavier Gomes
- Medical Imaging; Westmead Hospital; Sydney New South Wales Australia
| | - Catherine Owen
- Crown Princess Mary Cancer Centre; Westmead Hospital; Sydney New South Wales Australia
| | - Jeffrey Buchsbaum
- Departments of Radiation Oncology, Paediatrics, and Neurological Surgery; Indiana University College of Arts and Sciences; Indiana University School of Medicine; Bloomington Indiana USA
- Department of Physics; IU Proton Therapy Center; Riley Hospital for Children; Indiana University Hospital; Bloomington Indiana USA
| | - Verity Ahern
- Crown Princess Mary Cancer Centre; Westmead Hospital; Sydney New South Wales Australia
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24
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Kasper HB, Raeke L, Indelicato DJ, Symecko H, Hartsell W, Mahajan A, Hill-Kayser C, Perkins SM, Chang AL, Childs S, Buchsbaum JC, Laurie F, Khan AJ, Giraud C, Yeap BY, Yock TI. The Pediatric Proton Consortium Registry: A Multi-institutional Collaboration in U.S. Proton Centers. Int J Part Ther 2014. [DOI: 10.14338/ijpt.13-00006.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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