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Yan HH, Liu R, Wang N, Xu LY, Guo QH, Li J, Ma JM. Treatment of lacrimal gland adenoid cystic carcinoma: a systematic review and Meta-analysis. Int J Ophthalmol 2024; 17:164-172. [PMID: 38239951 PMCID: PMC10754659 DOI: 10.18240/ijo.2024.01.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/17/2023] [Indexed: 01/22/2024] Open
Abstract
AIM To evaluate lacrimal gland adenoid cystic carcinoma (LGACC) of prognosis in patients who underwent different treatment regimens. METHODS We searched PubMed, EMBASE, and the Cochrane Library for studies done on the treatment of LGACC, between January 1987 and April 2022. A Meta-analysis was conducted to pool the 5-year overall survival rate (OR), and the 5-year recurrence rate (RR) and 5-year metastasis rate (MR) were assessed. RESULTS The 30 studies involved 585 patients were included in the Meta-analysis. The pooled 5-year OR with surgery alone was 50%, the 5-year RR was 63%, and the 5-year MR was 34%. The pooled 5-year OR with surgery and adjuvant radiotherapy combined was 67% (95%CI 61%,73%), the 5-year RR was 41%, and the 5-year MR was 35%. The pooled 5-year OR with surgery and adjuvant chemoradiotherapy combined was 72% (95%CI 59%, 84%), the 5-year RR was 48%, and the 5-year MR was 36%. The pooled 5-year OR with surgery, intra-arterial cytoreductive chemotherapy, and adjuvant chemoradiotherapy combined was 78% (95%CI 68%, 89%), the 5-year RR was 15%, and the 5-year MR was 27%. CONCLUSION Comprehensive treatment is more effective than surgery alone. Surgery combined with intra-arterial chemotherapy and adjuvant chemoradiotherapy seems to add value to the therapeutic effect of comprehensive treatment of LGACC but further high-quality research is required to validate this.
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Affiliation(s)
- Hai-Han Yan
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing 100730, China
| | - Rui Liu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing 100730, China
| | - Nan Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing 100730, China
| | - Liang-Yuan Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing 100730, China
| | - Qi-Han Guo
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing 100730, China
| | - Jing Li
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing 100730, China
| | - Jian-Min Ma
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing 100730, China
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2
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Orlandi E, Barcellini A, Vischioni B, Fiore MR, Vitolo V, Iannalfi A, Bonora M, Chalaszczyk A, Ingargiola R, Riva G, Ronchi S, Valvo F, Fossati P, Ciocca M, Mirandola A, Molinelli S, Pella A, Baroni G, Pullia MG, Facoetti A, Orecchia R, Licitra L, Vago G, Rossi S. The Role of Carbon Ion Therapy in the Changing Oncology Landscape-A Narrative Review of the Literature and the Decade of Carbon Ion Experience at the Italian National Center for Oncological Hadrontherapy. Cancers (Basel) 2023; 15:5068. [PMID: 37894434 PMCID: PMC10605728 DOI: 10.3390/cancers15205068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/03/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Currently, 13 Asian and European facilities deliver carbon ion radiotherapy (CIRT) for preclinical and clinical activity, and, to date, 55 clinical studies including CIRT for adult and paediatric solid neoplasms have been registered. The National Center for Oncological Hadrontherapy (CNAO) is the only Italian facility able to accelerate both protons and carbon ions for oncological treatment and research. METHODS To summarise and critically evaluate state-of-the-art knowledge on the application of carbon ion radiotherapy in oncological settings, the authors conducted a literature search till December 2022 in the following electronic databases: PubMed, Web of Science, MEDLINE, Google Scholar, and Cochrane. The results of 68 studies are reported using a narrative approach, highlighting CNAO's clinical activity over the last 10 years of CIRT. RESULTS The ballistic and radiobiological hallmarks of CIRT make it an effective option in several rare, radioresistant, and difficult-to-treat tumours. CNAO has made a significant contribution to the advancement of knowledge on CIRT delivery in selected tumour types. CONCLUSIONS After an initial ramp-up period, CNAO has progressively honed its clinical, technical, and dosimetric skills. Growing engagement with national and international networks and research groups for complex cancers has led to increasingly targeted patient selection for CIRT and lowered barriers to facility access.
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Affiliation(s)
- Ester Orlandi
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Amelia Barcellini
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
- Department of Internal Medicine and Medical Therapy, University of Pavia, 27100 Pavia, Italy
| | - Barbara Vischioni
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Maria Rosaria Fiore
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Viviana Vitolo
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Alberto Iannalfi
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Maria Bonora
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Agnieszka Chalaszczyk
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Rossana Ingargiola
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Giulia Riva
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Sara Ronchi
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Francesca Valvo
- Scientific Directorate, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Piero Fossati
- Department of Radiation Oncology, MedAustron Ion Therapy Center, 2700 Wiener Neustadt, Austria
- Department for Basic and Translational Oncology and Haematology, Karl Landsteiner University of Health Sciences, 3500 Krems, Austria
| | - Mario Ciocca
- Medical Physics Unit, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
| | - Alfredo Mirandola
- Medical Physics Unit, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
| | - Silvia Molinelli
- Medical Physics Unit, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
| | - Andrea Pella
- Bioengineering Unit, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
| | - Guido Baroni
- Bioengineering Unit, National Center for Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
| | - Marco Giuseppe Pullia
- Radiobiology Unit, Research and Development Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Angelica Facoetti
- Radiobiology Unit, Research and Development Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Roberto Orecchia
- Scientific Directorate, IEO-European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Lisa Licitra
- Scientific Directorate, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
- Department of Head & Neck Medical Oncology 3, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
- Department of Oncology & Haemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Gianluca Vago
- Presidency, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
- School of Pathology, University of Milan, 20122 Milan, Italy
| | - Sandro Rossi
- General Directorate, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
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3
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Colombo E, Van Lierde C, Zlate A, Jensen A, Gatta G, Didonè F, Licitra LF, Grégoire V, Vander Poorten V, Locati LD. Salivary gland cancers in elderly patients: challenges and therapeutic strategies. Front Oncol 2022; 12:1032471. [PMID: 36505842 PMCID: PMC9733538 DOI: 10.3389/fonc.2022.1032471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/31/2022] [Indexed: 11/26/2022] Open
Abstract
Salivary gland carcinomas (SGCs) are the most heterogeneous subgroup of head and neck malignant tumors, accounting for more than 20 subtypes. The median age of SGC diagnosis is expected to rise in the following decades, leading to crucial clinical challenges in geriatric oncology. Elderly patients, in comparison with patients aged below 65 years, are generally considered less amenable to receiving state-of-the-art curative treatments for localized disease, such as surgery and radiation/particle therapy. In the advanced setting, chemotherapy regimens are often dampened by the consideration of cardiovascular and renal comorbidities. Nevertheless, the elderly population encompasses a broad spectrum of functionalities. In the last decades, some screening tools (e.g. the G8 questionnaire) have been developed to identify those subjects who should receive a multidimensional geriatric assessment, to answer the question about the feasibility of complex treatments. In the present article, we discuss the most frequent SGC histologies diagnosed in the elderly population and the relative 5-years survival outcomes based on the most recent data from the Surveillance, Epidemiology, and End Results (SEER) Program. Moreover, we review the therapeutic strategies currently available for locoregionally advanced and metastatic disease, taking into account the recent advances in precision oncology. The synergy between the Multidisciplinary Tumor Board and the Geriatrician aims to shape the most appropriate treatment pathway for each elderly patient, focusing on global functionality instead of the sole chronological age.
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Affiliation(s)
- Elena Colombo
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Charlotte Van Lierde
- Otorhinolaryngology-Head and Neck Surgery, Leuven Cancer Institute, University Hospitals Leuven and Department of Oncology, section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Alexandra Zlate
- Department of Radiation Oncology, Centre Leon Berard, Lyon, France
| | - Alexandra Jensen
- Department of Radiation Oncology, University Hospitals Giessen and Marburg (UKGM), Marburg, Germany
| | - Gemma Gatta
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Fabio Didonè
- Evaluative Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Lisa F. Licitra
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Department of Oncology and Hematology, University of Milan, Milan, Italy
| | - Vincent Grégoire
- Department of Radiation Oncology, Centre Leon Berard, Lyon, France
| | - Vander Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery, Leuven Cancer Institute, University Hospitals Leuven and Department of Oncology, section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Laura D. Locati
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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4
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Loap P, Vischioni B, Bonora M, Ingargiola R, Ronchi S, Vitolo V, Barcellini A, Goanta L, De Marzi L, Dendale R, Pacelli R, Locati L, Calugaru V, Mammar H, Cavalieri S, Kirova Y, Orlandi E. Biological Rationale and Clinical Evidence of Carbon Ion Radiation Therapy for Adenoid Cystic Carcinoma: A Narrative Review. Front Oncol 2021; 11:789079. [PMID: 34917512 PMCID: PMC8668942 DOI: 10.3389/fonc.2021.789079] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/15/2021] [Indexed: 12/13/2022] Open
Abstract
Adenoid cystic carcinoma (ACC) is a rare, basaloid, epithelial tumor, arising mostly from salivary glands. Radiation therapy can be employed as a single modality for unresectable tumors, in an adjuvant setting after uncomplete resection, in case of high-risk pathological features, or for recurrent tumors. Due to ACC intrinsic radioresistance, high linear energy transfer (LET) radiotherapy techniques have been evaluated for ACC irradiation: while fast neutron therapy has now been abandoned due to toxicity concerns, charged particle beams such as protons and carbon ions are at present the beams used for hadron therapy. Carbon ion radiation therapy (CIRT) is currently increasingly used for ACC irradiation. The aim of this review is to describe the immunological, molecular and clinicopathological bases that support ACC treatment with CIRT, as well as to expose the current clinical evidence that reveal the advantages of using CIRT for treating ACC.
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Affiliation(s)
- Pierre Loap
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy.,Department of Radiation Oncology, Institut Curie, Paris, France.,Proton Therapy Center, Institut Curie, Orsay, France
| | - Barbara Vischioni
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Maria Bonora
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Rossana Ingargiola
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Sara Ronchi
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Viviana Vitolo
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Amelia Barcellini
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Lucia Goanta
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Napoli, Italy
| | - Ludovic De Marzi
- Department of Radiation Oncology, Institut Curie, Paris, France.,Proton Therapy Center, Institut Curie, Orsay, France.,Institut Curie, PSL Research University, University Paris Saclay, INSERM LITO, Orsay, France
| | - Remi Dendale
- Department of Radiation Oncology, Institut Curie, Paris, France.,Proton Therapy Center, Institut Curie, Orsay, France
| | - Roberto Pacelli
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Napoli, Italy
| | - Laura Locati
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Valentin Calugaru
- Department of Radiation Oncology, Institut Curie, Paris, France.,Proton Therapy Center, Institut Curie, Orsay, France
| | - Hamid Mammar
- Department of Radiation Oncology, Institut Curie, Paris, France.,Proton Therapy Center, Institut Curie, Orsay, France
| | - Stefano Cavalieri
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Youlia Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France.,Proton Therapy Center, Institut Curie, Orsay, France
| | - Ester Orlandi
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
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5
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Teshima M, Shinomiya H, Kimura H, Hashikawa K, Kiyota N, Miyawaki D, Sasaki R, Kohmura E, Nibu K. Roles of skull base surgery and particle radiotherapy for orbital malignant tumors involving the skull base. Laryngoscope Investig Otolaryngol 2021; 6:1347-1352. [PMID: 34938873 PMCID: PMC8665474 DOI: 10.1002/lio2.687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 09/30/2021] [Accepted: 10/05/2021] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To investigate the oncological outcomes of orbital malignant tumors invading the skull base. METHODS A retrospective analysis was conducted on 16 patients with orbital malignant tumors invading the skull base. Eleven patients were treated with skull base surgery, four patients were treated with particle therapies, and one patient was treated with chemoradiotherapy (CRT) as initial treatment. RESULTS The most frequent histological type was adenoid cystic carcinoma in seven patients, followed by squamous cell carcinoma in two patients. Local recurrence occurred in two of the six surgically treated patients who did not receive postoperative radiotherapy (RT) or CRT. One of them was successfully salvaged by RT, and the other died of disease. With a median follow-up of 24 months, the 2-year overall, local control, and disease-free survival rates of all patients were 82.5%, 87.5%, and 59%, respectively. CONCLUSIONS Patients with positive surgical margins were at risk of local recurrence. Postoperative RT should be considered for all surgically treated patients.Level of Evidence: 4.
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Affiliation(s)
- Masanori Teshima
- Department of Otolaryngology—Head and Neck SurgeryKobe University Graduate School of MedicineKobeJapan
| | - Hirotaka Shinomiya
- Department of Otolaryngology—Head and Neck SurgeryKobe University Graduate School of MedicineKobeJapan
| | - Hidehito Kimura
- Department of NeurosurgeryKobe University Graduate School of MedicineKobeJapan
| | - Kazunobu Hashikawa
- Department of Plastic SurgeryKobe University Graduate School of MedicineKobeJapan
| | - Naomi Kiyota
- Department of Medical Oncology and HematologyKobe University Graduate School of MedicineKobeJapan
| | - Daisuke Miyawaki
- Department of Radiation OncologyKobe University Graduate School of MedicineKobeJapan
| | - Ryohei Sasaki
- Department of Radiation OncologyKobe University Graduate School of MedicineKobeJapan
| | | | - Ken‐ichi Nibu
- Department of Otolaryngology—Head and Neck SurgeryKobe University Graduate School of MedicineKobeJapan
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6
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Ebner DK, Malouff TD, Frank SJ, Koto M. The Role of Particle Therapy in Adenoid Cystic Carcinoma and Mucosal Melanoma of the Head and Neck. Int J Part Ther 2021; 8:273-284. [PMID: 34285953 PMCID: PMC8270088 DOI: 10.14338/ijpt-d-20-00076] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/11/2021] [Indexed: 12/24/2022] Open
Abstract
Particle irradiation is suitable for resistant histologies owing to a combination of improved dose delivery with potential radiobiologic advantages in high linear energy transfer radiation. Within the head and neck, adenoid cystic carcinoma and mucosal melanoma are two such histologies, being radioresistant and lying closely proximal to critical structures. Here, we review the use of particle irradiation for adenoid cystic carcinoma and mucosal melanoma of the head and neck.
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Affiliation(s)
- Daniel K Ebner
- Hospital of the National Institutes of Quantum and Radiological Science and Technology (QST Hospital), Chiba, Japan
| | - Timothy D Malouff
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Steven J Frank
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Masashi Koto
- Hospital of the National Institutes of Quantum and Radiological Science and Technology (QST Hospital), Chiba, Japan
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7
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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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8
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Ioakeim-Ioannidou M, MacDonald SM. Evolution of Care of Orbital Tumors with Radiation Therapy. J Neurol Surg B Skull Base 2020; 81:480-496. [PMID: 33072488 DOI: 10.1055/s-0040-1713894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Orbital tumors are rare lesions comprising 0.1% of all tumors and less than 20% of all ocular diseases. These lesions in children and adults differ significantly in their incidence, tumor type, and treatment management. Although surgery and systemic therapies are commonly used in the management of these diseases, radiation therapy has become a widely used treatment for both benign and malignant tumors of the orbit. Radiotherapy is used as a definitive treatment to provide local control while avoiding morbidity associated with surgery for some tumors while it is used as an adjuvant treatment following surgical resection for others. For many tumors, radiation provides excellent tumor control with preservation of visual function. This article is dedicated for presenting the most common applications of orbital radiotherapy. A brief overview of the commonly available radiation therapy modalities is given. Dose constraint goals are reviewed and acute and long-term side effects are discussed. Orbital tumors covered in this article include optic glioma, ocular melanoma, retinoblastoma, orbital rhabdomyosarcoma, orbital lymphoma, and lacrimal gland tumors. Background information, indications for radiotherapy, and goals of treatment for each case example are described.
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Affiliation(s)
- Myrsini Ioakeim-Ioannidou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Shannon M MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
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9
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Lesueur P, Rapeaud E, De Marzi L, Goudjil F, Levy C, Galatoire O, Jacomet PV, Dendale R, Calugaru V. Adenoid Cystic Carcinoma of the Lacrimal Gland: High Dose Adjuvant Proton Therapy to Improve Patients Outcomes. Front Oncol 2020; 10:135. [PMID: 32133287 PMCID: PMC7041626 DOI: 10.3389/fonc.2020.00135] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/27/2020] [Indexed: 12/11/2022] Open
Abstract
Introduction: Lacrymal cystic adenoid carcinoma is a rare disease for which optimal treatment is still debated. In fact, despite aggressive treatment such as eye sparing surgery or orbital exenteration, following by adjuvant radiotherapy, local recurrence and distant metastatic disease are common. This study aims to describe outcomes of eye surgery associated with high dose exclusive adjuvant proton beam irradiation. Materials and Methods: This is a monocentric institutional retrospective study. We retrospectively reviewed records of patients treated in our institution since 2008 with high dose adjuvant proton irradiation for a lacrymal cystic adenoid carcinoma up to a maximum of 75.6Gy(RBE). Other histologies or patients treated with a mix of photon-proton were excluded. A total of 15 patients were finally included. Results: Fifteen patients (80% women, 100% Performance status 0-1) with locally advanced disease (33% T3-T4, 47% R1-R2) were included. After a median follow-up of 67.4 months [13.4-122] the 3 years Overall Survival, local Progression free survival, and progression free survival rates were 78, 70, and 58%, respectively. Six patients exhibited a local recurrence. All patients with conservative surgery maintained their base-line visual acuity and visual field at last follow up. Four patients developed brain radionecrosis. Conclusion: This is the largest series of patients with ACC treated with high dose adjuvant proton therapy. Proton therapy is a safe and efficient treatment and should be considered as an adjuvant irradiation modality to privilege, for patients with lacrimal ACC after conservative or radical eyeball surgery. Dose delivered to temporal lobe should be limited to avoid brain radionecrosis.
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Affiliation(s)
- Paul Lesueur
- Radiation Oncology Department, Institut Curie Proton Therapy Center (ICPO), Orsay, France.,Radiation Oncology Department, Institut Curie, Paris, France.,Radiation Oncology Department, Centre François Baclesse, Caen, France.,Normandy University, Université de Caen Basse Normandie, Caen, France
| | - Etienne Rapeaud
- Radiation Oncology Department, Institut Curie Proton Therapy Center (ICPO), Orsay, France.,Radiation Oncology Department, Institut Curie, Paris, France.,Radiation Oncology Department, Centre François Baclesse, Caen, France
| | - Ludovic De Marzi
- Radiation Oncology Department, Institut Curie Proton Therapy Center (ICPO), Orsay, France
| | - Farid Goudjil
- Radiation Oncology Department, Institut Curie Proton Therapy Center (ICPO), Orsay, France
| | | | - Olivier Galatoire
- Ophtalmology Service, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| | | | - Rémi Dendale
- Radiation Oncology Department, Institut Curie Proton Therapy Center (ICPO), Orsay, France.,Radiation Oncology Department, Institut Curie, Paris, France
| | - Valentin Calugaru
- Radiation Oncology Department, Institut Curie Proton Therapy Center (ICPO), Orsay, France.,Radiation Oncology Department, Institut Curie, Paris, France
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Malouff TD, Mahajan A, Krishnan S, Beltran C, Seneviratne DS, Trifiletti DM. Carbon Ion Therapy: A Modern Review of an Emerging Technology. Front Oncol 2020; 10:82. [PMID: 32117737 PMCID: PMC7010911 DOI: 10.3389/fonc.2020.00082] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/16/2020] [Indexed: 12/13/2022] Open
Abstract
Radiation therapy is one of the most widely used therapies for malignancies. The therapeutic use of heavy ions, such as carbon, has gained significant interest due to advantageous physical and radiobiologic properties compared to photon based therapy. By taking advantage of these unique properties, carbon ion radiotherapy may allow dose escalation to tumors while reducing radiation dose to adjacent normal tissues. There are currently 13 centers treating with carbon ion radiotherapy, with many of these centers publishing promising safety and efficacy data from the first cohorts of patients treated. To date, carbon ion radiotherapy has been studied for almost every type of malignancy, including intracranial malignancies, head and neck malignancies, primary and metastatic lung cancers, tumors of the gastrointestinal tract, prostate and genitourinary cancers, sarcomas, cutaneous malignancies, breast cancer, gynecologic malignancies, and pediatric cancers. Additionally, carbon ion radiotherapy has been studied extensively in the setting of recurrent disease. We aim to provide a comprehensive review of the studies of each of these disease sites, with a focus on the current trials using carbon ion radiotherapy.
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Adeberg S, Akbaba S, Lang K, Held T, Verma V, Nikoghosyan A, Bernhardt D, Münter M, Freier K, Plinkert P, Hauswald H, Herfarth K, Rieken S, Debus J, Jensen AD. The Phase 1/2 ACCEPT Trial: Concurrent Cetuximab and Intensity Modulated Radiation Therapy with Carbon Ion Boost for Adenoid Cystic Carcinoma of the Head and Neck. Int J Radiat Oncol Biol Phys 2020; 106:167-173. [DOI: 10.1016/j.ijrobp.2019.09.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/13/2019] [Accepted: 09/19/2019] [Indexed: 01/17/2023]
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Adeberg S, Windisch P, Ehret F, Baur M, Akbaba S, Held T, Bernhardt D, Haefner MF, Krauss J, Kargus S, Freudlsperger C, Plinkert P, Flechtenmacher C, Herfarth K, Debus J, Rieken S. Intensity Modulated Radiotherapy (IMRT) With Carbon Ion Boost in the Multimodal Treatment of Salivary Duct Carcinoma. Front Oncol 2019; 9:1420. [PMID: 31921675 PMCID: PMC6932999 DOI: 10.3389/fonc.2019.01420] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/29/2019] [Indexed: 12/19/2022] Open
Abstract
Background: To assess outcomes and treatment related toxicity following intensity-modulated radiotherapy (IMRT) and a Carbon Ion Radiotherapy (CIRT) boost for salivary duct carcinoma (SDC). Methods: Twenty-eight consecutive patients with SDC who underwent a postoperative (82%) or definitive (18%) radiation therapy between 2010 and 2017 were assessed in this retrospective single-center analysis. CIRT boost was delivered with median 18 Gy(RBE) in 6 daily fractions, followed by an TomoTherapy®-based IMRT (median 54 Gy in 27 daily fractions). Treatment-related acute toxicity was assessed according to CTCAE Version 4. Results: Tumors were most commonly located in the major salivary glands (n = 25; 89%); 23 patients (82%) received previous surgery (R0: 30%; R1: 57%; R2: 4%; RX: 19%). Median follow-up was 30 months. Four patients (14%) experienced a local relapse and 3 (11%) developed locoregional recurrence. The two-year local control (LC) and locoregional control (LRC) was 96 and 93%, respectively. Median disease-free survival (DFS) was 27 months, metastasis-free survival (MFS) was 69 months, and overall survival (OS) was 93 months. Acute grade 3 toxicity occurred in 11 patients (mucositis, dermatitis, xerostomia; n = 2 each (7%) were the most common) and 2 osteonecroses of the mandibular (grade 3) occurred. No patients experienced grade ≥4 toxicities. Conclusions: Multimodal therapy approaches with surgery followed by IMRT and CIRT boost for SDC leads to good local and locoregional disease control. However, the frequent occurrence of distant metastases limits the prognosis and requires optimization of adjuvant systemic therapies.
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Affiliation(s)
- Sebastian Adeberg
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Heidelberg, Germany
| | - Paul Windisch
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Ehret
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Melissa Baur
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sati Akbaba
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Thomas Held
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Denise Bernhardt
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Matthias F Haefner
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | | | - Steffen Kargus
- Department of Oral and Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Freudlsperger
- Department of Oral and Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Peter Plinkert
- Department of Otorhinolaryngology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Klaus Herfarth
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Heidelberg, Germany
| | - Juergen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Heidelberg, Germany.,National Center for Tumor Diseases, Heidelberg, Germany
| | - Stefan Rieken
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Heidelberg, Germany
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Rackwitz T, Debus J. Clinical applications of proton and carbon ion therapy. Semin Oncol 2019; 46:226-232. [PMID: 31451309 DOI: 10.1053/j.seminoncol.2019.07.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 07/31/2019] [Indexed: 01/12/2023]
Abstract
Treatment of cancer patients with charged particles like proton and carbon ions landmarks a new era in high-precision medicine. This review aims to summarize the physical and biological advantages of charged particle beams over conventional photon irradiation, presents some highlights in the treatment of selected tumor entities, and gives an update on previous and ongoing clinical trials.
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Affiliation(s)
- Tilmann Rackwitz
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), University Hospital Heidelberg, Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), University Hospital Heidelberg, Heidelberg, Germany.
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), University Hospital Heidelberg, Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center (HIT), University Hospital Heidelberg, Heidelberg, Germany
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