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Kotecha R, La Rosa A, Mehta MP. How proton therapy fits into the management of adult intracranial tumors. Neuro Oncol 2024; 26:S26-S45. [PMID: 38437667 PMCID: PMC10911801 DOI: 10.1093/neuonc/noad183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
Intracranial tumors include a challenging array of primary and secondary parenchymal and extra-axial tumors which cause neurologic morbidity consequential to location, disease extent, and proximity to critical neurologic structures. Radiotherapy can be used in the definitive, adjuvant, or salvage setting either with curative or palliative intent. Proton therapy (PT) is a promising advance due to dosimetric advantages compared to conventional photon radiotherapy with regards to normal tissue sparing, as well as distinct physical properties, which yield radiobiologic benefits. In this review, the principles of efficacy and safety of PT for a variety of intracranial tumors are discussed, drawing upon case series, retrospective and prospective cohort studies, and randomized clinical trials. This manuscript explores the potential advantages of PT, including reduced acute and late treatment-related side effects and improved quality of life. The objective is to provide a comprehensive review of the current evidence and clinical outcomes of PT. Given the lack of consensus and directives for its utilization in patients with intracranial tumors, we aim to provide a guide for its judicious use in clinical practice.
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Affiliation(s)
- Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
- Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
- Department of Translational Medicine, Hebert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Alonso La Rosa
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
| | - Minesh P Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
- Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
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Zeng Y, Li H, Wang W, Liu X, Qin B, Dai S, Pang B, Liu M, Quan H, Yang K, Chang Y, Yang Z. Feasibility study of multiple-energy Bragg peak proton FLASH on a superconducting gantry with large momentum acceptance. Med Phys 2024; 51:2164-2174. [PMID: 38169535 DOI: 10.1002/mp.16932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/30/2023] [Accepted: 12/20/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND While the Bragg peak proton beam (BP) is capable of superior target conformity and organs-at-risk sparing than the transmission proton beam (TB), its efficacy in FLASH-RT is hindered by both a slow energy switching process and the beam current. A universal range shifter (URS) can pull back the high-energy proton beam while preserving the beam current. Meanwhile, a superconducting gantry with large momentum acceptance (LMA-SC gantry) enables fast energy switching. PURPOSE This study explores the feasibility of multiple-energy BP FLASH-RT on the LMA-SC gantry. METHOD AND MATERIALS A simultaneous dose and spot map optimization algorithm was developed for BP FLASH-RT treatment planning to improve the dose delivery efficiency. The URS was designed to be 0-27 cm thick, with 1 cm per step. BP plans using the URS were optimized using single-field optimization (SFO) and multiple-field optimization (MFO) for ten prostate cancer patients and ten lung cancer patients. The plan delivery parameters, dose, and dose rate metrics of BP plans were compared to those of TB plans using the parameters of the LMA-SC gantry. RESULTS Compared to TB plans, BP plans significantly reduced MUs by 42.7% (P < 0.001) with SFO and 33.3% (P < 0.001) with MFO for prostate cases. For lung cases, the reduction in MUs was 56.8% (P < 0.001) with SFO and 36.4% (P < 0.001) with MFO. BP plans also outperformed TB plans by reducing mean normal tissue doses. BP-SFO plans achieved a reduction of 56.7% (P < 0.001) for prostate cases and 57.7% (P < 0.001) for lung cases, while BP-MFO plans achieved a reduction of 54.2% (P < 0.001) for the prostate case and 40.0% (P < 0.001) for lung cases. For both TB and BP plans, normal tissues in prostate and lung cases received 100.0% FLASH dose rate coverage (>40 Gy/s). CONCLUSIONS By utilizing the URS and the LMA-SC gantry, it is possible to perform multiple-energy BP FLASH-RT, resulting in better normal tissue sparing, as compared to TB plans.
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Affiliation(s)
- Yiling Zeng
- Department of Medical Physics, School of Physics and Technology, Wuhan University, Wuhan, China
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Precision Radiation Oncology, Wuhan, China
| | - Heng Li
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Wei Wang
- State Key Laboratory of Advanced Electromagnetic Engineering and Technology, School of Electrical and Electronic Engineering, Huazhong University of Science and Technology, Wuhan, China
| | - Xu Liu
- State Key Laboratory of Advanced Electromagnetic Engineering and Technology, School of Electrical and Electronic Engineering, Huazhong University of Science and Technology, Wuhan, China
| | - Bin Qin
- State Key Laboratory of Advanced Electromagnetic Engineering and Technology, School of Electrical and Electronic Engineering, Huazhong University of Science and Technology, Wuhan, China
| | - Shuyang Dai
- School of Mathematics and Statistics, Wuhan University, Wuhan, P. R. China
| | - Bo Pang
- Department of Medical Physics, School of Physics and Technology, Wuhan University, Wuhan, China
| | - Muyu Liu
- Department of Medical Physics, School of Physics and Technology, Wuhan University, Wuhan, China
| | - Hong Quan
- Department of Medical Physics, School of Physics and Technology, Wuhan University, Wuhan, China
| | - Kunyu Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Precision Radiation Oncology, Wuhan, China
| | - Yu Chang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Precision Radiation Oncology, Wuhan, China
| | - Zhiyong Yang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Key Laboratory of Precision Radiation Oncology, Wuhan, China
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Lo CY, Tsai SW, Niu H, Chen FH, Hwang HC, Chao TC, Hsiao IT, Liaw JW. Gold-Nanoparticles-Enhanced Production of Reactive Oxygen Species in Cells at Spread-Out Bragg Peak under Proton Beam Radiation. ACS OMEGA 2023; 8:17922-17931. [PMID: 37251180 PMCID: PMC10210040 DOI: 10.1021/acsomega.3c01025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/26/2023] [Indexed: 05/31/2023]
Abstract
This study investigates the radiobiological effects of gold nanoparticles (GNPs) as radiosensitizers for proton beam therapy (PBT). Specifically, we explore the enhanced production of reactive oxygen species (ROS) in GNP-loaded tumor cells irradiated by a 230 MeV proton beam in a spread-out Bragg peak (SOBP) zone obtained by a passive scattering system. Our findings indicate that the radiosensitization enhancement factor is 1.24 at 30% cell survival fraction, 8 days after 6 Gy proton beam irradiation. Since protons deposit the majority of their energy at the SOBP region and interact with GNPs to induce more ejected electrons from the high-Z GNPs, these ejected electrons then react with water molecules to produce excessive ROS that can damage cellular organelles. Laser scanning confocal microscopy reveals the excessive ROS induced inside the GNP-loaded cells immediately after proton irradiation. Furthermore, the damage to cytoskeletons and mitochondrial dysfunction in GNP-loaded cells caused by the induced ROS becomes significantly severe, 48 h after proton irradiation. Our biological evidence suggests that the cytotoxicity of GNP-enhanced ROS production has the potential to increase the tumoricidal efficacy of PBT.
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Affiliation(s)
- Chang-Yun Lo
- Department
of Mechanical Engineering, Chang Gung University, Taoyuan 333, Taiwan
| | - Shiao-Wen Tsai
- Department
of Biomedical Engineering, Chang Gung University, Taoyuan 333, Taiwan
- Department
of Periodontics, Chang Gung Memorial Hospital, Taipei 105, Taiwan
| | - Huan Niu
- Accelerator
Laboratory, Nuclear Science and Technology Development Center, National Tsing Hua University, Hsinchu 300, Taiwan
| | - Fang-Hsin Chen
- Institute
of Nuclear Engineering and Science, National
Tsing Hua University, Hsinchu 300, Taiwan
- Department
of Radiation Oncology, Chang Gung Memorial
Hospital, Taoyuan 333, Taiwan
- Department
of Medical Imaging and Radiological Science, Chang Gung University, Taoyuan 333, Taiwan
| | - Hsiao-Chien Hwang
- Proton
and Radiation Therapy Center, Linkou Chang
Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Tsi-Chian Chao
- Department
of Medical Imaging and Radiological Science, Chang Gung University, Taoyuan 333, Taiwan
| | - Ing-Tsung Hsiao
- Department
of Medical Imaging and Radiological Science, Chang Gung University, Taoyuan 333, Taiwan
| | - Jiunn-Woei Liaw
- Department
of Mechanical Engineering, Chang Gung University, Taoyuan 333, Taiwan
- Proton
and Radiation Therapy Center, Linkou Chang
Gung Memorial Hospital, Taoyuan 333, Taiwan
- Department
of Mechanical Engineering, Ming Chi University
of Technology, New Taipei City 243, Taiwan
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