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Peters N, Taasti VT, Ackermann B, Bolsi A, Dahlgren CV, Ellerbrock M, Fracchiolla F, Gomà C, Góra J, Lopes PC, Rinaldi I, Salvo K, Tarp IS, Vai A, Bortfeld T, Lomax A, Richter C, Wohlfahrt P. Response to "Letter regarding Consensus guide on CT-based prediction of stopping-power ratio using a Hounsfield look-up table for proton therapy". Radiother Oncol 2024; 190:109961. [PMID: 37871749 DOI: 10.1016/j.radonc.2023.109961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 09/21/2023] [Indexed: 10/25/2023]
Affiliation(s)
- Nils Peters
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany; Massachusetts General Hospital and Harvard Medical School, Department of Radiation Oncology, Boston, MA, USA.
| | - Vicki Trier Taasti
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands.
| | - Benjamin Ackermann
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Alessandra Bolsi
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | | | - Malte Ellerbrock
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Francesco Fracchiolla
- Azienda Provinciale per i Servizi Sanitari (APSS) Protontherapy Department, Trento, Italy
| | - Carles Gomà
- Department of Radiation Oncology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Joanna Góra
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | | | - Ilaria Rinaldi
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Koen Salvo
- AZ Sint-Maarten, Department of Radiotherapy, Mechelen, Belgium
| | - Ivanka Sojat Tarp
- Aarhus University Hospital, Danish Center for Particle Therapy, Aarhus, Denmark
| | - Alessandro Vai
- Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
| | - Thomas Bortfeld
- Massachusetts General Hospital and Harvard Medical School, Department of Radiation Oncology, Boston, MA, USA
| | - Antony Lomax
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Christian Richter
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Patrick Wohlfahrt
- Massachusetts General Hospital and Harvard Medical School, Department of Radiation Oncology, Boston, MA, USA
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Speleers B, Schoepen M, Belosi F, Vakaet V, De Neve W, Deseyne P, Paelinck L, Vercauteren T, Parkes MJ, Lomax T, Van Greveling A, Bolsi A, Weber DC, Veldeman L, De Gersem W. Author Correction: Effects of deep inspiration breath hold on prone photon or proton irradiation of breast and regional lymph nodes. Sci Rep 2023; 13:13749. [PMID: 37612328 PMCID: PMC10447521 DOI: 10.1038/s41598-023-40643-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Affiliation(s)
- Bruno Speleers
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Radiotherapiepark, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Max Schoepen
- Department of Industrial Systems Engineering and Product Design, Faculty of Engineering and Architecture, Ghent University, Ghent, Belgium
| | | | - Vincent Vakaet
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Radiotherapiepark, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of Radiation Oncology, University Hospital Ghent, Ghent, Belgium
| | - Wilfried De Neve
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Radiotherapiepark, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Pieter Deseyne
- Department of Radiation Oncology, University Hospital Ghent, Ghent, Belgium
| | - Leen Paelinck
- Department of Radiation Oncology, University Hospital Ghent, Ghent, Belgium
| | - Tom Vercauteren
- Department of Radiation Oncology, University Hospital Ghent, Ghent, Belgium
| | - Michael J Parkes
- Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Tony Lomax
- Paul Scherrer Institut, Villigen, Switzerland
| | | | | | - Damien C Weber
- Paul Scherrer Institut, Villigen, Switzerland
- Radiation Oncology Department, University Hospital of Bern, Bern, Switzerland
- Radiation Oncology Department, University Hospital of Zurich, Zurich, Switzerland
| | - Liv Veldeman
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Radiotherapiepark, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of Radiation Oncology, University Hospital Ghent, Ghent, Belgium
| | - Werner De Gersem
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Radiotherapiepark, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of Radiation Oncology, University Hospital Ghent, Ghent, Belgium
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Actis O, Mayor A, Meer D, Rechsteiner U, Bolsi A, Lomax AJ, Weber DC. A bi-directional beam-line energy ramping for efficient patient treatment with scanned proton therapy. Phys Med Biol 2023; 68:175001. [PMID: 37506707 DOI: 10.1088/1361-6560/acebb2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/28/2023] [Indexed: 07/30/2023]
Abstract
Objective.The treatment of mobile tumours using Pencil Beam Scanning (PBS) has become more prevalent in the last decade. However, to achieve the same beam delivery quality as for static tumours, treatments have to be combined with motion mitigation techniques, not limited but including, breath hold, gating and re-scanning, which typically prolong treatment time. In this article we present a novel method of bi-directional energy modulation and demonstrate our initial experience in improvement of treatment efficiency. Approach.At Paul Scherrer Institute Gantry 2 mobile tumours are treated by combining PBS with gating and volumetric re-scanning (VR), where the target volume is irradiated multiple times. Initial implementation of VR used only descending beam energies, creating a substantial dead time due to the beam-line initialization (ramping) before each re-scan. In 2019 we commissioned an energy meandering strategy that allows us to avoid beam line ramping in-between energy series while maintaining beam delivery quality.Main results.The measured beam parameters difference for both energy sequence are in the order of the typical daily variations: 0.2 mm in beam position and 0.2 mm in range. Using machine log files, we performed point-to-point dose difference calculations between original and new applications where we observed dose differences of less than 2%. After three years of operation employing bi-directional energy modulation, we have analysed the individual beam delivery time for 181 patients and have compared this to simulations of the timing behaviour assuming uni-directional energy sequence application. Depending on treatment complexity, we obtained plan delivery time reductions of up to 55%, with a median time gain of 17% for all types of treatments.Significance. Bi-directional energy modulation can help improving patient treatment efficiency by reducing delivery times especially for complex and specialised irradiations. It could be implemented in many existing facilities without significant additional hardware upgrades.
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Affiliation(s)
- Oxana Actis
- Center for Proton Therapy, Paul Scherrer Institut, Switzerland
| | - Alexandre Mayor
- Center for Proton Therapy, Paul Scherrer Institut, Switzerland
| | - David Meer
- Center for Proton Therapy, Paul Scherrer Institut, Switzerland
| | - Urs Rechsteiner
- Center for Proton Therapy, Paul Scherrer Institut, Switzerland
| | | | - Antony John Lomax
- Center for Proton Therapy, Paul Scherrer Institut, Switzerland
- ETH Zurich, Switzerland
| | - Damien Charles Weber
- Center for Proton Therapy, Paul Scherrer Institut, Switzerland
- University Hospital Zurich, Switzerland
- University Hospital Bern, University of Bern, Switzerland
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Krcek R, Leiser D, García-Marqueta M, Bolsi A, Weber DC. Long Term Outcome and Quality of Life of Intracranial Meningioma Patients Treated with Pencil Beam Scanning Proton Therapy. Cancers (Basel) 2023; 15:3099. [PMID: 37370709 DOI: 10.3390/cancers15123099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
The aim of this study was to assess the clinical outcome, including QoL, of patients with intracranial meningiomas WHO grade 1-3 who were treated with Pencil Beam Scanning Proton Therapy (PBS PT) between 1997 and 2022. Two hundred patients (median age 50.4 years, 70% WHO grade 1) were analyzed. Acute and late side effects were classified according to CTCAE version 5.0. Time to event data were calculated. QoL was assessed descriptively by the EORTC-QLQ-C30 and BN20 questionnaires. With a median follow-up of 65 months (range: 3.8-260.8 months) the 5 year OS was 95.7% and 81.8% for WHO grade 1 and grade 2/3, respectively (p < 0.001). Twenty (10%) local failures were observed. Failures occurred significantly (p < 0.001) more frequent in WHO grade 2 or 3 meningioma (WHO grade 1: n = 7, WHO grade 2/3: n = 13), in patients with multiple meningiomas (p = 0.005), in male patients (p = 0.005), and when PT was initiated not as upfront therapy (p = 0.011). There were no high-grade toxicities in the majority (n = 176; 88%) of patients. QoL was assessed for 83 (41.5%) patients and for those patients PT did not impacted QoL negatively during the follow-up. In summary, we observed very few local recurrences of meningiomas after PBS PT, a stable QoL, and a low rate of high-grade toxicity.
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Affiliation(s)
- Reinhardt Krcek
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
| | - Dominic Leiser
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland
| | - Marta García-Marqueta
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland
| | - Alessandra Bolsi
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland
| | - Damien Charles Weber
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3012 Bern, Switzerland
- Department of Radiation Oncology, University Hospital of Zürich, 8091 Zürich, Switzerland
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Peters N, Trier Taasti V, Ackermann B, Bolsi A, Vallhagen Dahlgren C, Ellerbrock M, Fracchiolla F, Gomà C, Góra J, Cambraia Lopes P, Rinaldi I, Salvo K, Sojat Tarp I, Vai A, Bortfeld T, Lomax A, Richter C, Wohlfahrt P. Consensus guide on CT-based prediction of stopping-power ratio using a Hounsfield look-up table for proton therapy. Radiother Oncol 2023; 184:109675. [PMID: 37084884 DOI: 10.1016/j.radonc.2023.109675] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/08/2023] [Accepted: 04/10/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND AND PURPOSE Studies have shown large variations in stopping-power ratio (SPR) prediction from computed tomography (CT) across European proton centres. To standardise this process, a step-by-step guide on specifying a Hounsfield look-up table (HLUT) is presented here. MATERIALS AND METHODS The HLUT specification process is divided into six steps: Phantom setup, CT acquisition, CT number extraction, SPR determination, HLUT specification, and HLUT validation. Appropriate CT phantoms have a head- and body-sized part, with tissue-equivalent inserts in regard to X-ray and proton interactions. CT numbers are extracted from a region-of-interest covering the inner 70% of each insert in-plane and several axial CT slices in scan direction. For optimal HLUT specification, the SPR of phantom inserts is measured in a proton beam and the SPR of tabulated human tissues is computed stoichiometrically at 100 MeV. Including both phantom inserts and tabulated human tissues increases HLUT stability. Piecewise linear regressions are performed between CT numbers and SPRs for four tissue groups (lung, adipose, soft tissue, and bone) and then connected with straight lines. Finally, a thorough but simple validation is performed. RESULTS The best practices and individual challenges are explained comprehensively for each step. A well-defined strategy for specifying the connection points between the individual line segments of the HLUT is presented. The guide was tested exemplarily on three CT scanners from different vendors, proving its feasibility. CONCLUSION The presented step-by-step guide for CT-based HLUT specification with recommendations and examples can contribute to reduce inter-centre variations in SPR prediction.
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Affiliation(s)
- Nils Peters
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany; Massachusetts General Hospital and Harvard Medical School, Department of Radiation Oncology, Boston, MA, USA.
| | - Vicki Trier Taasti
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands.
| | - Benjamin Ackermann
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Alessandra Bolsi
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | | | - Malte Ellerbrock
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Francesco Fracchiolla
- Azienda Provinciale per i Servizi Sanitari (APSS) Protontherapy Department, Trento, Italy
| | - Carles Gomà
- Department of Radiation Oncology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Joanna Góra
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | | | - Ilaria Rinaldi
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Koen Salvo
- AZ Sint-Maarten, Department of Radiotherapy, Mechelen, Belgium
| | - Ivanka Sojat Tarp
- Aarhus University Hospital, Danish Center for Particle Therapy, Aarhus, Denmark
| | - Alessandro Vai
- Radiotherapy Department, Center for National Oncological Hadrontherapy (CNAO), 27100 Pavia, Italy
| | - Thomas Bortfeld
- Massachusetts General Hospital and Harvard Medical School, Department of Radiation Oncology, Boston, MA, USA
| | - Antony Lomax
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Christian Richter
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; German Cancer Consortium (DKTK), partner site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Patrick Wohlfahrt
- Massachusetts General Hospital and Harvard Medical School, Department of Radiation Oncology, Boston, MA, USA
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Trnkova P, Zhang Y, Toshito T, Heijmen B, Richter C, Aznar MC, Albertini F, Bolsi A, Daartz J, Knopf AC, Bertholet J. A survey of practice patterns for adaptive particle therapy for interfractional changes. Phys Imaging Radiat Oncol 2023; 26:100442. [PMID: 37197154 PMCID: PMC10183663 DOI: 10.1016/j.phro.2023.100442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 05/19/2023] Open
Abstract
Background and purpose Anatomical changes may compromise the planned target coverage and organs-at-risk dose in particle therapy. This study reports on the practice patterns for adaptive particle therapy (APT) to evaluate current clinical practice and wishes and barriers to further implementation. Materials and methods An institutional questionnaire was distributed to PT centres worldwide (7/2020-6/2021) asking which type of APT was used, details of the workflow, and what the wishes and barriers to implementation were. Seventy centres from 17 countries participated. A three-round Delphi consensus analysis (10/2022) among the authors followed to define recommendations on required actions and future vision. Results Out of the 68 clinically operational centres, 84% were users of APT for at least one treatment site with head and neck being most common. APT was mostly performed offline with only two online APT users (plan-library). No centre used online daily re-planning. Daily 3D imaging was used for APT by 19% of users. Sixty-eight percent of users had plans to increase their use or change their technique for APT. The main barrier was "lack of integrated and efficient workflows". Automation and speed, reliable dose deformation for dose accumulation and higher quality of in-room volumetric imaging were identified as the most urgent task for clinical implementation of online daily APT. Conclusion Offline APT was implemented by the majority of PT centres. Joint efforts between industry research and clinics are needed to translate innovations into efficient and clinically feasible workflows for broad-scale implementation of online APT.
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Affiliation(s)
- Petra Trnkova
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
- Corresponding author.
| | - Ye Zhang
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Toshiyuki Toshito
- Nagoya Proton Therapy Center, Nagoya City University West Medical Center, Nagoya, Japan
| | - Ben Heijmen
- Department of Radiotherapy, Erasmus University Medical Center (Erasmus MC), Rotterdam, the Netherlands
| | - Christian Richter
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden – Rossendorf, Dresden, Germany
| | - Marianne C. Aznar
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | | | - Alessandra Bolsi
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Juliane Daartz
- Department of Radiation Oncology, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, United States of America
| | - Antje C. Knopf
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
- Institute for Medical Engineering and Medical Informatics, School of Life Science FHNW, Muttenz, Switzerland
| | - Jenny Bertholet
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
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Vázquez M, Bachmann N, Pica A, Bolsi A, De Angelis C, Lomax AJ, Weber DC. Early outcome after craniospinal irradiation with pencil beam scanning proton therapy for children, adolescents and young adults with brain tumors. Pediatr Blood Cancer 2023; 70:e30087. [PMID: 36377685 DOI: 10.1002/pbc.30087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/21/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022]
Abstract
Central nervous system (CNS) tumors are the most common solid malignancies in children and adolescents and young adults (C-AYAs). Craniospinal irradiation (CSI) is an essential treatment component for some malignancies, but it can also lead to important toxicity. Pencil beam scanning proton therapy (PBSPT) allows for a minimization of dose delivered to organs at risk and, thus, potentially reduced acute and late toxicity. This study aims to report the clinical outcomes and toxicity rates after CSI for C-AYAs treated with PBSPT. Seventy-one C-AYAs (median age: 7.4 years) with CNS tumors were treated with CSI between 2004 and 2021. Medulloblastoma (n = 42: 59%) and ependymoma (n = 8; 11%) were the most common histologies. Median prescribed total PBSPT dose was 54 GyRBE (range: 18-60.4), and median prescribed craniospinal dose was 24 GyRBE (range: 18-36.8). Acute and late toxicities were coded according to Common Terminology Criteria for Adverse Events. After a median follow-up of 24.5 months, the estimated 2-year local control, distant control, and overall survival were 86.3%, 80.5%, and 84.7%, respectively. Late grade ≥3 toxicity-free rate was 92.6% at 2 years. Recurrent and metastatic tumors were associated with worse outcome. In conclusion, excellent tumor control with low toxicity rates was observed in C-AYAs with brain tumors treated with CSI using PBSPT.
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Affiliation(s)
- Miriam Vázquez
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - Nicolas Bachmann
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland.,Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Alessia Pica
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - Alessandra Bolsi
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - Claudio De Angelis
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - Antony J Lomax
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland.,Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Radiation Oncology, University Hospital of Zürich, Zürich, Switzerland
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Bachmann N, Vazquez M, Bolsi A, Pachigolla S, De Angelis C, Ahlhelm F, Lomax A, Pica A, Weber DC. RONC-02. Clinical outcome after craniospinal irradiation with pencil beam scanning proton therapy for children and young adults/adolescents with brain tumors. Neuro Oncol 2022. [PMCID: PMC9164887 DOI: 10.1093/neuonc/noac079.656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND: Craniospinal irradiation (CSI) is an essential treatment component to achieve cure for some brain tumors in children and young adults/adolescents (C-AYAs). Multimodal treatment approaches are however associated with treatment-related late toxicities in these developing patients. Pencil beam scanning proton therapy (PBSPT) allows for a minimization of dose delivered to organs at risk and the brain integral dose and, thus, potentially also a reduction of radiation-induced adverse events. We report the clinical outcome and toxicity rates after CSI for C-AYAs treated with PBSPT. METHODS: We reviewed 71 C-AYAs with a median age of 7.4 years (1.7 – 21.3) who received CSI with PBSPT. Medullobastoma (n=42, 59%) and ependymoma (n=8, 11%) were the most common histologies. Thirty-four (48%) patients presented with metastatic disease at diagnosis. Sixteen (23%) patients were treated for tumor recurrence/progression and 9 (13%) patients underwent re-irradiation. Median prescribed total dose was 54 GyRBE (18 – 60.4) and median craniospinal dose 24 GyRBE (18 – 36.8). Toxicities were recorded according to CTCAE v5.0. RESULTS: With a median follow-up time of 24 months (2 – 195), 12 (17%) patients died due to progressive disease. Eight (11%) patients experienced local failure and 15 (21%) distant failure after PBSPT. Estimated 2-year OS, LC and DC was 86.9%, 86.0% and 80.4%, respectively. Grade 3 acute toxicity (thrombocytopenia, neutropenia, nausea) was observed in 5 (7%) patients. Late grade 3 toxicities (stroke, cataract and CNS necrosis) were observed in 3 (4%) patients, 8, 9 and 16 months after PBSPT, respectively. One (1%) patient developed grade 4 CNS necrosis 8 months after CSI. Late grade ≥3 toxicity free rate was 92.3% at 2 years. No radiation-induced secondary cancer was observed. CONCLUSION: Excellent tumor and brain/spinal distant control and a low late grade ≥3 toxicity rate after CSI were observed in our cohort of C-AYAs treated with PBSPT.
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Affiliation(s)
- Nicolas Bachmann
- Paul Scherrer Institute , Villigen , Switzerland
- University Hospital Inselspital , Bern , Switzerland
| | | | | | | | | | | | - Antony Lomax
- Paul Scherrer Institute , Villigen , Switzerland
| | - Alessia Pica
- Paul Scherrer Institute , Villigen , Switzerland
| | - Damien Charles Weber
- Paul Scherrer Institute , Villigen , Switzerland
- University Hospital Inselspital , Bern , Switzerland
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Guo M, Batin E, Bolsi A, Safai S, Weber D, Lomax A, Chen Z, Zhang Y. PD-0402 Impact of CBCT-based patient positioning uncertainty due to the ROI/DOF selection for proton therapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02837-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Chatzaraki V, Bolsi A, Kubik-Huch RA, Schmidt B, Lomax AJ, Weber DC, Thali M, Niemann T. Influence of Radiation Dose, Photon Energy, and Reconstruction Kernel on rho/z Analysis in Spectral Computer Tomography: A Phantom Study. In Vivo 2022; 36:678-686. [PMID: 35241522 DOI: 10.21873/invivo.12753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The effective atomic number (Zeff) and electron density relative to water (ρe or Rho) of elements can be derived in dual-energy computed tomography (DECT). The aim of this phantom study was to investigate the effect of different photon energies, radiation doses, and reconstruction kernels on Zeff and Rho measured in DECT. MATERIALS AND METHODS An anthropomorphic head phantom including five probes of known composition was scanned under three tube-voltage combinations in DECT: Sn140/100 kV, 140/80 kV and Sn140/80 kV with incremented radiation doses. Raw data were reconstructed with four reconstruction kernels (I30, I40, I50, and I70). Rho and Zeff were measured for each probe for all possible combinations of scan and reconstruction parameters. RESULTS DECT-based Rho and Zeff closely approached the reference values with a mean and maximum error of 1.7% and 6.8%, respectively. Rho was lower for 140/80 kV compared with Sn140/100 kV and Sn140/80 kV with differences being 0.009. Zeff differed among all tube voltages with the most prominent difference being 0.28 between 140/80 kV and Sn140/100 kV. Zeff was lower in I70 compared with those of I30 and I40 with a difference of 0.07. Varying radiation dose yielded a variation of 0.0002 in Rho and 0.03 in Z, both considered negligible in practice. CONCLUSION DECT comprises a feasible method for the extraction of material-specific information. Slight variations should be taken into account when different radiation doses, photon energies, and kernels are applied; however, they are considered small and in practice not crucial for an effective tissue differentiation.
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Affiliation(s)
- Vasiliki Chatzaraki
- Department of Radiology, Kantonsspital Baden, Baden, Switzerland.,Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Alessandra Bolsi
- Paul Scherrer Institute (PSI), ETH Domain, Villigen, Switzerland
| | | | | | | | - Damien C Weber
- Paul Scherrer Institute (PSI), ETH Domain, Villigen, Switzerland
| | - Michael Thali
- Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Tilo Niemann
- Department of Radiology, Kantonsspital Baden, Baden, Switzerland;
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11
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Speleers B, Schoepen M, Belosi F, Vakaet V, De Neve W, Deseyne P, Paelinck L, Vercauteren T, Parkes M, Lomax T, Van Greveling A, Bolsi A, Weber D, Veldeman L, De Gersem W. PO-1108 Deep inspiration breath hold in prone photon or proton irradiation of breast and lymph nodes. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07559-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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12
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Bolsi A, Hoffmann A. SP-0581 Patterns of practice and guideline development: A status update from the EPTN image guidance working group. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08632-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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Zhang Y, Trnkova P, Heijmen B, Richter C, Aznar M, Albertini F, Bolsi A, Daartz J, Bertholet J, Knopf A. OC-0200 Patterns Of Practice in Adaptive and Real-Time Particle Therapy, Part I: intrafractional motion. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06815-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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14
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Speleers B, Schoepen M, Belosi F, Vakaet V, De Neve W, Deseyne P, Paelinck L, Vercauteren T, Parkes MJ, Lomax T, Van Greveling A, Bolsi A, Weber DC, Veldeman L, De Gersem W. Effects of deep inspiration breath hold on prone photon or proton irradiation of breast and regional lymph nodes. Sci Rep 2021; 11:6085. [PMID: 33727599 PMCID: PMC7966795 DOI: 10.1038/s41598-021-85401-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/23/2021] [Indexed: 12/14/2022] Open
Abstract
We report on a comparative dosimetrical study between deep inspiration breath hold (DIBH) and shallow breathing (SB) in prone crawl position for photon and proton radiotherapy of whole breast (WB) and locoregional lymph node regions, including the internal mammary chain (LN_MI). We investigate the dosimetrical effects of DIBH in prone crawl position on organs-at-risk for both photon and proton plans. For each modality, we further estimate the effects of lung and heart doses on the mortality risks of different risk profiles of patients. Thirty-one patients with invasive carcinoma of the left breast and pathologically confirmed positive lymph node status were included in this study. DIBH significantly decreased dose to heart for photon and proton radiotherapy. DIBH also decreased lung doses for photons, while increased lung doses were observed using protons because the retracting heart is displaced by low-density lung tissue. For other organs-at-risk, DIBH resulted in significant dose reductions using photons while minor differences in dose deposition between DIBH and SB were observed using protons. In patients with high risks for cardiac and lung cancer mortality, average thirty-year mortality rates from radiotherapy-related cardiac injury and lung cancer were estimated at 3.12% (photon DIBH), 4.03% (photon SB), 1.80% (proton DIBH) and 1.66% (proton SB). The radiation-related mortality risk could not outweigh the ~ 8% disease-specific survival benefit of WB + LN_MI radiotherapy in any of the assessed treatments.
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Affiliation(s)
- Bruno Speleers
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Radiotherapiepark, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Max Schoepen
- Department of Industrial Systems Engineering and Product Design, Faculty of Engineering and Architecture, Ghent University, Ghent, Belgium
| | | | - Vincent Vakaet
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Radiotherapiepark, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of Radiation Oncology, University Hospital Ghent, Ghent, Belgium
| | - Wilfried De Neve
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Radiotherapiepark, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Pieter Deseyne
- Department of Radiation Oncology, University Hospital Ghent, Ghent, Belgium
| | - Leen Paelinck
- Department of Radiation Oncology, University Hospital Ghent, Ghent, Belgium
| | - Tom Vercauteren
- Department of Radiation Oncology, University Hospital Ghent, Ghent, Belgium
| | - Michael J Parkes
- Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Tony Lomax
- Paul Scherrer Institut, Villigen, Switzerland
| | | | | | - Damien C Weber
- Paul Scherrer Institut, Villigen, Switzerland
- Radiation Oncology Department, University Hospital of Bern, Bern, Switzerland
- Radiation Oncology Department, University Hospital of Zurich, Zurich, Switzerland
| | - Liv Veldeman
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Radiotherapiepark, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of Radiation Oncology, University Hospital Ghent, Ghent, Belgium
| | - Werner De Gersem
- Department of Human Structure and Repair, Faculty of Medicine and Health Sciences, Ghent University, Radiotherapiepark, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of Radiation Oncology, University Hospital Ghent, Ghent, Belgium
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15
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Nesteruk KP, Bolsi A, Lomax AJ, Meer D, van de Water S, Schippers JM. A static beam delivery device for fast scanning proton arc-therapy. Phys Med Biol 2021; 66:055018. [PMID: 33498040 DOI: 10.1088/1361-6560/abe02b] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Arc-therapy is a dose delivery technique regularly applied in photon radiation therapy, and is currently subject of great interest for proton therapy as well. In this technique, proton beams are aimed at a tumor from different continuous ranges of incident directions (so called 'arcs'). This technique can potentially yield a better dose conformity around the tumor and a very low dose in the surrounding healthy tissue. Currently, proton-arc therapy is performed by rotating a proton gantry around the patient, adapting the normally used dose-delivery method to the arc-specific motion of the gantry. Here we present first results from a feasibility study of the conceptual design of a new static fast beam delivery device/system for proton-arc therapy, which could be used instead of a gantry. In this novel concept, the incident angle of proton beams can be set rapidly by only changing field strengths of small magnets. This device eliminates the motion of the heavy gantry and related hardware. Therefore, a reduction of the total treatment time is expected. In the feasibility study presented here, we concentrate on the concept of the beam transport. Based on several simple, but realistic assumptions and approximations, proton tracking calculations were performed in a 3D magnetic field map, to calculate the beam transport in this device and to investigate and address several beam-optics challenges. We propose and simulate corresponding solutions and discuss their outcomes. To enable the implementation of some usually applied techniques in proton therapy, such as pencil beam scanning, energy modulation and beam shaping, we present and discuss our proposals. Here we present the concept of a new idea to perform fast proton arc-scanning and we report on first results of a feasibility study. Based on these results, we propose several options and next steps in the design.
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Affiliation(s)
- K P Nesteruk
- Paul Scherrer Institute, Villigen PSI, Switzerland
| | - A Bolsi
- Paul Scherrer Institute, Villigen PSI, Switzerland
| | - A J Lomax
- Paul Scherrer Institute, Villigen PSI, Switzerland.,Department of Physics, ETH Zurich, Switzerland
| | - D Meer
- Paul Scherrer Institute, Villigen PSI, Switzerland
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16
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Weber DC, Bizzocchi N, Bolsi A, Jenkinson MD. Proton Therapy for Intracranial Meningioma for the Treatment of Primary/Recurrent Disease Including Re-Irradiation. Front Oncol 2020; 10:558845. [PMID: 33381447 PMCID: PMC7769250 DOI: 10.3389/fonc.2020.558845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/28/2020] [Indexed: 01/14/2023] Open
Abstract
Meningeal tumors represent approximately 10-25% of primary brain tumors and occur usually in elderly female patients. Most meningiomas are benign (80-85%) and for symptomatic and/or large tumors, surgery, with or without radiation therapy (RT), has been long established as an effective means of local tumor control. RT can be delivered to inoperable lesions or to those with non-benign histology and for Simpson I-III and IV-V resection. RT can be delivered with photons or particles (protons or carbon ions) in stereotactic or non-stereotactic conditions. Particle therapy delivered for these tumors uses the physical properties of charged carbon ions or protons to spare normal brain tissue (i.e. Bragg peak), with or without or a dose-escalation paradigm for non-benign lesions. PT can substantially decrease the dose delivered to the non-target brain tissues, including but not limited to the hippocampi, optic apparatus or cochlea. Only a limited number of meningioma patients have been treated with PT in the adjuvant or recurrent setting, as well as for inoperable lesions with pencil beam scanning and with protons only. Approximately 500 patients with image-defined or WHO grade I meningioma have been treated with protons. The reported outcome, usually 5-year local tumor control, ranges from 85 to 99% (median, 96%). For WHO grade II or III patients, the outcome of only 97 patients has been published, reporting a median tumor local control rate of 52% (range, 38-71.1). Only 24 recurring patients treated previously with photon radiotherapy and re-treated with PT were reported. The clinical outcome of these challenging patients seems interesting, provided that they presented initially with benign tumors, are not in the elderly category and have been treated previously with conventional radiation dose of photons. Overall, the number of meningioma patients treated or-re-irradiated with this treatment modality is small and the clinical evidence level is somewhat low (i.e. 3b-5). In this review, we detail the results of upfront PT delivered to patients with meningioma in the adjuvant setting and for inoperable tumors. The outcome of meningioma patients treated with this radiation modality for recurrent tumors, with or without previous RT, will also be reviewed.
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Affiliation(s)
- Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland.,Radiation Oncology Department, University Hospital Zürich, Zürich, Switzerland.,Radiation Oncology Department, University Hospital of Bern, Inselspital, Bern, Switzerland
| | - Nicola Bizzocchi
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - Alessandra Bolsi
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.,Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
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17
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Basler L, Poel R, Schröder C, Bolsi A, Lomax A, Tanadini-Lang S, Guckenberger M, Weber DC. Dosimetric analysis of local failures in skull-base chordoma and chondrosarcoma following pencil beam scanning proton therapy. Radiat Oncol 2020; 15:266. [PMID: 33198810 PMCID: PMC7670611 DOI: 10.1186/s13014-020-01711-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/06/2020] [Indexed: 12/04/2022] Open
Abstract
Background Despite combined modality treatment involving surgery and radiotherapy, a relevant proportion of skull-base chordoma and chondrosarcoma patients develop a local recurrence (LR). This study aims to analyze patterns of recurrence and correlate LR with a detailed dosimetric analysis. Methods 222 patients were treated with proton radiotherapy for chordoma (n = 151) and chondrosarcoma (n = 71) at the PSI between 1998 and 2012. All patients underwent surgery, followed by pencil-beam scanning proton therapy to a mean dose of 72.5 ± 2.2GyRBE. A retrospective patterns of recurrence analysis was performed: LR were contoured on follow-up MRI, registered with planning-imaging and the overlap with initial target structures (GTV, PTVhigh-dose, PTVlow-dose) was calculated. DVH parameters of planning structures and recurrences were calculated and correlated with LR using univariate and multivariate cox regression. Results After a median follow-up of 50 months, 35 (16%) LR were observed. Follow-up MRI imaging was available for 27 (77%) of these recurring patients. Only one (3.7%) recurrence was located completely outside the initial PTV (surgical pathway recurrence). The mean proportions of LR covered by the initial target structures were 48% (range 0–86%) for the GTV, 70% (range 0–100%) for PTVhigh and 83% (range 0–100%) for PTVlow. In the univariate analysis, the following DVH parameters were significantly associated with LR: GTV(V < 66GyRBE, p = 0.01), GTV(volume, p = 0.02), PTVhigh(max, p = 0.02), PTVhigh(V < 66GyRBE, p = 0.03), PTVhigh(V < 59GyRBE, p = 0.02), PTVhigh(volume, p = 0.01) and GTV(D95, p = 0.05). In the multivariate analysis, only histology (chordoma vs. chondrosarcoma, p = 0.01), PTVhigh(volume, p = 0.05) and GTV(V < 66GyRBE, p = 0.02) were independent prognostic factors for LR. Conclusion This study identified DVH parameters, which are associated with the risk of local recurrence after proton therapy using pencil-beam scanning for patients with skull-base chordoma and chondrosarcoma.
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Affiliation(s)
- Lucas Basler
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Forschungsstrasse 111, 5232, Villigen, Switzerland.
| | - Robert Poel
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Forschungsstrasse 111, 5232, Villigen, Switzerland
| | - Christina Schröder
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Forschungsstrasse 111, 5232, Villigen, Switzerland
| | - Alessandra Bolsi
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Forschungsstrasse 111, 5232, Villigen, Switzerland
| | - Antony Lomax
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Forschungsstrasse 111, 5232, Villigen, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Forschungsstrasse 111, 5232, Villigen, Switzerland.,Department of Radiation Oncology, University Hospital Zürich, University of Zurich, Zurich, Switzerland.,Department of Radiation Oncology, University Hospital Bern, University of Bern, Bern, Switzerland
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18
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De Angelis C, Albertini F, Weber D, Walser M, Lomax A, Bolsi A. OC-0702: Is there a correlation between robustness and tumor control for skull base proton PBS treatments? Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00724-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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19
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Fattori G, Hrbacek J, Regele H, Bula C, Mayor A, Danuser S, Oxley DC, Rechsteiner U, Grossmann M, Via R, Böhlen TT, Bolsi A, Walser M, Togno M, Colvill E, Lempen D, Weber DC, Lomax AJ, Safai S. Commissioning and quality assurance of a novel solution for respiratory-gated PBS proton therapy based on optical tracking of surface markers. Z Med Phys 2020; 32:52-62. [PMID: 32830006 PMCID: PMC9948868 DOI: 10.1016/j.zemedi.2020.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/01/2020] [Accepted: 07/10/2020] [Indexed: 12/15/2022]
Abstract
We present the commissioning and quality assurance of our clinical protocol for respiratory gating in pencil beam scanning proton therapy for cancer patients with moving targets. In a novel approach, optical tracking has been integrated in the therapy workflow and used to monitor respiratory motion from multiple surrogates, applied on the patients' chest. The gating system was tested under a variety of experimental conditions, specific to proton therapy, to evaluate reaction time and reproducibility of dose delivery control. The system proved to be precise in the application of beam gating and allowed the mitigation of dose distortions even for large (1.4cm) motion amplitudes, provided that adequate treatment windows were selected. The total delivered dose was not affected by the use of gating, with measured integral error within 0.15cGy. Analysing high-resolution images of proton transmission, we observed negligible discrepancies in the geometric location of the dose as a function of the treatment window, with gamma pass rate greater than 95% (2%/2mm) compared to stationary conditions. Similarly, pass rate for the latter metric at the 3%/3mm level was observed above 97% for clinical treatment fields, limiting residual movement to 3mm at end-exhale. These results were confirmed in realistic clinical conditions using an anthropomorphic breathing phantom, reporting a similarly high 3%/3mm pass rate, above 98% and 94%, for regular and irregular breathing, respectively. Finally, early results from periodic QA tests of the optical tracker have shown a reliable system, with small variance observed in static and dynamic measurements.
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Affiliation(s)
- Giovanni Fattori
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland.
| | - Jan Hrbacek
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Harald Regele
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Christian Bula
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Alexandre Mayor
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Stefan Danuser
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - David C. Oxley
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Urs Rechsteiner
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Martin Grossmann
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Riccardo Via
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Till T. Böhlen
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Alessandra Bolsi
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Marc Walser
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Michele Togno
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Emma Colvill
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Daniel Lempen
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Damien C. Weber
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland,Department of Radiation Oncology, University Hospital Zurich, 8091 Zurich, Switzerland,Department of Radiation Oncology, University Hospital Bern, 3000 Bern, Switzerland
| | - Antony J. Lomax
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland,Department of Physics, ETH Zurich, 8092 Zurich, Switzerland
| | - Sairos Safai
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
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20
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Beer J, Kountouri M, Kole AJ, Murray FR, Leiser D, Kliebsch U, Combescure C, Pica A, Bachtiary B, Bolsi A, Lomax AJ, Walser M, Weber DC. Outcomes, Prognostic Factors and Salvage Treatment for Recurrent Chordoma After Pencil Beam Scanning Proton Therapy at the Paul Scherrer Institute. Clin Oncol (R Coll Radiol) 2020; 32:537-544. [PMID: 32222414 DOI: 10.1016/j.clon.2020.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 02/14/2020] [Accepted: 02/18/2020] [Indexed: 12/14/2022]
Abstract
AIMS The outcome of chordoma patients with local or distant failure after proton therapy is not well established. We assessed the disease-specific (DSS) and overall survival of patients recurring after proton therapy and evaluated the prognostic factors affecting DSS. MATERIALS AND METHODS A retrospective analysis was carried out of 71 recurring skull base (n = 36) and extracranial (n = 35) chordoma patients who received adjuvant proton therapy at initial presentation (n = 42; 59%) or after post-surgical recurrence (n = 29; 41%). The median proton therapy dose delivered was 74 GyRBE (range 62-76). The mean age was 55 ± 14.2 years and the male/female ratio was about one. RESULTS The median time to first failure after proton therapy was 30.8 months (range 3-152). Most patients (n = 59; 83%) presented with locoregional failure only. There were only 12 (17%) distant failures, either with (n = 5) or without (n = 7) synchronous local failure. Eight patients (11%) received no salvage therapy for their treatment failure after proton therapy. Salvage treatments after proton therapy failure included surgery, systemic therapy and additional radiotherapy in 45 (63%), 20 (28%) and eight (11%) patients, respectively. Fifty-three patients (75%) died, most often from disease progression (47 of 53 patients; 89%). The median DSS and overall survival after failure was 3.9 (95% confidence interval 3.1-5.1) and 3.4 (95% confidence interval 2.5-4.4) years, respectively. On multivariate analysis, extracranial location and late failure (≥31 months after proton therapy) were independent favourable prognostic factors for DSS. CONCLUSION The survival of chordoma patients after a treatment failure following proton therapy is poor, particularly for patients who relapse early or recur in the skull base. Although salvage treatment is administered to most patients with uncontrolled disease, they will ultimately die as a result of disease progression in most cases.
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Affiliation(s)
- J Beer
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - M Kountouri
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland; Department of Radiation Oncology, University Hospital of Geneva (HUG), Geneva, Switzerland
| | - A J Kole
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland; Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - F R Murray
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - D Leiser
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - U Kliebsch
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - C Combescure
- Unit for Clinical Epidemiology, University Hospital of Geneva (HUG), Geneva, Switzerland
| | - A Pica
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - B Bachtiary
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - A Bolsi
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - A J Lomax
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - M Walser
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland
| | - D C Weber
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland; Department of Radiation Oncology, University Hospital of Zürich, Zürich, Switzerland; Department of Radiation Oncology, University Hospital of Bern, Bern, Switzerland.
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21
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Tran S, Puric E, Walser M, Poel R, Datta NR, Heuberger J, Pica A, Marder D, Lomax N, Bolsi A, Morach P, Bachtiary B, Seddon BM, Schneider R, Bodis S, Weber DC. Early results and volumetric analysis after spot-scanning proton therapy with concomitant hyperthermia in large inoperable sacral chordomas. Br J Radiol 2020; 93:20180883. [PMID: 30943055 PMCID: PMC7066944 DOI: 10.1259/bjr.20180883] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Large inoperable sacral chordomas show unsatisfactory local control rates even when treated with high dose proton therapy (PT). The aim of this study is assessing feasibility and reporting early results of patients treated with PT and concomitant hyperthermia (HT). METHODS: Patients had histologically proven unresectable sacral chordomas and received 70 Gy (relative biological effectiveness) in 2.5 Gy fractions with concomitant weekly HT. Toxicity was assessed according to CTCAE_v4. A volumetric tumor response analysis was performed. RESULTS: Five patients were treated with the combined approach. Median baseline tumor volume was 735 cc (range, 369-1142). All patients completed PT and received a median of 5 HT sessions (range, 2-6). Median follow-up was 18 months (range, 9-26). The volumetric analysis showed an objective response of all tumors (median shrinkage 46%; range, 9-72). All patients experienced acute Grade 2-3 local pain. One patient presented with a late Grade 3 iliac fracture. CONCLUSION Combining PT and HT in large inoperable sacral chordomas is feasible and causes acceptable toxicity. Volumetric analysis shows promising early results, warranting confirmation in the framework of a prospective trial. ADVANCES IN KNOWLEDGE: This is an encouraging first report of the feasibility and early results of concomitant HT and PT in treating inoperable sacral chordoma.
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Affiliation(s)
- Sebastien Tran
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen PSI, Switzerland
| | - Emsad Puric
- Cantonal Hospital Aarau, Radiation Oncology KSA-KSB, Aarau, Switzerland
| | - Marc Walser
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen PSI, Switzerland
| | - Robert Poel
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen PSI, Switzerland
| | | | - Juerg Heuberger
- Cantonal Hospital Aarau, Radiation Oncology KSA-KSB, Aarau, Switzerland
| | - Alessia Pica
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen PSI, Switzerland
| | - Dietmar Marder
- Cantonal Hospital Aarau, Radiation Oncology KSA-KSB, Aarau, Switzerland
| | - Nicoletta Lomax
- Cantonal Hospital Aarau, Radiation Oncology KSA-KSB, Aarau, Switzerland
| | - Alessandra Bolsi
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen PSI, Switzerland
| | - Petra Morach
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen PSI, Switzerland
| | - Barbara Bachtiary
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen PSI, Switzerland
| | - Beatrice M Seddon
- University College London Hospitals NHS Foundation Trust, London Sarcoma Service, London, United Kingdom
| | - Ralf Schneider
- Helios Medical Center Schwerin, Radiation Oncology, Schwerin, Germany
| | - Stephan Bodis
- Cantonal Hospital Aarau, Radiation Oncology KSA-KSB, Aarau, Switzerland
| | - Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen PSI, Switzerland
- Radiation Oncology Department, University Hospital of Zürich, Zurich, Switzerland
- Radiation Oncology Department, Inselspital, University Hospital of Bern, Bern, Switzerland
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22
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Murray FR, Snider JW, Schneider RA, Walser M, Bolsi A, Pica A, Lomax AJ, Weber DC. Prognostic factors for spinal chordomas and chondrosarcomas treated with postoperative pencil-beam scanning proton therapy: a large, single-institution experience. J Neurosurg Spine 2020; 32:921-930. [PMID: 32005008 DOI: 10.3171/2019.11.spine1927] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 11/15/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this paper was to evaluate the prognostic factors in surgical and adjuvant care for spinal chordomas and chondrosarcomas after surgery followed by high-dose pencil-beam scanning proton therapy (PBS-PT). METHODS From 1997 to 2016, 155 patients (61 female patients; median age 55 years) with spinal (cervical, n = 61; thoracic, n = 29; lumbar, n = 13; sacral, n = 46; pelvic, n = 6) classic chordomas (n = 116) and chondrosarcomas (n = 39; most were low grade) were treated with maximal safe resection followed by PBS-PT (median dose prescribed: 74 Gy [relative biological effectiveness], range 48.6-77 Gy). The majority of patients (n = 153, 98.7%) had undergone at least 1 resection prior to PBS-PT (median 1, range 0-5; biopsy only, n = 2). Fewer than half (45.1%) of the surgeries were rated as gross-total resections (GTRs) prior to PBS-PT. Surgical stabilization (SS) was present in 39% of all patients (n = 60). Ninety-one patients (59%) presented with macroscopic tumor at the start of PBS-PT. The median follow-up duration was 64.7 months (range 12.2-204.8 months). RESULTS The 5-year local tumor control, disease-free survival (DFS), and overall survival were 64.9% (95% CI 56.3%-73.5%), 59.4% (95% CI 50.6%-68.2%), and 77.9% (95% CI 70.6%-85.2%), respectively. In total, 63 patients (40.6%) experienced failure during the follow-up period: local only in 32 (20.6%), distal only in 7 (4.5%), local + distal in 19 (12.3%), surgical pathway failure (SPF) only in 2 (1.3%), local + SPF in 2 (1.3%), and distal + SPF in 1 (< 1%). Univariate analysis identified gross residual disease, the presence of SS, and treatment era prior to 2008 as highly significant for worse outcome, with all 3 remaining significant on multivariate analysis. The type of surgery (GTR or subtotal resection/biopsy) and whether GTR was achieved by en bloc or curettage did not show a significant prognostic effect. Surgical complications prior to PBS-PT were present in 42.5% of all surgically treated patients and were seen more commonly in patients with multiple surgical interventions (p = 0.005) and those operated on with the intent of en bloc resection (p = 0.006). CONCLUSIONS The extent of resection and metallic stabilization substantially influenced clinical outcomes for patients with spinal chordoma or chondrosarcoma despite high-dose adjuvant PBS-PT. Optimal upfront surgical management of these tumors continues to include GTR, as possible, with prompt adjuvant proton therapy.
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Affiliation(s)
- Fritz R Murray
- 1Center for Proton Therapy, Paul Scherrer Institute, Villigen
| | - James W Snider
- 2Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
| | | | - Marc Walser
- 1Center for Proton Therapy, Paul Scherrer Institute, Villigen
| | | | - Alessia Pica
- 1Center for Proton Therapy, Paul Scherrer Institute, Villigen
| | - Antony J Lomax
- 1Center for Proton Therapy, Paul Scherrer Institute, Villigen
- 3Department of Physics, ETH, Zurich
| | - Damien C Weber
- 1Center for Proton Therapy, Paul Scherrer Institute, Villigen
- 4Radiation Oncology Department, University Hospital of Bern
- 5Radiation Oncology Department, University Hospital of Zurich, Switzerland; and
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23
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Kountouri M, Pica A, Walser M, Albertini F, Bolsi A, Kliebsch U, Bachtiary B, Combescure C, Lomax AJ, Schneider R, Weber DC. Radiation-induced optic neuropathy after pencil beam scanning proton therapy for skull-base and head and neck tumours. Br J Radiol 2019; 93:20190028. [PMID: 31322969 DOI: 10.1259/bjr.20190028] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To assess the radiation-induced optic neuropathy (RION) prevalence, following high dose pencil beam scanning proton therapy (PBSPT) to skull base and head and neck (H&N) tumours. METHODS Between 1999 and 2014, 216 adult patients, median age 47 years (range, 18-77), were treated with PBS PT for skull base or H&N malignancies, delivering ≥45 GyRBE to the optic nerve(s) (ON) and/or optic chiasma (OC). The median administered dose to the planning target volume was 74.0 GyRBE (range, 54.0-77.4). The median follow-up was 5.3 years (range, 0.8-15.9). RESULTS RION was observed in 14 (6.5%) patients at a median time of 13.2 months (range, 4.8-42.6) following PBSPT. Most (92.9%) of RION were symptomatic. Most affected patients (11/14; 79%) developed unilateral toxicity. Grade 4, 3, 2 and 1 toxicity was observed in 10, 2, 1 and 1 patients, respectively. On univariate analyses, age (<70 vs ≥70 years; p < 0.0001), hypertension (p = 0.0007) and tumour abutting the optic apparatus (p = 0.012) were associated with RION. OC's V60 GyRBE was of border line significance (p = 0.06). None of the other evaluated OC-ON dose/volume metrics (Dmax, Dmean, V40-60) were significantly associated with this complication. CONCLUSION These data suggest that high-dose PBS PT for skull base and H&N tumours is associated with a low prevalence of RION. Caution should be however exercised when treating elderly/hypertensive patients with tumours abutting the optic apparatus. ADVANCES IN KNOWLEDGE This is the first study reporting the risk of developing RION following proton therapy with PBS technique, demonstrating the safety of this treatment.
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Affiliation(s)
- Melpomeni Kountouri
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, CH-5232, Villigen, Switzerland
| | - Alessia Pica
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, CH-5232, Villigen, Switzerland
| | - Marc Walser
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, CH-5232, Villigen, Switzerland
| | - Francesca Albertini
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, CH-5232, Villigen, Switzerland
| | - Alessandra Bolsi
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, CH-5232, Villigen, Switzerland
| | - Ulrike Kliebsch
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, CH-5232, Villigen, Switzerland
| | - Barbara Bachtiary
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, CH-5232, Villigen, Switzerland
| | - Christophe Combescure
- Service d'Epidemiologie Clinique, Hôpitaux Universitaire de Genève, CH 12011 Geneva, Geneva, Switzerland
| | - Antony J Lomax
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, CH-5232, Villigen, Switzerland.,Department of Physics, ETH, Zürich, Switzerland
| | - Ralf Schneider
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, CH-5232, Villigen, Switzerland
| | - Damien Charles Weber
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, CH-5232, Villigen, Switzerland.,University of Bern, Bern, Switzerland.,University of Zürich, Zürich, Switzerland
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24
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Weber DC, Lim PS, Tran S, Walser M, Bolsi A, Kliebsch U, Beer J, Bachtiary B, Lomax T, Pica A. Proton therapy for brain tumours in the area of evidence-based medicine. Br J Radiol 2019; 93:20190237. [PMID: 31067074 DOI: 10.1259/bjr.20190237] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
ADVANCES IN KNOWLEDGE This review details the indication of brain tumors for proton therapy and give a list of the open prospective trials for these challenging tumors.
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Affiliation(s)
- Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland.,University of Bern, Bern, Switzerland.,University of Zürich, Zürich, Switzerland
| | - Pei S Lim
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Sebastien Tran
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Marc Walser
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Alessandra Bolsi
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Ulrike Kliebsch
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Jürgen Beer
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Barbara Bachtiary
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Tony Lomax
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland.,Department of Physics, ETH, Zürich, Switzerland
| | - Alessia Pica
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
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25
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Siewert D, Belosi F, Gleyzes RG, Mikroutsikos L, Correia D, Pica A, Albertini F, Lomax A, Weber D, Bolsi A. EP-1610 Cranio Spinal Axis irradiations using Pencil Beam Scanning: the PSI experience. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32030-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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26
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Peters N, Wohlfahrt P, Bolsi A, Dahlgren C, De Marzi L, Ellerbrock M, Fracchiolla F, Free J, Gomà C, Góra J, Kajdrowicz T, MacKay R, Molinelli S, Nørrevang O, Rinaldi I, Rompokos V, Van der Tol P, Vermeren X, Richter C. OC-0667 Experimental assessment of inter-centre variation and accuracy in SPR prediction within the EPTN. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31087-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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27
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Bizzocchi N, De Angelis C, Hrbacek J, Lomax A, Weber D, Bolsi A. EP-2105 Robustness comparison between 6-and 8fields SIB proton plans on head and neck patients. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32525-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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28
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Matter M, Fachouri N, Nenoff L, Meier G, Bolsi A, Weber D, Lomax A, Albertini F. EP-2098 Measurement free patient specific verification for PBS proton plans – a quantitative evaluation. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32518-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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29
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Winterhalter C, Zepter S, Shim S, Meier G, Bolsi A, Fredh A, Hrbacek J, Oxley D, Zhang Y, Weber DC, Lomax A, Safai S. Evaluation of the ray-casting analytical algorithm for pencil beam scanning proton therapy. Phys Med Biol 2019; 64:065021. [PMID: 30641496 DOI: 10.1088/1361-6560/aafe58] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
For pencil beam scanned (PBS) proton therapy, analytical dose calculation engines are still typically used for the optimisation process, and often for the final evaluation of the plan. Recently however, the suitability of analytical calculations for planning PBS treatments has been questioned. Conceptually, the two main approaches for these analytical dose calculations are the ray-casting (RC) and the pencil-beam (PB) method. In this study, we compare dose distributions and dosimetric indices, calculated on both the clinical dose calculation grid and as a function of dose grid resolution, to Monte Carlo (MC) calculations. The analysis is done using a comprehensive set of clinical plans which represent a wide choice of treatment sites. When analysing dose difference histograms for relative treatment plans, pencil beam calculations with double grid resolution perform best, with on average 97.7%/91.9% (RC), 97.9%/92.7% (RC, double grid resolution), 97.6%/91.0% (PB) and 98.6%/94.0% (PB, double grid resolution) of voxels agreeing within ±5%/± 3% between the analytical and the MC calculations. Even though these point-to-point dose comparison shows differences between analytical and MC calculations, for all algorithms, clinically relevant dosimetric indices agree within ±4% for the PTV and within ±5% for critical organs. While the clinical agreement depends on the treatment site, there is no substantial difference of indices between the different algorithms. The pencil-beam approach however comes at a higher computational cost than the ray-casting calculation. In conclusion, we would recommend using the ray-casting algorithm for fast dose optimization and subsequently combine it with one MC calculation to scale the absolute dose and assure the quality of the treatment plan.
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Affiliation(s)
- Carla Winterhalter
- Centre for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland. Department of Physics, ETH Zurich, Zurich, Switzerland
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30
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Speleers BA, Belosi FM, De Gersem WR, Deseyne PR, Paelinck LM, Bolsi A, Lomax AJ, Boute BG, Van Greveling AE, Monten CM, Van de Velde JJ, Vercauteren TH, Veldeman L, Weber DC, De Neve WC. Comparison of supine or prone crawl photon or proton breast and regional lymph node radiation therapy including the internal mammary chain. Sci Rep 2019; 9:4755. [PMID: 30894606 PMCID: PMC6427000 DOI: 10.1038/s41598-019-41283-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 02/22/2019] [Indexed: 12/25/2022] Open
Abstract
We report on a dosimetrical study comparing supine (S) and prone-crawl (P) position for radiotherapy of whole breast (WB) and loco-regional lymph node regions, including the internal mammary chain (LN_IM). Six left sided breast cancer patients were CT-simulated in S and P positions and four patients only in P position. Treatment plans were made using non-coplanar volumetric modulated arc photon therapy (VMAT) or pencil beam scanning intensity modulated proton therapy (IMPT). Dose prescription was 15*2.67 Gy(GyRBE). The average mean heart doses for S or P VMAT were 5.6 or 4.3 Gy, respectively (p = 0.16) and 1.02 or 1.08 GyRBE, respectively for IMPT (p = 0.8; p < 0.001 for IMPT versus VMAT). The average mean lung doses for S or P VMAT were 5.91 or 2.90 Gy, respectively (p = 0.002) and 1.56 or 1.09 GyRBE, respectively for IMPT (p = 0.016). In high-risk patients, average (range) thirty-year mortality rates from radiotherapy-related cardiac injury and lung cancer were estimated at 6.8(5.4-9.4)% or 3.8(2.8-5.1)% for S or P VMAT (p < 0.001), respectively, and 1.6(1.1-2.0)% or 1.2(0.8-1.6)% for S or P IMPT (p = 0.25), respectively. Radiation-related mortality risk could outweigh the ~8% disease-specific survival benefit of WB + LN_IM radiotherapy for S VMAT but not P VMAT. IMPT carries the lowest radiation-related mortality risks.
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Affiliation(s)
- Bruno A Speleers
- Department of Radiotherapy and Experimental Cancer Research, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | | | - Werner R De Gersem
- Department of Radiotherapy and Experimental Cancer Research, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Pieter R Deseyne
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Leen M Paelinck
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | | | | | - Bert G Boute
- Industrial Design Center, Faculty of Engineering and Architecture, Ghent University, Ghent, Belgium
| | | | - Christel M Monten
- Department of Radiotherapy and Experimental Cancer Research, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Joris J Van de Velde
- Department of Anatomy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Tom H Vercauteren
- Department of Radiotherapy and Experimental Cancer Research, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Liv Veldeman
- Department of Radiotherapy and Experimental Cancer Research, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Damien C Weber
- Paul Scherrer Institut, Villigen, Switzerland.,Radiation Oncology Department, University Hospital of Bern, Bern, Switzerland
| | - Wilfried C De Neve
- Department of Radiotherapy and Experimental Cancer Research, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. .,Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium.
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Pelak M, Walser M, Bachtiary B, Bolsi A, Hrbacek J, Lomax A, Kliebsch U, Pica A, Weber D. PO-162 Patient outcome of pencil beam-scanning proton therapy in Head and Neck adenoid cystic carcinoma. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30328-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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32
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Winterhalter C, Fura E, Tian Y, Aitkenhead A, Bolsi A, Dieterle M, Fredh A, Meier G, Oxley D, Siewert D, Weber DC, Lomax A, Safai S. Validating a Monte Carlo approach to absolute dose quality assurance for proton pencil beam scanning. ACTA ACUST UNITED AC 2018; 63:175001. [DOI: 10.1088/1361-6560/aad3ae] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Bolsi A, Peroni M, Amelio D, Dasu A, Stock M, Toma-Dasu I, Nyström PW, Hoffmann A. Practice patterns of image guided particle therapy in Europe: A 2016 survey of the European Particle Therapy Network (EPTN). Radiother Oncol 2018; 128:4-8. [DOI: 10.1016/j.radonc.2018.03.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 03/10/2018] [Indexed: 12/17/2022]
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Snider JW, Schneider RA, Poelma-Tap D, Stieb S, Murray FR, Placidi L, Albertini F, Lomax A, Bolsi A, Kliebsch U, Malyapa R, Weber DC. Long-Term Outcomes and Prognostic Factors After Pencil-Beam Scanning Proton Radiation Therapy for Spinal Chordomas: A Large, Single-Institution Cohort. Int J Radiat Oncol Biol Phys 2018; 101:226-233. [DOI: 10.1016/j.ijrobp.2018.01.060] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 12/22/2017] [Accepted: 01/16/2018] [Indexed: 01/24/2023]
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Fredh A, Winterhalter C, Fura E, Bolsi A, Safai S, Weber D, Lomax A. EP-1815: Comparison of independent Monte Carlo calculations with measurements of spot scanned proton fields. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32124-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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36
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Hoffmann A, Bolsi A, Peroni M. SP-0220: EPTN WP4: image guidance in particle therapy. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30530-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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37
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Basler L, Poel R, Bolsi A, Lomax A, Tanadini-Lang S, Guckenberger M, Weber D. OC-0593: Dosimetric analysis of local failures in skull-base chordoma/chondrosarcoma following proton therapy. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30903-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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38
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Placidi L, Pica A, Ahllhelm F, Walser M, Lomax A, Bolsi A, Weber D. EP-1958: LET evaluation for pediatric craniopharyngioma with cerebral vasculopathies after PBS proton therapy. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32267-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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39
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Bojaxhiu B, Ahlhelm F, Walser M, Placidi L, Kliebsch U, Mikroutsikos L, Morach P, Bolsi A, Lomax T, Pica A, Weber DC. Radiation Necrosis and White Matter Lesions in Pediatric Patients With Brain Tumors Treated With Pencil Beam Scanning Proton Therapy. Int J Radiat Oncol Biol Phys 2018; 100:987-996. [DOI: 10.1016/j.ijrobp.2017.11.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 10/11/2017] [Accepted: 11/24/2017] [Indexed: 12/21/2022]
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40
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Weber DC, Murray FR, Correia D, Bolsi A, Frei-Welte M, Pica A, Lomax AJ, Schneider R, Bachtiary B. Pencil beam scanned protons for the treatment of patients with Ewing sarcoma. Pediatr Blood Cancer 2017. [PMID: 28627000 DOI: 10.1002/pbc.26688] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Few data exist regarding the clinical outcome of patients with Ewing sarcoma (EWS) treated with pencil beam scanning proton therapy (PT). We report the outcome of children, adolescents and young adults (AYA) treated with PT at the Paul Scherrer Institute. MATERIALS Thirty-eight patients (median age, 9.9 years) received a median dose of 54.9 Gy(RBE) (where RBE is relative biologic effectiveness). Size of the tumor ranged from 1.7 to 24 cm. Most common primary site was axial/pelvic (n = 27; 71%). Four patients (11%) presented with metastases at diagnosis. Twenty (53%) patients had chemo-PT only. Median follow-up was 49.6 months (range, 9.2-131.7). RESULTS The 5-year actuarial rate of local control (LC), distant metastasis-free survival (DMFS), and overall survival (OS) were 81.5%, 76.4%, and 83.0%, respectively. All local recurrences occurred in field and in patients with nonextremity primaries. Six patients died, all of tumor progression. Age < 10 years was a favorable factor of borderline significance for LC (P = 0.05) and OS (P = 0.05), but was significant for DMFS (P = 0.003). Tumor volume <200 ml was a significant prognostic factors for DMFS (P = 0.03), but not for OS (P = 0.07). Metastasis at diagnosis was a strong predictor of local failure (P = 0.003). Only two grade 3 late toxicities were observed. The 5-year actuarial rate of grade 3 toxicity-free survival was 90.9%. CONCLUSIONS These preliminary data suggest that the outcomes of children and AYA with EWS are good and PT was well tolerated with few late adverse events. The local and distant tumor control for older patients with large pre-PT tumor volumes remains problematic.
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Affiliation(s)
- Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Switzerland.,Radiation Oncology Department, University Hospital of Bern, Bern, Switzerland.,Radiation Oncology Department, University Hospital of Zürich, Zürich, Switzerland
| | - Fritz R Murray
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Switzerland
| | - Dora Correia
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Switzerland.,Radiation Oncology Department, University Hospital of Bern, Bern, Switzerland
| | - Alessandra Bolsi
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Switzerland
| | - Martina Frei-Welte
- Department of Anesthesia, University Children's Hospital Zürich, Zürich, Switzerland
| | - Alessia Pica
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Switzerland
| | - Antony J Lomax
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Switzerland.,Department of Physics, ETH, Zürich, Switzerland
| | - Ralf Schneider
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Switzerland
| | - Barbara Bachtiary
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Switzerland
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Belosi MF, van der Meer R, Garcia de Acilu Laa P, Bolsi A, Weber DC, Lomax AJ. Treatment log files as a tool to identify treatment plan sensitivity to inaccuracies in scanned proton beam delivery. Radiother Oncol 2017; 125:514-519. [PMID: 29054379 DOI: 10.1016/j.radonc.2017.09.037] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 10/18/2022]
Abstract
Dose distributions delivered at Gantry 2 at the Paul Scherrer Institut (PSI) can be reconstructed on the patient anatomy based on machine log files. With the present work, the dependency of the log file calculation on the planning optimization technique and on other planning parameters, such as field direction and tumour size, has been investigated. Interestingly, and despite the typically higher modulation of Intensity Modulated Proton Therapy (IMPT) plans, the results for both Single Field Uniform Distribution and IMPT approaches have been found to be similar. In addition, complex fields with steep in-field dose gradients, such as Simultaneous Integrated Boost, and with couch movements in between the delivery, also resulted in good agreement between planned and reconstructed doses. Nevertheless, highly modulated plans can have regions of larger local dose deviations and attention should therefore be paid during the planning stage to the location of isolated, highly weighted pencil beams. We propose also, that further effort should be invested in order to predict field robustness to delivery fluctuations before the clinical delivery of the plan as part of the plan specific Quality Assurance.
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Affiliation(s)
| | | | | | - Alessandra Bolsi
- Centre for Proton Therapy, Paul Scherrer Institut, Villigen, Switzerland
| | - Damien C Weber
- Centre for Proton Therapy, Paul Scherrer Institut, Villigen, Switzerland; Department of Radiation Oncology, University Hospital of Bern, Switzerland; Department of Radiation Oncology, University Hospital of Zürich, Switzerland
| | - Antony J Lomax
- Centre for Proton Therapy, Paul Scherrer Institut, Villigen, Switzerland; Department of Physics, Swiss Institute of Technology (ETH), Zürich, Switzerland
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Murray FR, Snider JW, Bolsi A, Lomax AJ, Walser M, Kliebsch U, Schneider RA, Weber DC. Long-Term Clinical Outcomes of Pencil Beam Scanning Proton Therapy for Benign and Non-benign Intracranial Meningiomas. Int J Radiat Oncol Biol Phys 2017; 99:1190-1198. [PMID: 28939227 DOI: 10.1016/j.ijrobp.2017.08.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 07/24/2017] [Accepted: 08/04/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To assess and report long-term clinical outcomes regarding local control, overall survival, and toxicity-free survival after pencil beam scanning proton therapy for intracranial meningiomas at a single institution. PATIENTS AND METHODS Ninety-six patients (male/female, 29/67; median age 52.8 years) with intracranial meningiomas (World Health Organization [WHO] grade 1, n=61 [63.5%]; WHO grade 2, n=33 [34.4%]; WHO grade 3, n=2 [2.1%]) were treated with pencil beam scanning proton therapy (n=53 [55.2%] at diagnosis, n=17 [17.7%] at recurrence, and n=26 [27.1%] for tumor progression). Median gross tumor volume before PBSPT was 21.4 cm3 (range, 0.0-546.5 cm3), with a median planning target volume of 123.4 cm3 (range, 4.6-1142.0 cm3). Median duration of follow-up was 56.9 months (range, 12.1-207.2 months). Late toxicity was graded according to the Common Terminology Criteria for Adverse Events, version 4.0. RESULTS Thirteen failures (14%) (male/female, 6/7) were observed, of which the majority (n=9, 69%) were of non-benign histology. The 5-year actuarial local control and overall survival were 86.4% and 88.2%, respectively. Five-year grade ≥3 toxicity-free survival was 89.1%. On univariate analysis, local control was worse for patients with higher WHO grade (P≤.001), those treated after at least 1 recurrence (P=.006), those with non-skull base tumor location (P=.014), and males (P=.032). Significant prognosticators for 5-year overall survival were local control (P≤.001), age (P=.002), and timing of proton therapy (initial vs recurrence) (P=.002). CONCLUSIONS Pencil beam scanning proton therapy is an effective and safe treatment for patients with intracranial meningiomas, resulting in high local control rates with limited toxicity. Up-front radiation likely results in improved outcomes and should be considered, especially for patients with non-benign tumors and/or for those with incomplete resections.
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Affiliation(s)
- Fritz R Murray
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland.
| | - James W Snider
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland; Department of Radiation Oncology, University of Maryland, School of Medicine, Baltimore, Maryland
| | - Alessandra Bolsi
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Antony J Lomax
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Marc Walser
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Ulrike Kliebsch
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Ralf A Schneider
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland; University of Bern, Bern, Switzerland; University of Zürich, Zürich, Switzerland
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Weber DC, Abrunhosa-Branquinho A, Bolsi A, Kacperek A, Dendale R, Geismar D, Bachtiary B, Hall A, Heufelder J, Herfarth K, Debus J, Amichetti M, Krause M, Orecchia R, Vondracek V, Thariat J, Kajdrowicz T, Nilsson K, Grau C. Profile of European proton and carbon ion therapy centers assessed by the EORTC facility questionnaire. Radiother Oncol 2017; 124:185-189. [DOI: 10.1016/j.radonc.2017.07.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 07/12/2017] [Accepted: 07/13/2017] [Indexed: 11/28/2022]
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Badiyan SN, Ulmer S, Ahlhelm FJ, Fredh ASM, Kliebsch U, Calaminus G, Bolsi A, Albertini F, Leiser D, Timmermann B, Malyapa RS, Schneider R, Lomax AJ, Weber DC. Clinical and Radiologic Outcomes in Adults and Children Treated with Pencil-Beam Scanning Proton Therapy for Low-Grade Glioma. Int J Part Ther 2017; 3:450-460. [PMID: 31772995 PMCID: PMC6871558 DOI: 10.14338/ijpt-16-00031.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 03/29/2017] [Indexed: 09/21/2023] Open
Abstract
PURPOSE We assessed clinical and radiologic outcomes in adults and children with low-grade glioma (LGG) of the brain treated with pencil-beam scanning (PBS) proton therapy (PT). MATERIALS AND METHODS Between 1997 and 2014, 28 patients were treated with PBS PT, 20 (71%) of whom were younger than 18 years. Median age at start of PT was 12.3 years (range, 2.2-53.0 years). Nine patients (32%) underwent at least a subtotal resection; 12 (43%) underwent biopsy; and 7 (25%) were diagnosed radiographically. Twelve patients (43%) had grade II and 9 (32%) had grade I gliomas. Eleven patients (39%) received chemotherapy before PT. A median dose of 54 Gy (relative biologic effectiveness) was administered. Radiologic response to PT was determined using the Response Evaluation Criteria in Solid Tumors (RECIST). Eight domains of quality of life (QoL) for 16 pediatric patients were assessed prospectively by patients' parents using the pediatric QoL proxy questionnaire. Progression-free survival and overall survival (OS) were estimated by the Kaplan-Meier method. Median follow-up was 42.1 months for living patients. RESULTS Ten patients (36%) developed local, clinical failure. Three patients (11%) died, all of tumor progression. Radiographic tumor response by RECIST was evaluable in 11 patients: 9 (82%) with stable disease, 1 (9%) with partial response, and 1 (9%) with complete response to PT. Three-year OS and progression-free survival were 83.4% and 56.0%, respectively. No ≥ grade III acute toxicities were observed. Grade III, late radiation necrosis developed in 1 patient (4%). No appreciable change in pediatric QoL proxy scores in children was noted in any of the 8 domains at any time point. CONCLUSION Treatment with PBS PT is effective for LGG, with minimal acute toxicity and, in children, no appreciable decline in QoL. More patients and longer follow-up are needed to determine the long-term efficacy and toxicity of PT for LGG.
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Affiliation(s)
- Shahed N. Badiyan
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Frank J. Ahlhelm
- Department of Radiology, Cantonal Hospital Baden, Baden, Switzerland
| | - Anna S. M. Fredh
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Ulrike Kliebsch
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Gabriele Calaminus
- Department of Pediatric Hematology and Oncology, University Hospital Münster, Münster, Germany
| | - Alessandra Bolsi
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | | | | | - Beate Timmermann
- Clinic for Particle Therapy, West German Proton Center, University Hospital Essen, Germany
| | - Robert S. Malyapa
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Ralf Schneider
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Antony J. Lomax
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
- Department of Physics, Swiss Institute of Technology, Zurich, Switzerland
| | - Damien C. Weber
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
- Department of Radiation Oncology, University Hospital Zürich, Zürich, Switzerland
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Belloni S, Peroni M, Safai S, Fattori G, Perrin R, Walser M, Niemann T, Kubik-Huch R, Lomax A, Weber D, Bolsi A. EP-1674: Experimental investigation of CT imaging approaches to deal with metal artefacts in proton therapy. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)32206-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Bojaxhiu B, Ahlhelm F, Walser M, Placidi L, Kliebsch U, Mikroutsikos L, Morach P, Bolsi A, Lomax T, Schneider R, Weber D. OC-0515: Radiation necrosis in children with brain tumours treated with pencil beam scanning proton therapy. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30955-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Belosi M, Van der Meer R, Garcia de Acilu Laa P, Bolsi A, Weber D, Lomax A. OC-0230: Treatment log files as a tool to identify inaccuracies in scanned proton beam delivery and planning. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30673-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kountouri M, Walser M, Schneider R, Bolsi A, Lomax A, Weber D. PV-0049: Recurrent skull base and extra-cranial chordoma following proton therapy: clinical outcomes. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30493-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Trnková P, Bolsi A, Albertini F, Weber DC, Lomax AJ. Factors influencing the performance of patient specific quality assurance for pencil beam scanning IMPT fields. Med Phys 2017; 43:5998. [PMID: 27806620 DOI: 10.1118/1.4964449] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE A detailed analysis of 2728 intensity modulated proton therapy (IMPT) fields that were clinically delivered to patients between 2007 and 2013 at Paul Scherrer Institute (PSI) was performed. The aim of this study was to analyze the results of patient specific dosimetric verifications and to assess possible correlation between the quality assurance (QA) results and specific field metrics. METHODS Dosimetric verifications were performed for every IMPT field prior to patient treatment. For every field, a steering file was generated containing all the treatment unit information necessary for treatment delivery: beam energy, beam angle, dose, size of air gap, nuclear interaction (NI) correction factor, number of range shifter plates, number of Bragg peaks (BPs) with their position and weight. This information was extracted and correlated to the results of dosimetric verification of each field which was a measurement of two orthogonal profiles using an orthogonal ionization chamber array in a movable water column. RESULTS The data analysis has shown more than 94% of all verified plans were within defined clinical tolerances. The differences between measured and calculated dose depend critically on the number of BPs, total thickness of all range shifter plates inserted in the beam path, and maximal range. An increase of the dose difference was observed with smaller number of BPs (i.e., smaller tumor) and smaller ranges (i.e., superficial tumors). The results of the verification do not depend, however, on the prescribed dose, NI correction, or the size of the air gap. There is no dependency of the transversal and longitudinal spot position precision on the beam angle. The value of NI correction depends on the number of spots and number of range shifter plates. CONCLUSIONS The presented study has shown that the verification method used at Centre for Proton Therapy at Paul Scherrer Institute is accurate and reproducible for performing patient specific QA. The results confirmed that the dose discrepancy is dependent on the size and location of the tumor.
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Affiliation(s)
- P Trnková
- Centre for Proton Therapy, Paul Scherrer Institute, PSI West, Villigen 5232, Switzerland
| | - A Bolsi
- Centre for Proton Therapy, Paul Scherrer Institute, PSI West, Villigen 5232, Switzerland
| | - F Albertini
- Centre for Proton Therapy, Paul Scherrer Institute, PSI West, Villigen 5232, Switzerland
| | - D C Weber
- Centre for Proton Therapy, Paul Scherrer Institute, PSI West, Villigen 5232, Switzerland and Radiation Oncology Department, University of Zürich, Rämistrasse 71, Zürich 8006, Switzerland
| | - A J Lomax
- Centre for Proton Therapy, Paul Scherrer Institute, PSI West, Villigen 5232, Switzerland and Department of Physics, ETH Zürich, Rämistrasse 101, Zürich 8092, Switzerland
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Placidi L, Bolsi A, Lomax AJ, Schneider RA, Malyapa R, Weber DC, Albertini F. Effect of Anatomic Changes on Pencil Beam Scanned Proton Dose Distributions for Cranial and Extracranial Tumors. Int J Radiat Oncol Biol Phys 2017; 97:616-623. [DOI: 10.1016/j.ijrobp.2016.11.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/31/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
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