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Shi S, Ou X, Liu C, Wen H, Jiang K. Immunoproteasome acted as immunotherapy 'coffee companion' in advanced carcinoma therapy. Front Immunol 2024; 15:1464267. [PMID: 39281672 PMCID: PMC11392738 DOI: 10.3389/fimmu.2024.1464267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Accepted: 08/14/2024] [Indexed: 09/18/2024] Open
Abstract
Immunoproteasome is a specialized form of proteasome which plays a crucial role in antigen processing and presentation, and enhances immune responses against malignant cells. This review explores the role of immunoproteasome in the anti-tumor immune responses, including immune surveillance and modulation of the tumor microenvironment, as well as its potential as a target for cancer immunotherapy. Furthermore, we have also discussed the therapeutic potential of immunoproteasome inhibitors, strategies to enhance antigen presentation and combination therapies. The ongoing trials and case studies in urology, melanoma, lung, colorectal, and breast cancers have also been summarized. Finally, the challenges facing clinical translation of immunoproteasome-targeted therapies, such as toxicity and resistance mechanisms, and the future research directions have been addressed. This review underscores the significance of targeting the immunoproteasome in combination with other immunotherapies for solid tumors and its potential broader applications in other diseases.
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Affiliation(s)
- Shaoyan Shi
- Department of Hand Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Xuehai Ou
- Department of Hand Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Chao Liu
- Department of Hand Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Hao Wen
- Department of Hand Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Ke Jiang
- Department of Hand Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Singh R, Bishop S, Jenkins J, Davis J, Upadhyay R, McLaughlin C, Sharma S, Baliga S, Palmer JD. Stereotactic Ablative Radiation Therapy (SABR) for Adolescent and Young Adult Malignancies. Cureus 2024; 16:e66890. [PMID: 39280449 PMCID: PMC11398949 DOI: 10.7759/cureus.66890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 08/13/2024] [Indexed: 09/18/2024] Open
Abstract
BACKGROUND There are limited studies examining local control (LC) and overall survival (OS) following stereotactic ablative radiation therapy (SABR) for adolescent and young adult (AYA) populations/histologies with local recurrences or metastatic disease. METHODS The RSSearch® Patient Registry, an international SABR registry, was evaluated for AYA patients treated with SABR. AYA patients with adult histologies/primaries were excluded. Kaplan-Meier analyses were employed to characterize LC and OS following SABR. Potential prognostic factors were assessed with log-rank tests for initial univariate analysis (UVA). For multivariate analyses (MVA), a Cox proportional hazards multivariate model was utilized. RESULTS A total of 19 AYA patients with 39 lesions treated with SABR were identified and included in the analysis. Four lesions (10.3%) were treated with SABR for primary tumor recurrence and 35 lesions were treated for metastatic disease. The median patient age was 34 years (range: 16-39 years). Common lesion locations included lung (11 lesions; 28.2%), non-spinal bone (nine lesions; 23.1%), and spine (six lesions; 15.4%). The median biological effective dose (BED10) was 61.5 Gy (range: 26.4-180). One-year LC and OS following SABR were 77.7% (95% CI: 58.5-88.7) and 72.7% (95% CI: 46.3-87.6), respectively. On UVA, BED10 ≥ 60 Gy was associated with superior one-year LC (94.4% vs. 47.6%; p<0.0001) as were sarcoma primaries (two-year LC: 92.3% vs. 42.2%;p = 0.0002). Central nervous system (CNS) primaries had significantly poorer one-year LC (20% vs 87.5%; p<0.0001) as well as spinal metastases (33.3% vs. 87.0%; p<0.0001). On MVA, BED10 < 60 Gy was associated with inferior LC (hazard ratio (HR) = 5.51;p = 0.01) with sarcoma primaries associated with superior LC (HR = 0.04;p = 0.008). CONCLUSION SABR with BED10 ≥ 60 Gy resulted in durable LC for AYA patients, particularly those with sarcoma primaries, though poor outcomes were noted in metastatic CNS malignancies.
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Affiliation(s)
- Raj Singh
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, USA
| | - Sophia Bishop
- Department of Radiation Oncology, The Radiosurgery Society, San Jose, USA
| | - Jan Jenkins
- Clinical Programs, The Radiosurgery Society, San Mateo, USA
| | - Joanne Davis
- Clinical Programs, The Radiosurgery Society, San Mateo, USA
| | - Rituraj Upadhyay
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, USA
| | - Christopher McLaughlin
- Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, USA
| | - Sanjeev Sharma
- Department of Radiation Oncology, St. Mary's Medical Center, Huntington, USA
| | - Sujith Baliga
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, USA
| | - Joshua D Palmer
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, USA
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Upadhyay R, Klamer B, Matsui J, Chakravarthy VB, Scharschmidt T, Yeager N, Setty BA, Cripe TP, Roberts RD, Aldrink JH, Singh R, Raval RR, Palmer JD, Baliga S. Disease Control and Toxicity Outcomes after Stereotactic Ablative Radiation Therapy for Recurrent and/or Metastatic Cancers in Young-Adult and Pediatric Patients. Cancers (Basel) 2024; 16:2090. [PMID: 38893209 PMCID: PMC11171376 DOI: 10.3390/cancers16112090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Pediatric patients with metastatic and/or recurrent solid tumors have poor survival outcomes despite standard-of-care systemic therapy. Stereotactic ablative radiation therapy (SABR) may improve tumor control. We report the outcomes with the use of SABR in our pediatric solid tumor population. METHODS This was a single-institutional study in patients < 30 years treated with SABR. The primary endpoint was local control (LC), while the secondary endpoints were progression-free survival (PFS), overall survival (OS), and toxicity. The survival analysis was performed using Kaplan-Meier estimates in R v4.2.3. RESULTS In total, 48 patients receiving 135 SABR courses were included. The median age was 15.6 years (interquartile range, IQR 14-23 y) and the median follow-up was 18.1 months (IQR: 7.7-29.1). The median SABR dose was 30 Gy (IQR 25-35 Gy). The most common primary histologies were Ewing sarcoma (25%), rhabdomyosarcoma (17%), osteosarcoma (13%), and central nervous system (CNS) gliomas (13%). Furthermore, 57% of patients had oligometastatic disease (≤5 lesions) at the time of SABR. The one-year LC, PFS, and OS rates were 94%, 22%, and 70%, respectively. No grade 4 or higher toxicities were observed, while the rates of any grade 1, 2, and 3 toxicities were 11.8%, 3.7%, and 4.4%, respectively. Patients with oligometastatic disease, lung, or brain metastases and those who underwent surgery for a metastatic site had a significantly longer PFS. LC at 1-year was significantly higher for patients with a sarcoma histology (95.7% vs. 86.5%, p = 0.01) and for those who received a biological equivalent dose (BED10) > 48 Gy (100% vs. 91.2%, p = 0.001). CONCLUSIONS SABR is well tolerated in pediatric patients with 1-year local failure and OS rates of <10% and 70%, respectively. Future studies evaluating SABR in combination with systemic therapy are needed to address progression outside of the irradiated field.
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Affiliation(s)
- Rituraj Upadhyay
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (R.U.); (J.M.); (R.S.); (R.R.R.); (J.D.P.)
| | - Brett Klamer
- Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA;
| | - Jennifer Matsui
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (R.U.); (J.M.); (R.S.); (R.R.R.); (J.D.P.)
| | - Vikram B. Chakravarthy
- Department of Neurosurgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA;
| | - Thomas Scharschmidt
- Department of Orthopedic Surgery, Nationwide Children’s Hospital, Columbus, OH 43215, USA;
| | - Nicholas Yeager
- Department of Pediatric Oncology, Nationwide Children’s Hospital, Columbus, OH 43205, USA; (N.Y.); (B.A.S.); (T.P.C.); (R.D.R.)
| | - Bhuvana A. Setty
- Department of Pediatric Oncology, Nationwide Children’s Hospital, Columbus, OH 43205, USA; (N.Y.); (B.A.S.); (T.P.C.); (R.D.R.)
| | - Timothy P. Cripe
- Department of Pediatric Oncology, Nationwide Children’s Hospital, Columbus, OH 43205, USA; (N.Y.); (B.A.S.); (T.P.C.); (R.D.R.)
| | - Ryan D. Roberts
- Department of Pediatric Oncology, Nationwide Children’s Hospital, Columbus, OH 43205, USA; (N.Y.); (B.A.S.); (T.P.C.); (R.D.R.)
| | - Jennifer H. Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH 43205, USA;
| | - Raj Singh
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (R.U.); (J.M.); (R.S.); (R.R.R.); (J.D.P.)
| | - Raju R. Raval
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (R.U.); (J.M.); (R.S.); (R.R.R.); (J.D.P.)
| | - Joshua D. Palmer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (R.U.); (J.M.); (R.S.); (R.R.R.); (J.D.P.)
| | - Sujith Baliga
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (R.U.); (J.M.); (R.S.); (R.R.R.); (J.D.P.)
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Buchberger DS, Cook SK, Anderson PM, Shepard DR, Ku JA, Fritz MA, Sindwani R, Recinos P, Murphy ES, Koyfman SA. Salvage stereotactic body radiation therapy re-irradiation for unresectable locally recurrent nasopharyngeal rhabdomyosarcoma in a young adult: A case report. Pediatr Blood Cancer 2023; 70:e30548. [PMID: 37461101 DOI: 10.1002/pbc.30548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/27/2023] [Indexed: 08/24/2023]
Affiliation(s)
- David S Buchberger
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samantha K Cook
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Peter M Anderson
- Pediatric Hematology/Oncology and Bone Marrow Transplant, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Dale R Shepard
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jamie A Ku
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael A Fritz
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Raj Sindwani
- Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Pablo Recinos
- Department of Neurological Surgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Erin S Murphy
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shlomo A Koyfman
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Elgazar A, Awad AK, Rashed AM, Kelany M, Saber HS. Pleomorphic rhabdomyosarcoma of the liver in an adult: An extremely rare case report and review of literature. Int J Surg Case Rep 2023; 109:108585. [PMID: 37541015 PMCID: PMC10412826 DOI: 10.1016/j.ijscr.2023.108585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 08/06/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Primary hepatic sarcomas are one of the extremely rare malignant tumors representing less than 0.1 % of all primary malignant neoplasms. CASE PRESENTATION AND CLINICAL DISCUSSION A known compensated cirrhotic HCV 60-year-old female lady MELD score 8 with a medical history of controlled diabetes and hypertension presented to our hepatobiliary clinic experiencing a chronic right hypochondrial pain that radiate to her right shoulder of 3 months duration. O/E there was right hypochondrial and epigastric tenderness. Pelvi-abdominal US was done then PET CT which revealed a large exophytic focal lesion measuring about 8 × 7 × 6 cm and achieving 12.4 SUV max on FDG uptake. Pre-operative US guided true-cut biopsy showed small oval rounded cells with focal spindling and the neoplastic cells showed hyperchromatic pleomorphic nuclei with little cytoplasm with a positive reaction of tumor cells stained with Desmin and Myogenin with a diagnosis of pleomorphic rhabdomyosarcoma. The patient was scheduled for neoadjuvant chemotherapy and then elective Right hemihepatectomy. Although many challenges were encountered during the resection of the tumor as the tumor was attached to the under surface of the diaphragm, the tumor was resected with a safety margin of 1 cm with frozen histopathological examination being negative for any malignant cells. The patient's postoperative course was uneventful apart from wound infection and was discharged on the postoperative sixth day. CONCLUSION The percutaneous liver biopsy plays an important role in the diagnosis of liver's rhabdomyosarcomas. Neoadjuvant chemotherapy addresses the behavior of the tumor, together with early surgical intervention can lead to favorable outcomes and reduce the recurrence.
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Affiliation(s)
- Amr Elgazar
- Department of General Surgery, Ain-Shams University Hospitals, Cairo, Egypt.
| | - Ahmed K Awad
- Department of General Surgery, Ain-Shams University Hospitals, Cairo, Egypt; Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Amier M Rashed
- Department of General Surgery, Ain-Shams University Hospitals, Cairo, Egypt
| | - Mohamed Kelany
- Department of Clinical Oncology, Ain-Shams University Hospitals, Cairo, Egypt
| | - Hatem Sayed Saber
- Department of General Surgery, Ain-Shams University Hospitals, Cairo, Egypt
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Boboila S, Okochi S, Banerjee D, Barton S, Street C, Zenilman AL, Wang Q, Gartrell RD, Saenger YM, Welch D, Wu CC, Kadenhe-Chiweshe A, Yamashiro DJ, Connolly EP. Combining immunotherapy with high-dose radiation therapy (HDRT) significantly inhibits tumor growth in a syngeneic mouse model of high-risk neuroblastoma. Heliyon 2023; 9:e17399. [PMID: 37408891 PMCID: PMC10319189 DOI: 10.1016/j.heliyon.2023.e17399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 06/11/2023] [Accepted: 06/15/2023] [Indexed: 07/07/2023] Open
Abstract
Purpose The mortality in patients with MYCN-amplified high-risk neuroblastoma remains greater than 50% despite advances in multimodal therapy. Novel therapies are urgently needed that requires preclinical evaluation in appropriate mice models. Combinatorial treatment with high-dose radiotherapy (HDRT) and immunotherapy has emerged as an effective treatment option in a variety of cancers. Current models of neuroblastoma do not recapitulate the anatomic and immune environment in which multimodal therapies can be effectively tested, and there is a need for an appropriate syngeneic neuroblastoma mice model to study interaction of immunotherapy with host immune cells. Here, we develop a novel syngeneic mouse model of MYCN-amplified neuroblastoma and report the relevance and opportunities of this model to study radiotherapy and immunotherapy. Materials and methods A syngeneic allograft tumor model was developed using the murine neuroblastoma cell line 9464D derived a tumor from TH-MYCN transgenic mouse. Tumors were generated by transplanting 1 mm3 portions of 9464D flank tumors into the left kidney of C57Bl/6 mice. We investigated the effect of combining HDRT with anti-PD1 antibody on tumor growth and tumor microenvironment. HDRT (8 Gy x 3) was delivered by the small animal radiation research platform (SARRP). Tumor growth was monitored by ultrasound. To assess the effect on immune cells tumors sections were co-imuunostained for six biomarkers using the Vectra multispectral imaging platform. Results Tumor growth was uniform and confined to the kidney in 100% of transplanted tumors. HDRT was largely restricted to the tumor region with minimal scattered out-of-field dose. Combinatorial treatment with HDRT and PD-1 blockade significantly inhibited tumor growth and prolonged mice survival. We observed augmented T-lymphocyte infiltration, especially CD3+CD8+ lymphocytes, in tumors of mice which received combination treatment. Conclusion We have developed a novel syngeneic mouse model of MYCN amplified high-risk neuroblastoma. We have utilized this model to show that combining immunotherapy with HDRT inhibits tumor growth and prolongs mice survival.
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Affiliation(s)
- Shuobo Boboila
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Shunpei Okochi
- Department of Surgery, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Debarshi Banerjee
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Sunjay Barton
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Cherease Street
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Ariela L. Zenilman
- Department of Surgery, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Qi Wang
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Robyn D. Gartrell
- Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Yvonne M. Saenger
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - David Welch
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Cheng-Chia Wu
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Angela Kadenhe-Chiweshe
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Darrell J. Yamashiro
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Pathology, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Eileen P. Connolly
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York, NY 10032, USA
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Ferrari A, Orbach D, Casanova M, van Noesel MM, Berlanga P, Brennan B, Corradini N, Schoot RA, Ramirez-Villar GL, Hjalgrim LL, Alaggio R, Guillen Burrieza G, Safwat A, Cameron AL, van Rijn RR, Minard-Colin V, Zanetti I, Bisogno G, Chisholm JC, Merks JHM. Metastatic adult-type non-rhabdomyosarcoma soft tissue sarcomas in children and adolescents: A cohort study from the European paediatric Soft tissue sarcoma Study Group. Cancer 2023. [PMID: 37084075 DOI: 10.1002/cncr.34814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/01/2023] [Accepted: 03/22/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Limited data exist on the clinical behavior of pediatric non-rhabdomyosarcoma soft tissue sarcomas (NRSTS) with distant metastases at onset, and a clear standard of care has not yet been defined. METHODS This cohort study reports on pediatric adult-type metastatic NRSTS enrolled in two concurrent prospective European studies, i.e., the randomized BERNIE study and the single-arm MTS 2008 study developed by the European paediatric Soft tissue sarcoma Study Group. Treatment programs were originally designed for patients with metastatic rhabdomyosarcoma, i.e., nine courses of multidrug chemotherapy (with or without bevacizumab in the BERNIE study), followed by 12 cycles of maintenance therapy, whereas radiotherapy and/or surgery (on primary tumor and/or metastases) were delayed until after seven courses of chemotherapy had been administered. RESULTS The study included 61 patients <21 years old treated from July 2008 to December 2016. The lung was the site of metastases in 75% of the cases. All patients received multi-agent chemotherapy, 44% had local therapy to primary tumor, and 18% had treatment of metastases. Median time to progression/relapse was 6 months. A high rate of tumor progression was observed during the initial part of the chemotherapy program. With a median follow-up of 41.5 months (range, 2-111 months), 3-year event-free survival and overall survival were 15.4% (95% confidence interval [CI], 7.6-25.7) and 34.9% (95% CI, 22.7-47.5), respectively. There were no statistically significant differences in outcome depending on the type of treatment administered. CONCLUSIONS The study confirmed the overall poor outcome for patients with metastatic NRSTS, whose treatment remains a challenge. PLAIN LANGUAGE SUMMARY Pediatric non-rhabdomyosarcoma soft tissue sarcomas form a heterogeneous group of rare tumors. Although recent international studies have defined the standard of care for patients with localized disease, limited data are available on the clinical behavior of patients with distant metastases. This study on 61 metastatic cases treated on two prospective European protocols confirms that the chances of survival of such patients are often dismal and a standard treatment is still lacking.
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Affiliation(s)
- Andrea Ferrari
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Daniel Orbach
- SIREDO Oncology Center, Institut Curie, PSL University, Paris, France
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Max M van Noesel
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Pablo Berlanga
- Department of Pediatric and Adolescent Oncology, Gustave-Roussy, Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Bernadette Brennan
- Pediatric Oncology, Royal Manchester Children's Hospital, Manchester, UK
| | - Nadege Corradini
- Department of Pediatric Oncology, Institut d'Hematologie et d'Oncologie Pédiatrique,/Centre Léon Bérard, Lyon, France
| | - Reineke A Schoot
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | | | - Lisa Lyngsie Hjalgrim
- Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Rita Alaggio
- Pathology Department, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Gabriela Guillen Burrieza
- Surgical Oncology and Neonatal Surgery, Pediatric Surgery Department, Hospital Infantil Universitari Vall d'Hebron, Barcelona, Spain
| | - Akmal Safwat
- Oncology Department and Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Alison L Cameron
- Bristol Haematology and Oncology Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Rick R van Rijn
- Department of Radiology and Nuclear Medicine, UMC University of Amsterdam, Amsterdam, Netherlands
| | - Veronique Minard-Colin
- Department of Pediatric and Adolescent Oncology, Gustave-Roussy, Cancer Campus, Université Paris-Saclay, Villejuif, France
| | - Ilaria Zanetti
- Pediatric Hematology Oncology Division, University Hospital of Padua, Padua, Italy
| | - Gianni Bisogno
- Pediatric Hematology Oncology Division, University Hospital of Padua, Padua, Italy
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Julia C Chisholm
- Children and Young People's Unit, The Royal Marsden Hospital and Institute of Cancer Research, Sutton, UK
| | - Johannes H M Merks
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Sudmeier LJ, Madden N, Zhang C, Brock K, Esiashvili N, Eaton BR. Palliative radiotherapy for children: Symptom response and treatment-associated toxicity according to radiation therapy dose and fractionation. Pediatr Blood Cancer 2023; 70:e30195. [PMID: 36642970 PMCID: PMC10430237 DOI: 10.1002/pbc.30195] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 11/08/2022] [Accepted: 12/19/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND/OBJECTIVES Radiotherapy is an effective palliative treatment in advanced cancer. Shorter palliative treatment courses are recommended for adults, though pediatric data addressing treatment efficacy and toxicity according to radiation therapy (RT) dose and fractionation are limited. DESIGN/METHODS Total 213 patients aged 21 years or younger receiving 422 palliative radiotherapy treatment courses from 2003 to 2016 were included. Symptom response and treatment-associated toxicity were recorded and analyzed in relationship to demographic and treatment variables. RESULTS Common diagnoses included sarcoma (32.5%), neuroblastoma (24.9%), leukemia/lymphoma (14.9%), and central nervous system tumors (10.9%). The most common indication for treatment was pain (46.7%). Patients received a median of 10 fractions, 2.5 Gy dose per fraction, and 21 Gy total dose. Number of RT fractions was five or less in 166 (39.3%), six to 10 fractions in 117 (27.2%), and 10 or more fractions in 139 (32.9%) of courses. Complete or partial pain relief was achieved in 85% (151 of 178 evaluable patients), including 77.8% receiving five or less fractions and 89.6% receiving more than five fractions. Highest toxicity was grade 1 in 159 (38.9%), grade 2 in 26 (6.4%), and grade 3 in two (0.5%) treatments. On multivariable analysis, RT delivered 30 or more days from death (OR 12.13, 95% CI: 2.13-69.2, p = .005) and no adjuvant chemotherapy (OR 0.14, 95% CI: 0.03-0.54, p = .005) were significantly associated with pain response, and five or less fractions were significantly associated with lower toxicity (OR 0.24, 95% CI: 0.06-0.97, p = .045). CONCLUSIONS Palliative RT courses of five or less fractions result in high rates of pain control and are associated with low toxicity in pediatric patients with cancer.
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Affiliation(s)
- Lisa J Sudmeier
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Nicholas Madden
- Hulston Cancer Center, CoxHealth, Springfield, Missouri, USA
| | - Chao Zhang
- Department of Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Katharine Brock
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Natia Esiashvili
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
| | - Bree R Eaton
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, Georgia, USA
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA
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Singh R, Valluri A, Didwania P, Lehrer EJ, Baliga S, Hiniker S, Braunstein SE, Murphy ES, Lazarev S, Tinkle C, Terezakis S, Palmer JD. Efficacy and Safety of Stereotactic Body Radiation Therapy for Pediatric Malignancies: The LITE-SABR Systematic Review and Meta-Analysis. Adv Radiat Oncol 2023; 8:101123. [PMID: 36845622 PMCID: PMC9943773 DOI: 10.1016/j.adro.2022.101123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/23/2022] [Indexed: 01/06/2023] Open
Abstract
Purpose Limited data are currently available on clinical outcomes after stereotactic body radiation therapy (SBRT) for pediatric and adolescent and young adult (AYA) patients with cancer. We aimed to perform a systematic review and study-level meta-analysis to characterize associated local control (LC), progression-free survival (PFS), overall survival, and toxicity after SBRT. Methods and Materials Relevant studies were queried using a Population, Intervention, Control, Outcomes, Study Design (PICOS)/Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)/Meta-analysis of Observational Studies in Epidemiology (MOOSE) selection criteria. Primary outcomes were 1-year and 2-year LC as well as incidence of acute and late grade 3 to 5 toxicities, with secondary outcomes of 1-year overall survival and 1-year PFS. Outcome effect sizes were estimated with weighted random effects meta-analyses. Mixed-effects weighted regression models were performed to examine potential correlations between biologically effective dose (BED10), LC, and toxicity incidence. Results Across 9 published studies, we identified 142 pediatric and AYA patients with 217 lesions that were treated with SBRT. Estimated 1-year and 2-year LC rates were 83.5% (95% confidence interval, 70.9%-96.2%) and 74.0% (95% CI, 64.6%-83.4%), respectively, with an estimated acute and late grade 3 to 5 toxicity rate of 2.9% (95% CI, 0.4%-5.4%; all grade 3). The estimated 1-year OS and PFS rates were 75.4% (95% CI, 54.5%-96.3%) and 27.1% (95% CI, 17.3%-37.0%), respectively. On meta-regression, higher BED10 was correlated with improved 2-year LC with every 10 Gy10 increase in BED10 associated with a 5% improvement in 2-year LC (P = .02) in sarcoma-predominant cohorts. Conclusions SBRT provided durable LC for pediatric and AYA patients with cancer with minimal severe toxicities. Dose escalation may result in improved LC for sarcoma-predominant cohorts without a subsequent increase in toxicity. However, further investigations with patient-level data and prospective inquiries are indicated to better define the role of SBRT based on patient and tumor-specific characteristics.
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Affiliation(s)
- Raj Singh
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, Virginia
| | - Anisha Valluri
- Department of Radiation Oncology, Marshall University Joan C. Edwards School of Medicine, Huntington, West Virginia
| | | | - Eric J. Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sujith Baliga
- Department of Radiation Oncology, James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Susan Hiniker
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California
| | - Steve E. Braunstein
- Department of Radiation Oncology, University of California, San Francisco, California
| | - Erin S. Murphy
- Department of Radiation Oncology, Taussig Cancer Institute Cleveland Clinic, Cleveland, Ohio
| | - Stanislav Lazarev
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Christopher Tinkle
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Stephanie Terezakis
- Department of Radiation Oncology, University of Minnesota, Minneapolis, Minnesota
| | - Joshua D. Palmer
- Department of Radiation Oncology, James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, Ohio
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Yu HB, Han BJ, Cao HJ. Prevention of Radiodermatitis With Topical Chinese Herbal Medicine: A Systematic Review and Meta-Analysis. Front Pharmacol 2022; 13:819733. [PMID: 35814240 PMCID: PMC9257048 DOI: 10.3389/fphar.2022.819733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: Topical Chinese herbal medicine (TCHM) is widely used to prevent radiodermatitis in patients who receive radiation therapy in China. However, evidence regarding its efficacy remains limited. The purpose of the review is to evaluate the effects of TCHM in preventing radiodermatitis. Methods: The protocol of this review was registered in PROSPERO (CRD42020220620). Relevant clinical trials were identified (from January 1, 2010, to April 24, 2022) through 11 electronic databases, including PubMed, SpringerLink, Proquest, the Cochrane Central Register of Controlled Trials, Scopus, the ProQuest Dissertation & Theses Global, PsycINFO, Applied Social Sciences Index and Abstracts, the Chinese National Knowledge Infrastructure Databases, Wangfang Data Knowledge Service Platform, and the Chongqing VIP Chinese Science and Technology Periodical Database. The quality of the included trials was assessed through a risk of bias assessment using Version 2 of the Cochrane risk-of-bias tool (RoB 2.0). We included RCTs that compared TCHM single used or as adjunctive treatment with routine drugs, conventional therapy, or placebo for cancer patients who are about to start radiation therapy and do not possess any type of dermatitis or skin lesions at that time. Primary outcomes of interest were the incidence of radiodermatitis and the grade of radiodermatitis according to the RTOG (Radiation Therapy Oncology Group). Secondary outcomes included the recovery time of skin and mucosa, the occurrence time of radiodermatitis, the radiation dose, quality of life, and adverse events. Data were summarized using risk ratio (RR) calculations and 95% confidence intervals (CI) for binary outcomes or mean difference (MD) with 95% CI for continuous outcomes. Certainty of the evidence was assessed according to the GRADE criteria. Results: In this review, 38 randomized controlled trials (RCTs) were included. Risk of bias assessment through RoB 2.0 showed that two studies were rated as low risk, two studies were rated as high risk, and the rest were rated as having some concerns. Compared with routine drugs, TCHM may have an advantage in reducing RTOG grading (RR = 0.46, 95%CI 0.35–0.60), decreasing the recovery time of radiodermatitis (MD = −2.35, 95%CI 3.58 to −1.12 days), delaying the occurrence of radiodermatitis (MD = 2.36, 95%CI 1.74–2.98), and improving the quality of life of patients (RR = 1.46, 95%CI 1.03–2.06). Compared with conventional therapy, TCHM may also have an advantage in decreasing the grade of RTOG (RR = 0.28, 95%CI 0.21–0.38). Conclusion: Current low evidence revealed that TCHM may have better efficacy in the prevention of radiodermatitis; however, more high-quality RCTs are still warranted to testify this conclusion. Systematic Review Registration: (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020220620), identifier (PROSPERO 2020 CRD42020220620).
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Baliga S, Matsui J, Klamer B, Cetnar A, Ewing A, Cadieux C, Gupta A, Setty BA, Roberts RD, Olshefski RS, Cripe TP, Scharschmidt TJ, Aldrink J, Mardis E, Yeager ND, Palmer JD. Clinical outcomes and efficacy of stereotactic body radiation therapy in children, adolescents, and young adults with metastatic solid tumors. Br J Radiol 2022; 95:20211088. [PMID: 35073182 PMCID: PMC10993982 DOI: 10.1259/bjr.20211088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/07/2022] [Accepted: 01/12/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The objective of this study is to report disease outcomes and toxicity with the use of stereotactic body radiation therapy (SBRT) in the treatment of pediatric metastatic disease. METHODS All pediatric and adolescent young adult (AYA) patients' who received SBRT were included between the years 2000 and 2020. Study endpoints included local control (LC), progression-free survival (PFS), overall survival (OS), cumulative incidence (CI) of death or local failure and toxicity. The end points with respect to survival and LC were calculated using the Kaplan-Meier estimate. The cumulative incidence of local failure was calculated using death as a competing risk. RESULTS 16 patients with 36 lesions irradiated met inclusion criteria and formed the study cohort. The median OS and PFS for the entire cohort were 17 months and 15.7 months, respectively. The 1 year OS for the entire cohort was 75%. The 6- and 12 month local control was 85 and 78%, respectively. There were no local failures in irradiated lesions for patients who received a BED10≥100 Gy. Patients who were treated with SBRT who had ≤5 metastatic lesions at first recurrence had a superior 1 year OS of 100 vs 50% for those with >5 lesions. One patient (6.3%) experienced a Grade 3 central nervous system toxicity. CONCLUSION LC was excellent with SBRT delivered to metastatic disease, particularly for lesions receiving a BED10≥100 Gy. High-grade toxicity was rare in our patient population. Patients with five or fewer metastatic sites have a significantly better OS compared to >5 sites. ADVANCES IN KNOWLEDGE This study demonstrates that SBRT is safe and efficacious in the treatment of pediatric oligometastatic disease.
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Affiliation(s)
- Sujith Baliga
- Department of Radiation Oncology, The James Cancer Hospital at
the Ohio State University Wexner Medical Center,
Columbus, OH, USA
| | - Jennifer Matsui
- Department of Radiation Oncology, The James Cancer Hospital at
the Ohio State University Wexner Medical Center,
Columbus, OH, USA
| | - Brett Klamer
- Department of Biomedical Informatics, College of Medicine at
the Ohio State University, Columbus,
OH, USA
| | - Ashley Cetnar
- Department of Radiation Oncology, The James Cancer Hospital at
the Ohio State University Wexner Medical Center,
Columbus, OH, USA
| | - Ashlee Ewing
- Department of Radiation Oncology, The James Cancer Hospital at
the Ohio State University Wexner Medical Center,
Columbus, OH, USA
| | - Catherine Cadieux
- Department of Radiation Oncology, The James Cancer Hospital at
the Ohio State University Wexner Medical Center,
Columbus, OH, USA
| | - Ajay Gupta
- Division of Hematology/Oncology, Roswell Park Comprehensive
Cancer Center, Buffalo, NY,
USA
| | - Bhuvana A Setty
- Division of Hematology, Oncology, Blood and Marrow Transplant,
Nationwide Children’s Hospital,
Columbus, OH, USA
| | - Ryan D Roberts
- Division of Hematology, Oncology, Blood and Marrow Transplant,
Nationwide Children’s Hospital,
Columbus, OH, USA
| | - Randal S Olshefski
- Division of Hematology, Oncology, Blood and Marrow Transplant,
Nationwide Children’s Hospital,
Columbus, OH, USA
| | - Timothy P Cripe
- Division of Hematology, Oncology, Blood and Marrow Transplant,
Nationwide Children’s Hospital,
Columbus, OH, USA
| | - Thomas J Scharschmidt
- Division of Pediatric Orthopedic Oncology, Department of
Surgery, Nationwide Children’s Hospital,
Columbus, OH, USA
| | - Jennifer Aldrink
- Division of Pediatric Surgery, Department of Surgery,
Nationwide Children’s Hospital,
Columbus, OH, USA
| | - Elaine Mardis
- The Steve and Cindy Rasmussen Institute for Genomic Medicine,
Nationwide Children’s Hospital,
Columbus, OH, USA
| | - Nicholas D Yeager
- Division of Hematology, Oncology, Blood and Marrow Transplant,
Nationwide Children’s Hospital,
Columbus, OH, USA
| | - Joshua David Palmer
- Department of Radiation Oncology, The James Cancer Hospital at
the Ohio State University Wexner Medical Center,
Columbus, OH, USA
- Division of Hematology, Oncology, Blood and Marrow Transplant,
Nationwide Children’s Hospital,
Columbus, OH, USA
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Zhang X, Lv B, Rui L, Cai L, Liu F. Regression Analysis of Factors Based on Cluster Analysis of Acute Radiation Pneumonia due to Radiation Therapy for Lung Cancer. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:3727794. [PMID: 34691377 PMCID: PMC8528627 DOI: 10.1155/2021/3727794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/17/2021] [Accepted: 09/24/2021] [Indexed: 11/18/2022]
Abstract
We conducted in this paper a regression analysis of factors associated with acute radiation pneumonia due to radiation therapy for lung cancer utilizing cluster analysis to explore the predictive effects of clinical and dosimetry factors on grade ≥2 radiation pneumonia due to radiation therapy for lung cancer and to further refine the effect of the ratio of the volume of the primary foci to the volume of the lung lobes in which they are located on radiation pneumonia, to refine the factors that are clinically effective in predicting the occurrence of grade ≥2 radiation pneumonia. This will provide a basis for better guiding lung cancer radiation therapy, reducing the occurrence of grade ≥2 radiation pneumonia, and improving the safety of radiotherapy. Based on the characteristics of the selected surveillance data, the experimental simulation of the factors of acute radiation pneumonia due to lung cancer radiation therapy was performed based on three signal detection methods using fuzzy mean clustering algorithm with drug names as the target and adverse drug reactions as the characteristics, and the drugs were classified into three categories. The method was then designed and used to determine the classification correctness evaluation function as the best signal detection method. The factor classification and risk feature identification of acute radiation pneumonia due to radiation therapy for lung cancer based on ADR were achieved by using cluster analysis and feature extraction techniques, which provided a referenceable method for establishing the factor classification mechanism of acute radiation pneumonia due to radiation therapy for lung cancer and a new idea for reuse of ADR surveillance report data resources.
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Affiliation(s)
- Xiaofeng Zhang
- Respiratory Department, The Affiliated Hospital of Jiangnan University, Wuxi Jiangsu 214062, China
| | - Beili Lv
- Respiratory Department, The Affiliated Hospital of Jiangnan University, Wuxi Jiangsu 214062, China
| | - Lijun Rui
- Respiratory Department, The Affiliated Hospital of Jiangnan University, Wuxi Jiangsu 214062, China
| | - Liming Cai
- Respiratory Department, The Affiliated Hospital of Jiangnan University, Wuxi Jiangsu 214062, China
| | - Fenglan Liu
- Respiratory Department, The Affiliated Hospital of Jiangnan University, Wuxi Jiangsu 214062, China
- Medical School Liaocheng University, Shandong Liaocheng 250200, China
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Out-of-field dose in stereotactic radiotherapy for paediatric patients. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2021; 19:1-5. [PMID: 34307913 PMCID: PMC8295843 DOI: 10.1016/j.phro.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/18/2021] [Accepted: 05/22/2021] [Indexed: 11/23/2022]
Abstract
Background and purpose Stereotactic radiotherapy combines image guidance and high precision delivery with small fields to deliver high doses per fraction in short treatment courses. In preparation for extension of these treatment techniques to paediatric patients we characterised and compared doses out-of-field in a paediatric anthropomorphic phantom for small flattened and flattening filter free (FFF) photon beams. Method and materials Dose measurements were taken in several organs and structures outside the primary field in an anthropomorphic phantom of a 5 year old child (CIRS) using thermoluminescence dosimetry (LiF:Mg,Cu,P). Out-of-field doses from a medical linear accelerator were assessed for 6 MV flattened and FFF beams of field sizes between 2 × 2 and 10 × 10 cm2. Results FFF beams resulted in reduced out-of-field doses for all field sizes when compared to flattened beams. Doses for FFF and flattened beams converged for all field sizes at larger distances (>40 cm) from the central axis as leakage becomes the primary source of out-of-field dose. Rotating the collimator to place the MLC bank in the longitudinal axis of the patient was shown to reduce the peripheral doses measured by up to 50% in Varian linear accelerators. Conclusion Minimising out-of-field doses by using FFF beams and aligning the couch and collimator to provide tertiary shielding demonstrated advantages of small field, FFF treatments in a paediatric setting.
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