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Trnková P, Dasu A, Placidi L, Stock M, Toma-Dasu I, Brouwer CL, Gosling A, Jouglar E, Kristensen I, Martin V, Moinuddin S, Pasquie I, Peters S, Pica A, Plaude S, Righetto R, Rombi B, Thariat J, van der Weide H, Hoffmann A, Bolsi A. Patterns of practice of image guided particle therapy for cranio-spinal irradiation: A site specific multi-institutional survey of European Particle Therapy Network. Phys Med 2024; 123:103407. [PMID: 38906046 DOI: 10.1016/j.ejmp.2024.103407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/22/2024] [Accepted: 06/07/2024] [Indexed: 06/23/2024] Open
Abstract
PURPOSE To investigate the current practice patterns in image-guided particle therapy (IGPT) for cranio-spinal irradiation (CSI). METHODS A multi-institutional survey was distributed to European particle therapy centres to analyse all aspects of IGPT. Based on the survey results, a Delphi consensus analysis was developed to define minimum requirements and optimal workflow for clinical practice. The centres participating in the institutional survey were invited to join the Delphi process. RESULTS Eleven centres participated in the survey. Imaging for treatment planning was rather similar among the centres with Computed Tomography (CT) being the main modality. For positioning verification, 2D IGPT was more commonly used than 3D IGPT. Two centres performed routinely imaging for plan adaptation, by the rest ad hoc. Eight centres participated in the Delphi consensus analysis. The full consensus was reached on the use of CT imaging without contrast for treatment planning and the role of magnetic resonance imaging (MRI) in target and organs-at-risk delineation. There was an agreement on the necessity to perform patient position verification and correction before each isocentre. The most important outcome was the clear need for standardization and harmonization of the workflow. CONCLUSION There were differences in CSI IGPT clinical practice among the European particle therapy centres. Moreover, the optimal workflow as identified by experts was not yet reached. There is a strong need for consensus guidelines. The state-of-the-art imaging technology and protocols need to be implemented into clinical practice to improve the quality of IGPT for CSI.
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Affiliation(s)
- Petra Trnková
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria.
| | - Alexandru Dasu
- The Skandion Clinic, Uppsala, Sweden; Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Lorenzo Placidi
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Department of Diagnostic Imaging, Oncological Radiotherapy and Haematology, Rome, Italy
| | - Markus Stock
- MedAustron Ion Therapy Centre, Wiener Neustadt, Austria; Karl Landsteiner University of Health Sciences, Wiener Neustadt, Austria
| | - Iuliana Toma-Dasu
- Medical Radiation Physics, Department of Physics, Stockholm University, Stockholm, Sweden; Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
| | - Charlotte L Brouwer
- University of Groningen, University Medical Centre Groningen, Department of Radiation Oncology, the Netherlands
| | - Andrew Gosling
- Department of Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Emmanuel Jouglar
- Department of Radiation Oncology, Institute Curie, PSL Research University, Orsay, Paris, France
| | - Ingrid Kristensen
- Radiation Physics, Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden
| | - Valentine Martin
- Department of Radiation Oncology, Institute Gustave Roussy, Villejuif, France
| | - Syed Moinuddin
- Department of Radiotherapy, University College London Hospitals NHS Foundation Trust, London, UK
| | - Isabelle Pasquie
- Department of Radiation Oncology, Institute Curie, PSL Research University, Orsay, Paris, France
| | - Sarah Peters
- Department of Particle Therapy, University Hospital Essen, Germany; West German Proton Therapy Centre Essen (WPE), Essen, Germany
| | - Alessia Pica
- Centre for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Sandija Plaude
- West German Proton Therapy Centre Essen (WPE), Essen, Germany
| | - Roberto Righetto
- Medical Physics Unit, Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Barbara Rombi
- Proton Therapy Unit, Santa Chiara Hospital, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Juliette Thariat
- Department of Radiotherapy, Centre François Baclesse, Caen, France
| | - Hiske van der Weide
- University of Groningen, University Medical Centre Groningen, Department of Radiation Oncology, the Netherlands
| | - Aswin Hoffmann
- OncoRay - National Centre for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany; Department of Radiotherapy and Radiation Oncology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Alessandra Bolsi
- Centre for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
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Yoshimura T, Yamada R, Kinoshita R, Matsuura T, Kanehira T, Tamura H, Nishioka K, Yasuda K, Taguchi H, Katoh N, Kobashi K, Hashimoto T, Aoyama H. Probability of normal tissue complications for hematologic and gastrointestinal toxicity in postoperative whole pelvic radiotherapy for gynecologic malignancies using intensity-modulated proton therapy with robust optimization. JOURNAL OF RADIATION RESEARCH 2024; 65:369-378. [PMID: 38499489 PMCID: PMC11115445 DOI: 10.1093/jrr/rrae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/26/2023] [Indexed: 03/20/2024]
Abstract
This retrospective treatment-planning study was conducted to determine whether intensity-modulated proton therapy with robust optimization (ro-IMPT) reduces the risk of acute hematologic toxicity (H-T) and acute and late gastrointestinal toxicity (GI-T) in postoperative whole pelvic radiotherapy for gynecologic malignancies when compared with three-dimensional conformal radiation therapy (3D-CRT), intensity-modulated X-ray (IMXT) and single-field optimization proton beam (SFO-PBT) therapies. All plans were created for 13 gynecologic-malignancy patients. The prescribed dose was 45 GyE in 25 fractions for 95% planning target volume in 3D-CRT, IMXT and SFO-PBT plans and for 99% clinical target volume (CTV) in ro-IMPT plans. The normal tissue complication probability (NTCP) of each toxicity was used as an in silico surrogate marker. Median estimated NTCP values for acute H-T and acute and late GI-T were 0.20, 0.94 and 0.58 × 10-1 in 3D-CRT; 0.19, 0.65 and 0.24 × 10-1 in IMXT; 0.04, 0.74 and 0.19 × 10-1 in SFO-PBT; and 0.06, 0.66 and 0.15 × 10-1 in ro-IMPT, respectively. Compared with 3D-CRT and IMXT plans, the ro-IMPT plan demonstrated significant reduction in acute H-T and late GI-T. The risk of acute GI-T in ro-IMPT plan is equivalent with IMXT plan. The ro-IMPT plan demonstrated potential clinical benefits for reducing the risk of acute H-T and late GI-T in the treatment of gynecologic malignances by reducing the dose to the bone marrow and bowel bag while maintaining adequate dose coverage to the CTV. Our results indicated that ro-IMPT may reduce acute H-T and late GI-T risk with potentially improving outcomes for postoperative gynecologic-malignancy patients with concurrent chemotherapy.
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Affiliation(s)
- Takaaki Yoshimura
- Department of Health Sciences and Technology, Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan
- Department of Medical Physics, Hokkaido University Hospital, Sapporo 060-8648, Japan
- Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo 060-8648, Japan
| | - Ryota Yamada
- Department of Radiation Technology, Hokkaido University Hospital, Sapporo 060-8648, Japan
| | - Rumiko Kinoshita
- Department of Radiation Oncology, Hokkaido University Hospital, Sapporo 060-8648, Japan
| | - Taeko Matsuura
- Department of Medical Physics, Hokkaido University Hospital, Sapporo 060-8648, Japan
- Faculty of Engineering, Hokkaido University, Sapporo 060–8638, Japan
| | - Takahiro Kanehira
- Department of Medical Physics, Hokkaido University Hospital, Sapporo 060-8648, Japan
| | - Hiroshi Tamura
- Department of Radiation Technology, Hokkaido University Hospital, Sapporo 060-8648, Japan
| | - Kentaro Nishioka
- Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo 060-8648, Japan
| | - Koichi Yasuda
- Department of Radiation Oncology, Hokkaido University Hospital, Sapporo 060-8648, Japan
| | - Hiroshi Taguchi
- Department of Radiation Oncology, Hokkaido University Hospital, Sapporo 060-8648, Japan
| | - Norio Katoh
- Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Sapporo 060-8648, Japan
| | - Keiji Kobashi
- Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo 060-8648, Japan
| | - Takayuki Hashimoto
- Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo 060-8648, Japan
| | - Hidefumi Aoyama
- Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Sapporo 060-8648, Japan
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Fukumitsu N, Kubota H, Demizu Y, Suzuki T, Hasegawa D, Kosaka Y, Kawamura A, Soejima T. Comparison of passive-scattered and intensity-modulated proton beam therapy of craniospinal irradiation with proton beams for pediatric and young adult patients with brain tumors. Jpn J Radiol 2024; 42:182-189. [PMID: 37874526 PMCID: PMC10811119 DOI: 10.1007/s11604-023-01499-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/06/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE To investigate the dose stability of craniospinal irradiation based on irradiation method of proton beam therapy (PBT). METHODS AND MATERIALS Twenty-four pediatric and young adult brain tumor patients (age: 1-24 years) were examined. Treatment method was passive-scattered PBT (PSPT) in 8 patients and intensity-modulated PBT (IMPT) in 16 patients. The whole vertebral body (WVB) technique was used in 13 patients whose ages were younger than 10, and vertebral body sparing (VBS) technique was used for the remaining 11 patients aged 10 and above. Dose stability of planning target volume (PTV) against set-up error was investigated. RESULTS The minimum dose (Dmin) of IMPT was higher than that of PSPT (p = 0.01). Inhomogeneity index (INH) of IMPT was lower than that of PSPT (p = 0.004). When the irradiation field of the cervical spinal cord level (C level) was shifted, the maximum dose (Dmax) was lower in IMPT, and mean dose (Dmean) was higher than PSPT as movement became greater to the cranial-caudal direction (p = 0.000-0.043). Dmin was higher and INH was lower in IMPT in all directions (p = 0.000-0.034). When the irradiation field of the lumber spinal cord level (L level) was shifted, Dmax was lower in IMPT as movement became greater to the cranial direction (p = 0.000-0.028). Dmin was higher and INH was lower in IMPT in all directions (p = 0.000-0.022). CONCLUSIONS The PTV doses of IMPT and PSPT are robust and stable in both anterior-posterior and lateral directions at both C level and L level, but IMPT is more robust and stable than PSPT for cranial-caudal movements. TRIAL REGISTRY Clinical Trial Registration number: No. 04-03.
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Affiliation(s)
- Nobuyoshi Fukumitsu
- Department of Radiation Oncology, Kobe Proton Center, 1-6-8, Minatojima-Minamimachi, Kobe, 650-0047, Japan.
| | - Hikaru Kubota
- Department of Radiation Oncology, Kobe Proton Center, 1-6-8, Minatojima-Minamimachi, Kobe, 650-0047, Japan
| | - Yusuke Demizu
- Department of Radiation Oncology, Kobe Proton Center, 1-6-8, Minatojima-Minamimachi, Kobe, 650-0047, Japan
| | - Takeshi Suzuki
- Department of Anesthesiology, Kobe Proton Center, Kobe, Japan
| | - Daiichiro Hasegawa
- Department of Hematology and Oncology, Hyogo Children's Hospital, Kobe, Japan
| | - Yoshiyuki Kosaka
- Department of Hematology and Oncology, Hyogo Children's Hospital, Kobe, Japan
| | | | - Toshinori Soejima
- Department of Radiation Oncology, Kobe Proton Center, 1-6-8, Minatojima-Minamimachi, Kobe, 650-0047, Japan
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Fukumitsu N, Kubota H, Mima M, Demizu Y, Suzuki T, Hasegawa D, Kosaka Y, Kawamura A, Soejima T. Comparison of Craniospinal Irradiation Using Proton Beams According to Irradiation Method and Initial Experience Treating Pediatric Patients. Adv Radiat Oncol 2023; 8:101251. [PMID: 37408669 PMCID: PMC10318217 DOI: 10.1016/j.adro.2023.101251] [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: 02/07/2023] [Accepted: 04/11/2023] [Indexed: 07/07/2023] Open
Abstract
Purpose This study compared craniospinal irradiation using proton beam therapy (PBT) according to irradiation method and investigated the initial effects. Methods and Materials Twenty-four pediatric patients (1-24 years old) who received proton craniospinal irradiation were examined. Passive scattered PBT (PSPT) and intensity modulated PBT (IMPT) were used in 8 and 16 patients, respectively. The whole vertebral body technique was used for 13 patients <10 years old, and the vertebral body sparing (VBS) technique was used for the remaining 11 patients aged ≥10 years. The follow-up period was 17 to 44 (median, 27) months. Organ-at-risk and planning target volume (PTV) doses and other clinical data were examined. Results The maximum lens dose using IMPT was lower than that using PSPT (P = .008). The mean thyroid, lung, esophagus, and kidney doses were lower in patients treated using the VBS technique compared with the whole vertebral body technique (all P < .001). The minimum PTV dose of IMPT was higher than that of PSPT (P = .01). The inhomogeneity index of IMPT was lower than that of PSPT (P = .004). Conclusions IMPT is better than PSPT at reducing the dose to the lens. The VBS technique can decrease the doses to neck-chest-abdomen organs. The PTV coverage of IMPT is superior to that of PSPT.
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Affiliation(s)
| | | | | | | | | | | | | | - Atsufumi Kawamura
- Neurosurgery, Hyogo Prefectual Kobe Children's Hospital, Kobe, Japan
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Koh KN, Wong RX, Lee DE, Han JW, Byun HK, Yoon HI, Kim DS, Lyu CJ, Kang HJ, Hong KT, Lee JH, Kim IH, Phi JH, Kim SK, Wong TT, Lee HL, Lai IC, Kang YM, Ra YS, Ahn SD, Im HJ, Looi WS, Low SYY, Tan EEK, Park HJ, Shin SH, Fuji H, Suh CO, Chen YW, Kim JY. Outcomes of intracranial germinoma-A retrospective multinational Asian study on effect of clinical presentation and differential treatment strategies. Neuro Oncol 2021; 24:1389-1399. [PMID: 34935949 PMCID: PMC9340637 DOI: 10.1093/neuonc/noab295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND This multinational study was conducted to report clinical presentations and treatment strategies in patients with intracranial germinomas across selected Asian centers, including failure patterns, risk factors, and outcomes. METHODS A retrospective data collection and analysis of these patients, treated between 1995 and 2015 from eight healthcare institutions across four countries was undertaken. RESULTS From the results, 418 patients were analyzed, with a median follow-up of 8.9 years; 79.9% of the patients were M0, and 87.6% had β-human chorionic gonadotropin values <50 mIU/mL. The 5/10-year overall survival (OS) and recurrence-free survival (RFS) rates were 97.2%/96.2% and 89.9%/86.9%, respectively. RFS was predicted by the radiotherapy (RT) field, with focal RT having the worst outcome, whereas chemotherapy usage had no impact on survival. Among patients who received chemotherapy, response to chemotherapy did not predict survival outcomes. In M0 patients, primary basal ganglia tumors predicted a worse RFS. In patients with bifocal tumors, an extended field RT was associated with better outcomes. In multivariable analysis, only RT fields were associated with RFS. In relapsed patients, salvage rates were high at 85.7%. Additionally, patients who received salvage RT had a better outcome (91.6% vs. 66.7%). CONCLUSIONS Survival outcomes of patients with germinoma were excellent. Thus, the focus of treatment for intracranial germinoma should be on survivorship. Further studies are warranted to find the optimal intensity and volume of radiation, including the role of chemotherapy in the survival of patients with intracranial germinomas, considering age, primary tumor location, and extent of disease.
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Affiliation(s)
| | | | - Dong-Eun Lee
- Division of Cancer Epidemiology and Management, Research Institute, National Cancer Center, Goyang, Korea
| | - Jung Woo Han
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Hwa Kyung Byun
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Hong In Yoon
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Dong-Seok Kim
- Department of Neurosurgery, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Chuhl Joo Lyu
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, Severance Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Hyoung Jin Kang
- Departments of Pediatrics, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Taek Hong
- Departments of Pediatrics, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Joo Ho Lee
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Il Han Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hoon Phi
- Division of Pediatric Neurosurgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Ki Kim
- Division of Pediatric Neurosurgery, Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Tai-Tong Wong
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Hsin-Lun Lee
- Department of Radiation Oncology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - I-Chun Lai
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Yu-Mei Kang
- Department of Neurosurgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan
| | - Young-Shin Ra
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Do Ahn
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho Joon Im
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Wen Shen Looi
- Department of Radiation Oncology, National Cancer Centre, Singapore, Singapore
| | - Sharon Yin Yee Low
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore,Neurosurgical Service, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Enrica Ee Kar Tan
- Department of Pediatric Subspecialties, Pediatric Hematology/Oncology Service, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Hyun Jin Park
- Center for Pediatric Oncology, National Cancer Center, Goyang, Korea
| | - Sang Hoon Shin
- Neuro-Oncology Clinic, National Cancer Center, Goyang, Korea
| | - Hiroshi Fuji
- Department of Radiation Oncology, National Center for Child Health and Development, Tokyo, Japan
| | - Chang-Ok Suh
- Department of Radiation Oncology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Korea
| | - Yi-Wei Chen
- Yi-Wei Chen, MD, PhD, Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Rd., Taipei 112, Taiwan ()
| | - Joo-Young Kim
- Corresponding Authors: Joo-Young Kim, MD, PhD, Department of Radiation Oncology, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Insandong-gu, Goyang, Gyeonggi-do 10408, Korea ()
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