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Stokkevåg CH, Journy N, Vogelius IR, Howell RM, Hodgson D, Bentzen SM. Radiation Therapy Technology Advances and Mitigation of Subsequent Neoplasms in Childhood Cancer Survivors. Int J Radiat Oncol Biol Phys 2024; 119:681-696. [PMID: 38430101 DOI: 10.1016/j.ijrobp.2024.01.206] [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: 09/20/2023] [Revised: 12/17/2023] [Accepted: 01/13/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE In this Pediatric Normal Tissue Effects in the Clinic (PENTEC) vision paper, challenges and opportunities in the assessment of subsequent neoplasms (SNs) from radiation therapy (RT) are presented and discussed in the context of technology advancement. METHODS AND MATERIALS The paper discusses the current knowledge of SN risks associated with historic, contemporary, and future RT technologies. Opportunities for research and SN mitigation strategies in pediatric patients with cancer are reviewed. RESULTS Present experience with radiation carcinogenesis is from populations exposed during widely different scenarios. Knowledge gaps exist within clinical cohorts and follow-up; dose-response and volume effects; dose-rate and fractionation effects; radiation quality and proton/particle therapy; age considerations; susceptibility of specific tissues; and risks related to genetic predisposition. The biological mechanisms associated with local and patient-level risks are largely unknown. CONCLUSIONS Future cancer care is expected to involve several available RT technologies, necessitating evidence and strategies to assess the performance of competing treatments. It is essential to maximize the utilization of existing follow-up while planning for prospective data collection, including standardized registration of individual treatment information with linkage across patient databases.
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Affiliation(s)
- Camilla H Stokkevåg
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway; Department of Physics and Technology, University of Bergen, Bergen, Norway.
| | - Neige Journy
- French National Institute of Health and Medical Research (INSERM) Unit 1018, Centre for Research in Epidemiology and Population Health, Paris Saclay University, Gustave Roussy, Villejuif, France
| | - Ivan R Vogelius
- Department of Clinical Oncology, Centre for Cancer and Organ Diseases and University of Copenhagen, Copenhagen, Denmark
| | - Rebecca M Howell
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - David Hodgson
- Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Søren M Bentzen
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, Maryland
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2
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García-Aroca MA, Fernández-de Miguel JM, Franceschi MAD, Fernández-Vaquero MA, Meléndez-Salinas DA, Piñero-Merino M, Álvarez-Avello JM. Inhalation anesthesia without any intravenous management for pediatric proton beam therapy. Paediatr Anaesth 2023; 33:946-954. [PMID: 37526245 DOI: 10.1111/pan.14739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/14/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023]
Abstract
INTRODUCTION Proton beam therapy is an oncological treatment, argued to be an appropriate tumor irradiation technique for childhood solid tumors. Due to its duration and the need for immobility, many children require anesthesia for proton therapy sessions. As not many centers in the world provide this therapy, there is little published research about pediatric anesthesia for these cases, and the available data suggest a preference for intravenous anesthesia or combined intravenous and inhalation anesthesia. We conducted this study with the aim of describing and analyzing the inhalation anesthetic management of children undergoing proton therapy at our medical center, comparing our results with studies that have followed different anesthetic protocols. METHODS We reviewed two major databases (Web of Science and Scopus) to find papers that had addressed, to date, anesthesia for pediatric proton therapy. To describe our anesthetic management, we included all pediatric patients treated with proton therapy under anesthesia in our center between June 2020 and August 2021. The characteristics of the patients, their diagnoses, treatments, airway management, drugs administered, duration of induction, and recovery from anesthesia, and adverse effects where all recorded. All anesthesiologists followed a strict anesthetic protocol based only on inhalational anesthesia with sevoflurane delivered via laryngeal mask airway. RESULTS Of the total of 1082 papers found in Web of Science and Scopus on pediatric proton therapy, 11 have addressed its anesthetic management, using intravenous or combined intravenous and inhalation anesthesia. Between June 2020 and August 2021, 31 children were anesthetized in our center to receive proton therapy under inhalational anesthesia (total number of sessions: 873). The mean anesthesia induction time was 4.1 min (SD = 0.7, 95% CI [3.9, 4.4]). The mean anesthesia recovery time was 13.8 min (SD = 4.1, 95% CI [12.3, 15.3]). The percentage of non-serious adverse effects was 0.7% (Clopper-Pearson 95% CI [0.3, 1.5]). The percentage of serious adverse effects was 0.1% (Clopper-Pearson 95% CI [0, 0.6]), without statistically significant difference with other published works with different anesthetic approaches. CONCLUSION Inhalation anesthesia without any intravenous management for pediatric proton therapy is, in our experience, an effective technique with a complication rate similar to other anesthetic approaches.
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Affiliation(s)
- Miguel A García-Aroca
- Department of Anesthesia and Intensive Care, Clínica Universidad de Navarra, Madrid, Spain
| | | | | | | | | | - María Piñero-Merino
- Department of Anesthesia and Intensive Care, Clínica Universidad de Navarra, Madrid, Spain
| | - José M Álvarez-Avello
- Department of Anesthesia and Intensive Care, Clínica Universidad de Navarra, Madrid, Spain
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3
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Li LR, Sethi G, Zhang X, Liu CL, Huang Y, Liu Q, Ren BX, Tang FR. The neuroprotective effects of icariin on ageing, various neurological, neuropsychiatric disorders, and brain injury induced by radiation exposure. Aging (Albany NY) 2022; 14:1562-1588. [PMID: 35165207 PMCID: PMC8876913 DOI: 10.18632/aging.203893] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/08/2022] [Indexed: 11/25/2022]
Abstract
Epimedium brevicornum Maxim, a Traditional Chinese Medicine, has been used for the treatment of impotence, sinew and bone disorders, “painful impediment caused by wind-dampness,” numbness, spasms, hypertension, coronary heart disease, menopausal syndrome, bronchitis, and neurasthenia for many years in China. Recent animal experimental studies indicate that icariin, a major bioactive component of epimedium may effectively treat Alzheimer’s disease, cerebral ischemia, depression, Parkinson’s disease, multiple sclerosis, as well as delay ageing. Our recent study also suggested that epimedium extract could exhibit radio-neuro-protective effects and prevent ionizing radiation-induced impairment of neurogenesis. This paper reviewed the pharmacodynamics of icariin in treating different neurodegenerative and neuropsychiatric diseases, ageing, and radiation-induced brain damage. The relevant molecular mechanisms and its anti-neuroinflammatory, anti-apoptotic, anti-oxidant, as well as pro-neurogenesis roles were also discussed.
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Affiliation(s)
- Ling Rui Li
- The School of Basic Medicine, Health Science Center, Yangtze University, Jingzhou 434023, Hubei, China
| | - Gautam Sethi
- Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117600, Singapore
| | - Xing Zhang
- The School of Basic Medicine, Health Science Center, Yangtze University, Jingzhou 434023, Hubei, China
| | - Cui Liu Liu
- The School of Basic Medicine, Health Science Center, Yangtze University, Jingzhou 434023, Hubei, China
| | - Yan Huang
- The School of Basic Medicine, Health Science Center, Yangtze University, Jingzhou 434023, Hubei, China
| | - Qun Liu
- The School of Basic Medicine, Health Science Center, Yangtze University, Jingzhou 434023, Hubei, China
| | - Bo Xu Ren
- The School of Basic Medicine, Health Science Center, Yangtze University, Jingzhou 434023, Hubei, China
| | - Feng Ru Tang
- Radiation Physiology Lab, Singapore Nuclear Research and Safety Initiative, National University of Singapore, Singapore 138602, Singapore
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4
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Spiotto MT, McGovern SL, Gunn GB, Grosshans D, McAleer MF, Frank SJ, Paulino AC. Proton Radiotherapy to Reduce Late Complications in Childhood Head and Neck Cancers. Int J Part Ther 2021; 8:155-167. [PMID: 34285943 PMCID: PMC8270100 DOI: 10.14338/ijpt-20-00069.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 12/07/2020] [Indexed: 11/21/2022] Open
Abstract
In most childhood head and neck cancers, radiotherapy is an essential component of treatment; however, it can be associated with problematic long-term complications. Proton beam therapy is accepted as a preferred radiation modality in pediatric cancers to minimize the late radiation side effects. Given that childhood cancers are a rare and heterogeneous disease, the support for proton therapy comes from risk modeling and a limited number of cohort series. Here, we discuss the role of proton radiotherapy in pediatric head and neck cancers with a focus on reducing radiation toxicities. First, we compare the efficacy and expected toxicities in proton and photon radiotherapy for childhood cancers. Second, we review the benefit of proton radiotherapy in reducing acute and late radiation toxicities, including risks for secondary cancers, craniofacial development, vision, and cognition. Finally, we review the cost effectiveness for proton radiotherapy in pediatric head and neck cancers. This review highlights the benefits of particle radiotherapy for pediatric head and neck cancers to improve the quality of life in cancer survivors, to reduce radiation morbidities, and to maximize efficient health care use.
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Affiliation(s)
- Michael T Spiotto
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Susan L McGovern
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G Brandon Gunn
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David Grosshans
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mary Frances McAleer
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Steven J Frank
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Arnold C Paulino
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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5
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Simovic M, Bolkestein M, Moustafa M, Wong JKL, Körber V, Benedetto S, Khalid U, Schreiber HS, Jugold M, Korshunov A, Hübschmann D, Mack N, Brons S, Wei PC, Breckwoldt MO, Heiland S, Bendszus M, Jürgen D, Höfer T, Zapatka M, Kool M, Pfister SM, Abdollahi A, Ernst A. Carbon ion radiotherapy eradicates medulloblastomas with chromothripsis in an orthotopic Li-Fraumeni patient-derived mouse model. Neuro Oncol 2021; 23:2028-2041. [PMID: 34049392 PMCID: PMC8643436 DOI: 10.1093/neuonc/noab127] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Medulloblastomas with chromothripsis developing in children with Li-Fraumeni Syndrome (germline TP53 mutations) are highly aggressive brain tumors with dismal prognosis. Conventional photon radiotherapy and DNA-damaging chemotherapy are not successful for these patients and raise the risk of secondary malignancies. We hypothesized that the pronounced homologous recombination deficiency in these tumors might offer vulnerabilities that can be therapeutically utilized in combination with high linear energy transfer carbon ion radiotherapy. Methods We tested high-precision particle therapy with carbon ions and protons as well as topotecan with or without PARP inhibitor in orthotopic primary and matched relapsed patient-derived xenograft models. Tumor and normal tissue underwent longitudinal morphological MRI, cellular (markers of neurogenesis and DNA damage-repair), and molecular characterization (whole-genome sequencing). Results In the primary medulloblastoma model, carbon ions led to complete response in 79% of animals irrespective of PARP inhibitor within a follow-up period of 300 days postirradiation, as detected by MRI and histology. No sign of neurologic symptoms, impairment of neurogenesis or in-field carcinogenesis was detected in repair-deficient host mice. PARP inhibitors further enhanced the effect of proton irradiation. In the postradiotherapy relapsed tumor model, median survival was significantly increased after carbon ions (96 days) versus control (43 days, P < .0001). No major change in the clonal composition was detected in the relapsed model. Conclusion The high efficacy and favorable toxicity profile of carbon ions warrants further investigation in primary medulloblastomas with chromothripsis. Postradiotherapy relapsed medulloblastomas exhibit relative resistance compared to treatment-naïve tumors, calling for exploration of multimodal strategies.
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Affiliation(s)
- Milena Simovic
- Group Genome Instability in Tumors, German Cancer Research Center (DKFZ).,Faculty of Biosciences, Heidelberg University
| | - Michiel Bolkestein
- Group Genome Instability in Tumors, German Cancer Research Center (DKFZ)
| | - Mahmoud Moustafa
- Division of Molecular & Translational Radiation Oncology,Heidelberg Ion-Beam Therapy Center (HIT).,Heidelberg Institute for Radiation Oncology (HIRO).,National Center for Radiation Oncology (NCRO).,National Center for Tumor Diseases (NCT).,Heidelberg University Hospital (UKHD) and DKFZ.,German Cancer Consortium (DKTK), partner site Heidelberg, DKFZ.,Department of Clinical Pathology, Suez Canal University, Ismailia-Egypt
| | - John K L Wong
- German Cancer Consortium (DKTK), partner site Heidelberg, DKFZ.,Division of Molecular Genetics, DKFZ
| | | | | | - Umar Khalid
- Group Genome Instability in Tumors, German Cancer Research Center (DKFZ).,Faculty of Biosciences, Heidelberg University
| | - Hannah Sophia Schreiber
- Group Genome Instability in Tumors, German Cancer Research Center (DKFZ).,Faculty of Medicine, Heidelberg University
| | | | - Andrey Korshunov
- German Cancer Consortium (DKTK), partner site Heidelberg, DKFZ.,Clinical Cooperation Unit Neuropathology, DKFZ, Department of Neuropathology, UKHD
| | - Daniel Hübschmann
- German Cancer Consortium (DKTK), partner site Heidelberg, DKFZ.,Computational Oncology Group, Molecular Diagnostics Program at the NCT and DKFZ.,Heidelberg Institute for Stem cell Technology and Experimental Medicine.,Department of Pediatric Oncology, Hematology and Immunology, UKHD
| | - Norman Mack
- German Cancer Consortium (DKTK), partner site Heidelberg, DKFZ.,Division of Molecular Genetics, DKFZ.,Department of Pediatric Oncology, Hematology and Immunology, UKHD.,Hopp Children's Cancer Center, NCT Heidelberg (KiTZ).,Division of Pediatric Neurooncology, DKFZ
| | | | | | | | | | | | - Debus Jürgen
- Heidelberg Institute for Radiation Oncology (HIRO).,National Center for Tumor Diseases (NCT).,German Cancer Consortium (DKTK), partner site Heidelberg, DKFZ.,Department of Radiation Oncology, UKHD.,Department of Radiation Oncology, Eberhard-Karls-University Tuebingen.,Clinical Cooperation Unit Radiation Oncology, DKFZ
| | | | - Marc Zapatka
- German Cancer Consortium (DKTK), partner site Heidelberg, DKFZ.,Division of Molecular Genetics, DKFZ
| | - Marcel Kool
- German Cancer Consortium (DKTK), partner site Heidelberg, DKFZ.,Hopp Children's Cancer Center, NCT Heidelberg (KiTZ).,Division of Pediatric Neurooncology, DKFZ.,Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Stefan M Pfister
- German Cancer Consortium (DKTK), partner site Heidelberg, DKFZ.,Department of Pediatric Oncology, Hematology and Immunology, UKHD.,Hopp Children's Cancer Center, NCT Heidelberg (KiTZ).,Division of Pediatric Neurooncology, DKFZ
| | - Amir Abdollahi
- Division of Molecular & Translational Radiation Oncology,Heidelberg Ion-Beam Therapy Center (HIT).,Heidelberg Institute for Radiation Oncology (HIRO).,National Center for Radiation Oncology (NCRO).,National Center for Tumor Diseases (NCT).,Heidelberg University Hospital (UKHD) and DKFZ.,German Cancer Consortium (DKTK), partner site Heidelberg, DKFZ
| | - Aurélie Ernst
- Group Genome Instability in Tumors, German Cancer Research Center (DKFZ)
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Malouff TD, Mahajan A, Krishnan S, Beltran C, Seneviratne DS, Trifiletti DM. Carbon Ion Therapy: A Modern Review of an Emerging Technology. Front Oncol 2020; 10:82. [PMID: 32117737 PMCID: PMC7010911 DOI: 10.3389/fonc.2020.00082] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/16/2020] [Indexed: 12/13/2022] Open
Abstract
Radiation therapy is one of the most widely used therapies for malignancies. The therapeutic use of heavy ions, such as carbon, has gained significant interest due to advantageous physical and radiobiologic properties compared to photon based therapy. By taking advantage of these unique properties, carbon ion radiotherapy may allow dose escalation to tumors while reducing radiation dose to adjacent normal tissues. There are currently 13 centers treating with carbon ion radiotherapy, with many of these centers publishing promising safety and efficacy data from the first cohorts of patients treated. To date, carbon ion radiotherapy has been studied for almost every type of malignancy, including intracranial malignancies, head and neck malignancies, primary and metastatic lung cancers, tumors of the gastrointestinal tract, prostate and genitourinary cancers, sarcomas, cutaneous malignancies, breast cancer, gynecologic malignancies, and pediatric cancers. Additionally, carbon ion radiotherapy has been studied extensively in the setting of recurrent disease. We aim to provide a comprehensive review of the studies of each of these disease sites, with a focus on the current trials using carbon ion radiotherapy.
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7
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Tashiro M, Kubota Y, Torikoshi M, Ohno T, Nakano T. Divided-volume matching technique for volume displacement estimation of patient positioning in radiation therapy. Phys Med 2019; 62:1-12. [PMID: 31153388 DOI: 10.1016/j.ejmp.2019.04.028] [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: 12/14/2018] [Revised: 03/28/2019] [Accepted: 04/26/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE We propose the Divided-Volume Matching (DVM) technique to visualize and estimate three-dimensional (3D) displacements of internal structures to enable more accurate patient positioning for radiation therapy. METHODS A CT volume is divided into a volume of interest (VOI) and a base volume (BV); 2D-3D matching is achieved using digital radiography (DR) images and digitally reconstructed radiographs (DRRs), where the DRRs are iteratively generated by changing the 3D positions and rotation angles of the separate volumes independently to identify the best match with the DR images. We demonstrate this technique with two phantom and two clinical cases. RESULTS 3D displacements of the VOIs could be estimated independently and simultaneously with those of the BVs, with accuracies comparable to those of the conventional 2D-3D matching. The proposed technique yielded more suitable matching results when internal displacements occurred in the regions of interest (ROIs). The best matches were found when the ROI was confined to the focused structure, initial displacement values were coarsely adjusted, one volume was matched while the other was fixed, or any combination thereof. CONCLUSIONS The proposed technique can be used effectively for independent displacement estimations of VOIs and BVs for patient positioning in radiation therapy.
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Affiliation(s)
- Mutsumi Tashiro
- Gunma University Initiative for Advanced Research, 3-39-22 Showa-Machi, Maebashi, Gunma 371-8511, Japan; Gunma University Heavy Ion Medical Center, 3-39-22 Showa-Machi, Maebashi, Gunma 371-8511, Japan.
| | - Yoshiki Kubota
- Gunma University Heavy Ion Medical Center, 3-39-22 Showa-Machi, Maebashi, Gunma 371-8511, Japan
| | - Masami Torikoshi
- Gunma University Heavy Ion Medical Center, 3-39-22 Showa-Machi, Maebashi, Gunma 371-8511, Japan
| | - Tatsuya Ohno
- Gunma University Heavy Ion Medical Center, 3-39-22 Showa-Machi, Maebashi, Gunma 371-8511, Japan
| | - Takashi Nakano
- Gunma University Initiative for Advanced Research, 3-39-22 Showa-Machi, Maebashi, Gunma 371-8511, Japan; Gunma University Heavy Ion Medical Center, 3-39-22 Showa-Machi, Maebashi, Gunma 371-8511, Japan
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The Role of Particle Therapy for the Treatment of Skull Base Tumors and Tumors of the Central Nervous System (CNS). Top Magn Reson Imaging 2019; 28:49-61. [PMID: 31022048 DOI: 10.1097/rmr.0000000000000197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Radiation therapy (RT) is a mainstay in the interdisciplinary treatment of brain tumors of the skull base and brain. Technical innovations during the past 2 decades have allowed for increasingly precise treatment with better sparing of adjacent healthy tissues to prevent treatment-related side effects that influence patients' quality of life. Particle therapy with protons and charged ions offer favorable kinetics with sharp dose deposition in a well-defined depth (Bragg-Peak) and a steep radiation fall-off beyond that maximum. This review highlights the role of particle therapy in the management of primary brain tumors and tumors of the skull base.
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Radioprotective effect of epimedium on neurogenesis and cognition after acute radiation exposure. Neurosci Res 2018; 145:46-53. [PMID: 30145270 DOI: 10.1016/j.neures.2018.08.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/16/2018] [Accepted: 08/22/2018] [Indexed: 01/26/2023]
Abstract
The radioprotective effect of herb epimedium (or yin yang huo) extract (5 g/kg, oral administration daily for 4 weeks) on neurogenesis and cognition after acute radiation exposure with 5.5 Gy was evaluated in Balb/c mice by behavioral tests and immunohistochemical study. The results indicated that epimedium extract could improve animal weight loss, locomotor activity and spatial learning and memory which are similar to pre-irradiation intraperitoneal injection (100 mg/kg) of amifostine phosphate, a well- known radioprotective drug. Immunohistochemical study showed that epimedium extract prevented the loss of proliferation cells, newly generated neurons, and interneurons in the hilus, in particular, the subgranular zone of the dentate gyrus. It suggests that herb epimedium may be a promising radio-neuro-protective drug to prevent radiation-induced neuropsychological disorders.
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Proton therapy for pediatric malignancies: Fact, figures and costs. A joint consensus statement from the pediatric subcommittee of PTCOG, PROS and EPTN. Radiother Oncol 2018; 128:44-55. [PMID: 29937209 DOI: 10.1016/j.radonc.2018.05.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 05/11/2018] [Accepted: 05/15/2018] [Indexed: 12/18/2022]
Abstract
Radiotherapy plays an important role in the management of childhood cancer, with the primary aim of achieving the highest likelihood of cure with the lowest risk of radiation-induced morbidity. Proton therapy (PT) provides an undisputable advantage by reducing the radiation 'bath' dose delivered to non-target structures/volume while optimally covering the tumor with tumoricidal dose. This treatment modality comes, however, with an additional costs compared to conventional radiotherapy that could put substantial financial pressure to the health care systems with societal implications. In this review we assess the data available to the oncology community of PT delivered to children with cancer, discuss on the urgency to develop high-quality data. Additionally, we look at the advantage of combining systemic agents with protons and look at the cost-effectiveness data published so far.
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11
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Mohamad O, Imai R, Kamada T, Nitta Y, Araki N. Carbon ion radiotherapy for inoperable pediatric osteosarcoma. Oncotarget 2018; 9:22976-22985. [PMID: 29796166 PMCID: PMC5955418 DOI: 10.18632/oncotarget.25165] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 03/30/2018] [Indexed: 12/28/2022] Open
Abstract
Background Unresectable pediatric osteosarcoma has poor outcomes with conventional treatments. Results Twenty-six patients aged 11–20 years (median 16) had inoperable osteosarcoma of the trunk (24 pelvic, 1 mediastinal and 1 paravertebral) without any other lesion at initial examination. There were 22 primary, 1 locally recurrent and 3 metastatic cases. Median CIRT dose was 70.4 Gy RBE (relative biological effectiveness) delivered in 16 fractions. Median follow-up was 32.7 months. Overall survival was 50.0% and 41.7% at 3 and 5 years, respectively. Ten patients survived for more than 5 years (range 5–20.7 years). Local control was 69.9% and 62.9% at 3 and 5 years, respectively and progression-free survival was 34.6% at 3 and 5 years. Only largest tumor diameter correlated with 5-year overall survival and local control. There were 4 grade 3-4 CIRT-related late toxicities, 1 case of bone fracture and no treatment-related mortalities. All patients (except 1) were able to ambulate after CIRT. Conclusions CIRT was safe and efficacious in the treatment of inoperable pediatric osteosarcoma with improved local control and overall survival compared to conventional treatments. Methods We retrospectively reviewed the records of pediatric and adolescent patients who received carbon ion radiotherapy (CIRT) for inoperable osteosarcoma between 1996 and 2014.
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Affiliation(s)
- Osama Mohamad
- Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan.,University of Texas Southwestern Medical Center, Department of Radiation Oncology, Dallas, Texas, USA
| | - Reiko Imai
- Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Tadashi Kamada
- Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Yuki Nitta
- Research Center Hospital for Charged Particle Therapy, National Institute of Radiological Sciences, National Institutes for Quantum and Radiological Science and Technology, Chiba, Japan
| | - Nobuhito Araki
- Ashiya Municipal Hospital, 3 9-1 Asahigaoka, Ashiya City, Hyogo, Japan
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12
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Mohamad O, Yamada S, Durante M. Clinical Indications for Carbon Ion Radiotherapy. Clin Oncol (R Coll Radiol) 2018; 30:317-329. [DOI: 10.1016/j.clon.2018.01.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 11/20/2017] [Indexed: 12/16/2022]
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13
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Wahl N, Hennig P, Wieser HP, Bangert M. Analytical incorporation of fractionation effects in probabilistic treatment planning for intensity-modulated proton therapy. Med Phys 2018; 45:1317-1328. [PMID: 29393506 DOI: 10.1002/mp.12775] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 01/05/2018] [Accepted: 01/05/2018] [Indexed: 12/25/2022] Open
Affiliation(s)
- Niklas Wahl
- Department of Medical Physics in Radiation Oncology; German Cancer Research Center - DKFZ; Im Neuenheimer Feld 280 Heidelberg 69120 Germany
- Heidelberg Institute for Radiation Oncology - HIRO; Im Neuenheimer Feld 280 Heidelberg 69120 Germany
- Fakultät für Physik und Astronomie; Universität Heidelberg; Im Neuenheimer Feld 226 Heidelberg 69120 Germany
| | - Philipp Hennig
- Max Planck Institute for Intelligent Systems; Max-Planck-Ring 4 Tübingen 72076 Germany
| | - Hans-Peter Wieser
- Department of Medical Physics in Radiation Oncology; German Cancer Research Center - DKFZ; Im Neuenheimer Feld 280 Heidelberg 69120 Germany
- Heidelberg Institute for Radiation Oncology - HIRO; Im Neuenheimer Feld 280 Heidelberg 69120 Germany
- Medizinische Fakultät Heidelberg; Universität Heidelberg; Im Neuenheimer Feld 672 Heidelberg 69120 Germany
| | - Mark Bangert
- Department of Medical Physics in Radiation Oncology; German Cancer Research Center - DKFZ; Im Neuenheimer Feld 280 Heidelberg 69120 Germany
- Heidelberg Institute for Radiation Oncology - HIRO; Im Neuenheimer Feld 280 Heidelberg 69120 Germany
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14
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Adeberg S, Bernhardt D, Harrabi SB, Uhl M, Paul A, Bougatf N, Verma V, Unterberg A, Wick W, Haberer T, Combs SE, Herfarth K, Debus J, Rieken S. Sequential proton boost after standard chemoradiation for high-grade glioma. Radiother Oncol 2017; 125:266-272. [DOI: 10.1016/j.radonc.2017.09.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/15/2017] [Accepted: 09/29/2017] [Indexed: 11/28/2022]
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15
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Aricò G, Gehrke T, Jakubek J, Gallas R, Berke S, Jäkel O, Mairani A, Ferrari A, Martišíková M. Investigation of mixed ion fields in the forward direction for 220.5 MeV/u helium ion beams: comparison between water and PMMA targets. ACTA ACUST UNITED AC 2017; 62:8003-8024. [DOI: 10.1088/1361-6560/aa875e] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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16
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Stokkevåg CH, Schneider U, Muren LP, Newhauser W. Radiation-induced cancer risk predictions in proton and heavy ion radiotherapy. Phys Med 2017; 42:259-262. [DOI: 10.1016/j.ejmp.2017.04.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 04/01/2017] [Accepted: 04/19/2017] [Indexed: 12/20/2022] Open
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17
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Ermoian RP, Breneman J, Walterhouse DO, Chi YY, Meza J, Anderson J, Hawkins DS, Hayes-Jordan AA, Parham DM, Yock TI, Donaldson SS, Wolden SL. 45 Gy is not sufficient radiotherapy dose for Group III orbital embryonal rhabdomyosarcoma after less than complete response to 12 weeks of ARST0331 chemotherapy: A report from the Soft Tissue Sarcoma Committee of the Children's Oncology Group. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26540. [PMID: 28548706 PMCID: PMC5568701 DOI: 10.1002/pbc.26540] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 01/27/2017] [Accepted: 01/31/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Recent Children's Oncology Group (COG) trials tested the efficacy of reduced therapy in an effort to lessen late effects compared to the Intergroup Rhabdomyosarcoma Study (IRS) IV regimen with associated hematologic and hepatic toxicity, and infertility. Here, we analyze the efficacy of 45 Gray (Gy) local radiotherapy (RT) in patients with Group III orbital embryonal rhabdomyosarcoma (ERMS) enrolled on the COG low-risk study ARST0331. PROCEDURE Sixty-two patients with Group III orbital ERMS were treated on ARST0331 with four cycles of vincristine (VCR), dactinomycin (DACT), and cyclophosphamide (CPM; VAC, total cumulative CPM dose 4.8 g/m2 ) followed by four cycles of VCR and DACT over 22 weeks. Forty-five Gray of radiation was administered in 25 fractions beginning at week 13 of therapy. RESULTS Fifty-three patients were evaluable for this response analysis; seven had missing week 12 response evaluation data and two had progressive disease prior to starting RT. Median follow-up was 7.8 years. None of the 15 patients with radiographic complete response (CR) compared to 6 of the 38 patients with <CR after 12 weeks of VAC chemotherapy had local recurrences (P = 0.11). There was no difference in overall survival by response at week 12 (P = 0.52). CONCLUSIONS For patients with Group III orbital ERMS achieving a CR following VAC chemotherapy that includes modest dose CPM, 45 Gy may be sufficient for durable failure-free survival. However, for those with <CR treated with the ARST0331 systemic therapy, a different local therapy approach may be needed to achieve the control rate of IRS-IV without its toxicity.
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Affiliation(s)
- Ralph P. Ermoian
- Department of Radiation Oncology, University of Washington, Washington
| | - John Breneman
- Department of Radiation Oncology, University of Cincinnati, Ohio
| | - David O. Walterhouse
- Department of Pediatrics-Hematology, Oncology and Stem Cell Transplantation, Northwestern University, Illinois
| | - Yueh-Yun Chi
- Department of Biostatistics, University of Florida, Florida
| | - Jane Meza
- Department of Biostatistics, University of Nebraska, Nebraska
| | - James Anderson
- Department of Biostatistics, University of Nebraska, Nebraska
| | | | - Andrea A. Hayes-Jordan
- Department of Pediatric Surgery, The University of Texas Health Science Center at Houston, Texas
| | - David M. Parham
- Department of Pathology and Laboratory Medicine, Children’s Hospital Los Angeles and Keck School of Medicine, University of Southern California, California
| | - Torunn I. Yock
- Department of Radiation Oncology, Massachusetts General Hospital, Massachusetts
| | - Sarah S. Donaldson
- Department of Radiation Oncology, Stanford University School of Medicine, California
| | - Suzanne L. Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York
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Bhattacharya S, Asaithamby A. Repurposing DNA repair factors to eradicate tumor cells upon radiotherapy. Transl Cancer Res 2017; 6:S822-S839. [PMID: 30613483 DOI: 10.21037/tcr.2017.05.22] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cancer is the leading cause of death worldwide. Almost 50% of all cancer patients undergo radiation therapy (RT) during treatment, with varying success. The main goal of RT is to kill tumor cells by damaging their DNA irreversibly while sparing the surrounding normal tissue. The outcome of RT is often determined by how tumors recognize and repair their damaged DNA. A growing body of evidence suggests that tumors often show abnormal expression of DNA double-strand break (DSB) repair genes that are absent from normal cells. Defects in a specific DNA repair pathway make tumor cells overly dependent on alternative or backup pathways to repair their damaged DNA. These tumor cell-specific abnormalities in the DNA damage response (DDR) machinery can potentially be used as biomarkers for treatment outcomes or as targets for sensitization to ionizing radiation (IR). An improved understanding of genetic or epigenetic alterations in the DNA repair pathways specific to cancer cells has paved the way for new treatments that combine pharmacological exploitation of tumor-specific molecular vulnerabilities with IR. Inhibiting DNA repair pathways has the potential to greatly enhance the therapeutic ratio of RT. In this review, we will discuss DNA repair pathways in active cells and how these pathways are deregulated in tumors. We will also describe the impact of targeting cancer-specific aberrations in the DDR as a treatment strategy to improve the efficacy of RT. Finally, we will address the current roadblocks and future prospects of these approaches.
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Affiliation(s)
- Souparno Bhattacharya
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Aroumougame Asaithamby
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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19
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Carbon Ion Radiotherapy: A Review of Clinical Experiences and Preclinical Research, with an Emphasis on DNA Damage/Repair. Cancers (Basel) 2017; 9:cancers9060066. [PMID: 28598362 PMCID: PMC5483885 DOI: 10.3390/cancers9060066] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 05/21/2017] [Accepted: 06/06/2017] [Indexed: 12/31/2022] Open
Abstract
Compared to conventional photon-based external beam radiation (PhXRT), carbon ion radiotherapy (CIRT) has superior dose distribution, higher linear energy transfer (LET), and a higher relative biological effectiveness (RBE). This enhanced RBE is driven by a unique DNA damage signature characterized by clustered lesions that overwhelm the DNA repair capacity of malignant cells. These physical and radiobiological characteristics imbue heavy ions with potent tumoricidal capacity, while having the potential for simultaneously maximally sparing normal tissues. Thus, CIRT could potentially be used to treat some of the most difficult to treat tumors, including those that are hypoxic, radio-resistant, or deep-seated. Clinical data, mostly from Japan and Germany, are promising, with favorable oncologic outcomes and acceptable toxicity. In this manuscript, we review the physical and biological rationales for CIRT, with an emphasis on DNA damage and repair, as well as providing a comprehensive overview of the translational and clinical data using CIRT.
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20
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Manganaro L, Russo G, Cirio R, Dalmasso F, Giordanengo S, Monaco V, Muraro S, Sacchi R, Vignati A, Attili A. A Monte Carlo approach to the microdosimetric kinetic model to account for dose rate time structure effects in ion beam therapy with application in treatment planning simulations. Med Phys 2017; 44:1577-1589. [DOI: 10.1002/mp.12133] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/18/2017] [Accepted: 01/18/2017] [Indexed: 11/11/2022] Open
Affiliation(s)
- Lorenzo Manganaro
- Physics Department; Università degli studi di Torino; Torino Italy
- Istituto Nazionale di Fisica Nucleare (INFN); Torino Italy
| | - Germano Russo
- Istituto Nazionale di Fisica Nucleare (INFN); Torino Italy
| | - Roberto Cirio
- Physics Department; Università degli studi di Torino; Torino Italy
- Istituto Nazionale di Fisica Nucleare (INFN); Torino Italy
| | - Federico Dalmasso
- Physics Department; Università degli studi di Torino; Torino Italy
- Istituto Nazionale di Fisica Nucleare (INFN); Torino Italy
| | | | - Vincenzo Monaco
- Physics Department; Università degli studi di Torino; Torino Italy
- Istituto Nazionale di Fisica Nucleare (INFN); Torino Italy
| | - Silvia Muraro
- Istituto Nazionale di Fisica Nucleare (INFN); Milano Italy
| | - Roberto Sacchi
- Physics Department; Università degli studi di Torino; Torino Italy
- Istituto Nazionale di Fisica Nucleare (INFN); Torino Italy
| | - Anna Vignati
- Istituto Nazionale di Fisica Nucleare (INFN); Torino Italy
| | - Andrea Attili
- Istituto Nazionale di Fisica Nucleare (INFN); Torino Italy
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21
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Abstract
OPINION STATEMENT Proton therapy is characterized by certain physical properties leading to a reduction in integral dose. As proton therapy becomes more widely available, the ongoing discussion on the real indications for proton therapy becomes more important. In the present article, data on proton therapy for tumors of the central nervous system (CNS) is summarized and discussed in view of modern photon treatments. Still today, no randomized controlled trials are available confirming any clinical benefit of protons in CNS tumors. For certain skull base lesions, such as chordomas and chondrosarcomas, dose escalation is possible with protons thus patients should be referred to a proton center if readily available. For vestibular schwannoma, at present, proton data are inferior to advanced photons. For glioma patients, early data is present for low-grade gliomas, presenting comparable results to photons; dose escalation studies for high-grade gliomas have led to significant side effects, thus strategies of dose-escalation need to rethought. For skull base meningiomas, data from stereotactic series and IMRT present excellent local control with minimal side effects, thus any improvement with protons might only be marginal. The largest benefit is considered in pediatric CNS tumors, due to the intricate radiation sensitivity of children's normal tissue, as well as the potential of long-term survivorship. Long-term data is still lacking, and even recent analyses do not all lead to a clear reduction in side effects with improvement of outcome; furthermore, clinical data seem to be comparable. However, based on the preclinical evidence, proton therapy should be evaluated in every pediatric patient. Protons most likely have a benefit in terms of reduction of long-term side effects, such as neurocognitive sequelae or secondary malignancies; moreover, dose escalation can be performed in radio-resistant histologies. Clinical data with long-term follow-up is still warranted to prove any superiority to advanced photons in CNS tumors. If available, protons should be evaluated for chordoma or chondrosarcoma of the skull base and pediatric tumors. However, many factors are important for excellent oncology care, and no time delay or inferior oncological care should be accepted for the sake of protons only.
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Affiliation(s)
- Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany. .,Institute of Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany.
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22
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Mannina EM, Bartlett GK, McMullen KP. Extended Volumetric Follow-up of Juvenile Pilocytic Astrocytomas Treated with Proton Beam Therapy. Int J Part Ther 2016; 3:291-299. [PMID: 31772980 DOI: 10.14338/ijpt-16-00020.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 09/12/2016] [Indexed: 11/21/2022] Open
Abstract
Purpose To describe volume changes following proton beam therapy (PBT) for juvenile pilocytic astrocytoma (JPA), we analyzed post-PBT magnetic resonance imaging (MRI) to clarify survivorship, response rate, and the concept of pseudoprogression. Materials and Methods Pediatric patients with a histologic diagnosis of JPA after a biopsy or subtotal resection and at least 4 post-PBT MRIs were retrospectively reviewed. After PBT, tumors were contoured on follow-up T1-contrasted MRIs, and 3-dimensional volumes were plotted against time, with thresholds for progressive disease and partial response. Patterns of response, pseudoprogression, and progression were uncovered. Post-PBT clinical course was described by the need for further intervention and survivorship. Results Fifteen patients with a median of 10 follow-up MRIs made up this report: 60% were heavily pretreated with multiple lines of chemotherapy, and 67% had undergone subtotal resection. With a median follow-up of 55.3 months after a median of 5400 centigray equivalents PBT, estimates of 5-year overall survival and intervention-free survival were 93% and 72%, respectively. The crude response rate of 73% included pseudoprogressing patients, who comprised 20% of the entire cohort; the phenomenon peaked between 3 and 8 months and resolved by 18 months. One nonresponder expired from progression. Post-PBT intervention was required in 53% of patients, with 1 patient resuming chemotherapy. There were no further resections or radiotherapy. One patient developed acute lymphoblastic leukemia, and another developed biopsy-proven radionecrosis. Conclusion The PBT for inoperable/progressive JPA provided 72% 5-year intervention-free survival in heavily pretreated patients. Although most patients responded, 20% demonstrated pseudoprogression. The need for post-PBT surveillance for progression and treatment-induced sequelae should not be underestimated in this extended survivorship cohort.
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Affiliation(s)
- Edward M Mannina
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Greg K Bartlett
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kevin P McMullen
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
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23
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Combs SE. [Clinical Evaluation of Proton Therapy - How much benefit can be considered a benefit?]. Strahlenther Onkol 2016; 192:498-9. [PMID: 27272659 DOI: 10.1007/s00066-016-0994-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Stephanie E Combs
- Klinik und Poliklinik für RadioOnkologie und Strahlentherapie, Technische Universität München, Klinikum rechts der Isar, Ismaninger Straße 22, 81675, München, Deutschland. .,Institut für innovative Radiotherapie (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764, Oberschleißheim, Deutschland.
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24
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Ebner DK, Kamada T. The Emerging Role of Carbon-Ion Radiotherapy. Front Oncol 2016; 6:140. [PMID: 27376030 PMCID: PMC4894867 DOI: 10.3389/fonc.2016.00140] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 05/23/2016] [Indexed: 12/20/2022] Open
Abstract
Carbon-ion radiotherapy (CIRT) has progressed rapidly in technological delivery, indications, and efficacy. Owing to a focused dose distribution in addition to high linear energy transfer and subsequently high relative biological effect, CIRT is uniquely able to target otherwise untreatable hypoxic and radioresistant disease while opening the door for substantially hypofractionated treatment of normal and radiosensitive disease. CIRT has increasingly garnered international attention and is nearing the tipping point for international adoption.
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Affiliation(s)
- Daniel K. Ebner
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan
| | - Tadashi Kamada
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan
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25
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Ye F, Zhao T, Liu X, Jin X, Liu X, Wang T, Li Q. Long-term Autophagy and Nrf2 Signaling in the Hippocampi of Developing Mice after Carbon Ion Exposure. Sci Rep 2015; 5:18636. [PMID: 26689155 PMCID: PMC4686898 DOI: 10.1038/srep18636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 11/20/2015] [Indexed: 12/29/2022] Open
Abstract
To explore charged particle radiation-induced long-term hippocampus damage, we investigated the expression of autophagy and antioxidant Nrf2 signaling-related proteins in the mouse hippocampus after carbon ion radiation. Heads of immature female Balb/c mice were irradiated with carbon ions of different LETs at various doses. Behavioral tests were performed on the mice after maturation. Acute and chronic expression of LC3-II, p62/SQSTM1, nuclear Nrf2, activated caspase-3 and the Bax/Bcl-2 ratio were measured in the hippocampi. Secondary X-ray insult was adopted to amplify potential damages. Long-term behavioral changes were observed in high-LET carbon ion-irradiated mice. There were no differences in the rates of LC3-II induction and p62/SQSTM1 degradation compared to the control group regardless of whether the mice received the secondary X-ray insult. A high nuclear Nrf2 content and low apoptosis level in hippocampal cells subjected to secondary X-rays were observed for the mice exposed to relatively low-LET carbon ions. Therefore, carbon ion exposure in the immature mouse led to an LET-dependent behavioral change after maturation. Although autophagy was intact, the persistently high nuclear Nrf2 content in the hippocampus might account for the unchanged behavioral pattern in mice exposed to the relatively low-LET carbon ions and the subsequent increased radioresistance of the hippocampus.
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Affiliation(s)
- Fei Ye
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China.,Department of Modern Physics, Lanzhou University, Lanzhou 730000, China.,University of Chinese Academy of Sciences, Beijing 100049, China.,Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Lanzhou 730000, China
| | - Ting Zhao
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China.,Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Lanzhou 730000, China
| | - Xiongxiong Liu
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China.,Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Lanzhou 730000, China
| | - Xiaodong Jin
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China.,Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Lanzhou 730000, China
| | - Xinguo Liu
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China.,Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Lanzhou 730000, China
| | - Tieshan Wang
- Department of Modern Physics, Lanzhou University, Lanzhou 730000, China
| | - Qiang Li
- Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China.,Key Laboratory of Heavy Ion Radiation Biology and Medicine of Chinese Academy of Sciences, Lanzhou 730000, China
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26
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Beccaria K, Sainte-Rose C, Zerah M, Puget S. Paediatric Chordomas. Orphanet J Rare Dis 2015; 10:116. [PMID: 26391590 PMCID: PMC4578760 DOI: 10.1186/s13023-015-0340-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 09/07/2015] [Indexed: 01/11/2023] Open
Abstract
Paediatric chordomas are rare malignant tumours arising from primitive notochordal remnants with a high rate of recurrence. Only 5 % of them occur in the first two decades such less than 300 paediatric cases have been reported so far in the literature. In children, the average age at diagnosis is 10 years with a male-to-female ratio closed to 1. On the opposite to adults, the majority of paediatric chordomas are intracranial, characteristically centered on the sphenooccipital synchondrosis. Metastatic spread seems to be the prerogative of the under 5-year-old children with more frequent sacro-coccygeal locations and undifferentiated histology. The clinical presentation depends entirely on the tumour location. The most common presenting symptoms are diplopia and signs of raised intracranial pressure. Sacrococcygeal forms may present with an ulcerated subcutaneous mass, radicular pain, bladder and bowel dysfunctions. Diagnosis is suspected on computerised tomography showing the bone destruction and with typically lobulated appearance, hyperintense on T2-weighted magnetic resonance imaging. Today, treatment relies on as complete surgical resection as possible (rarely achieved because of frequent invasiveness of functional structures) followed by adjuvant radiotherapy by proton therapy. The role of chemotherapy has not been proven. Prognosis is better than in adults and depends on the extent of surgical resection, age and histology subgroup. Biological markers are still lacking to improve prognosis by developing targeted therapy.
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Affiliation(s)
- Kévin Beccaria
- Service de neurochirurgie, hôpital Necker-Enfants Malades, Paris, France.
- Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, Paris, France.
| | - Christian Sainte-Rose
- Service de neurochirurgie, hôpital Necker-Enfants Malades, Paris, France.
- Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, Paris, France.
| | - Michel Zerah
- Service de neurochirurgie, hôpital Necker-Enfants Malades, Paris, France.
- Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, Paris, France.
| | - Stéphanie Puget
- Service de neurochirurgie, hôpital Necker-Enfants Malades, Paris, France.
- Faculté de médecine, université Paris Descartes, Sorbonne Paris Cité, Paris, France.
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27
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Dwyer M. Defining the role of proton therapy in the optimal management of paediatric patients in Australia and New Zealand. J Med Imaging Radiat Oncol 2015; 60:105-11. [DOI: 10.1111/1754-9485.12391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 08/16/2015] [Indexed: 02/01/2023]
Affiliation(s)
- Mary Dwyer
- Department of Radiation Oncology and Cancer Imaging; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
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28
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Grant SR, Grosshans DR, Bilton SD, Garcia JA, Amin M, Chambers MS, McGovern SL, McAleer MF, Morrison WH, Huh WW, Kupferman ME, Mahajan A. Proton versus conventional radiotherapy for pediatric salivary gland tumors: Acute toxicity and dosimetric characteristics. Radiother Oncol 2015; 116:309-15. [PMID: 26232128 DOI: 10.1016/j.radonc.2015.07.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 07/12/2015] [Accepted: 07/18/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE We evaluated acute toxicity profiles and dosimetric data for children with salivary gland tumors treated with adjuvant photon/electron-based radiation therapy (X/E RT) or proton therapy (PRT). METHODS AND MATERIALS We identified 24 patients who had received adjuvant radiotherapy for salivary gland tumors. Data were extracted from the medical records and the treatment planning systems. Toxicity was scored according to the Common Terminology Criteria for Adverse Effects 4.0. RESULTS Eleven patients received X/E RT and 13 PRT, with a median prescribed dose of 60 Gy in each group. In the X/E RT group, 54% of patients developed acute grade II/III dermatitis, 27% grade II/III dysphagia, and 91% grade II/III mucositis, and the median weight loss was 5.3% with one patient requiring feeding tube placement. In the PRT group, 53% had acute grade II/III dermatitis, 0% grade II/III dysphagia, and 46% grade II/III mucositis, with a median weight gain of 1.2%. Additionally, PRT was associated with lower mean doses to several normal surrounding midline and contralateral structures. CONCLUSION In this retrospective study of pediatric salivary tumors, PRT was associated with a favorable acute toxicity and dosimetric profile. Continued follow-up is needed to identify long-term toxicity and survival data.
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Affiliation(s)
| | - David R Grosshans
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - Stephen D Bilton
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - John A Garcia
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - Mayank Amin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - Mark S Chambers
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - Susan L McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - Mary F McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - William H Morrison
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - Winston W Huh
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - Michael E Kupferman
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, United States
| | - Anita Mahajan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States.
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29
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Blattmann C, Oertel S, Thiemann M, Dittmar A, Roth E, Kulozik AE, Ehemann V, Weichert W, Huber PE, Stenzinger A, Debus J. Histone deacetylase inhibition sensitizes osteosarcoma to heavy ion radiotherapy. Radiat Oncol 2015; 10:146. [PMID: 26178881 PMCID: PMC4504102 DOI: 10.1186/s13014-015-0455-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 07/06/2015] [Indexed: 01/20/2023] Open
Abstract
Background Minimal improvements in treatment or survival of patients with osteosarcoma have been achieved during the last three decades. Especially in the case of incomplete tumor resection, prognosis remains poor. Heavy ion radiotherapy (HIT) and modern anticancer drugs like histone deacetylase inhibitors (HDACi) have shown promising effects in osteosarcoma in vitro. In this study, we tested the effect of HIT and the combination of HIT and the HDACi suberoylanilide hydroxamic acid (SAHA) in a xenograft mouse model. Methods Osteosarcoma xenografts were established by subcutaneous injection of KHOS-24OS cells and treated with either vehicle (DMSO), SAHA, HIT or HIT and SAHA. Tumor growth was determined and tumor necrosis, proliferation rate, apoptotic rate as well as vessel density were evaluated. Results Here, we show that the combination of HIT and SAHA induced a significant delay of tumor growth through increased rate of apoptosis, increased expression of p53 and p21Waf1/Cip1, inhibition of proliferation and angiogenesis compared to tumors treated with HIT only. Conclusion HIT and in particular the combination of HIT and histone deacetylase inhibition is a promising treatment strategy in OS and may be tested in clinical trials.
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Affiliation(s)
- Claudia Blattmann
- Department of Pediatric Oncology, Hematology and Immunology, University Children's, Hospital of Heidelberg, Heidelberg, Germany. .,Department of Radiation Oncology, German Cancer Research Center, Heidelberg, Germany. .,German Cancer Consortium (DKTK), Heidelberg, Germany. .,Pädiatrie 5, Olgahospital, Kriegsbergstr. 62, 70174, Stuttgart, Germany.
| | - Susanne Oertel
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany. .,Department of Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.
| | - Markus Thiemann
- Department of Pediatric Oncology, Hematology and Immunology, University Children's, Hospital of Heidelberg, Heidelberg, Germany. .,Department of Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.
| | - Anne Dittmar
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany. .,Department of Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.
| | - Eva Roth
- Department of Pediatric Oncology, Hematology and Immunology, University Children's, Hospital of Heidelberg, Heidelberg, Germany. .,Department of Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.
| | - Andreas E Kulozik
- Department of Pediatric Oncology, Hematology and Immunology, University Children's, Hospital of Heidelberg, Heidelberg, Germany. .,German Cancer Consortium (DKTK), Heidelberg, Germany. .,National Center for Tumor Diseases (NCT), University of Heidelberg, Heidelberg, Germany.
| | - Volker Ehemann
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany.
| | - Wilko Weichert
- Institute of Pathology, University of Heidelberg, Heidelberg, Germany. .,German Cancer Consortium (DKTK), Heidelberg, Germany. .,National Center for Tumor Diseases (NCT), University of Heidelberg, Heidelberg, Germany.
| | - Peter E Huber
- Department of Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.
| | | | - Jürgen Debus
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany. .,Department of Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.
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Rieber JG, Kessel KA, Witt O, Behnisch W, Kulozik AE, Debus J, Combs SE. Treatment tolerance of particle therapy in pediatric patients. Acta Oncol 2015; 54:1049-55. [PMID: 25615893 DOI: 10.3109/0284186x.2014.998273] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Curative treatment of pediatric cancer not only focuses on long-term survival, but also on reducing treatment-related side effects. Advantages of particle therapy are mainly due to their physical ability of significantly reducing integral dose. METHODS Between January 2009 and December 2012, we treated 83 pediatric patients (aged 21 and younger) at the Heidelberg Ion Therapy Center at University Hospital of Heidelberg (HIT). In total 56 patients (67%) received proton irradiation, while 25 (30%) patients were treated with carbon ions (C12). Two patients received both treatments (3%). Treatment toxicity was analyzed retrospectively and documented according to the CTCAE/RTOG classification. In a second step, treatment toxicity from ion therapy was analyzed in comparison to treatment toxicity during photon irradiation of a comparable historical group of 19 pediatric patients. RESULTS In all patients, particle therapy was tolerated well (median follow-up time 3.7 months), children (20 patients) with at least two follow-up visits showed a median follow-up time of 10.2 months. During the first two months patients mainly suffered from radiogenic skin reaction (63%), mucositis (30%), headache and dizziness (35%) as well as nausea and vomiting (13%). Severe toxicity reaction (grade II-IV) was only seen in patients who had intensive simultaneous chemotherapy or who had undergone several operations in the irradiated area before radiotherapy (18%). Treatment toxicity during ion therapy was comparable to treatment toxicity from photon irradiation of a historical group. CONCLUSIONS In comparison to conventional therapy, patients with particle therapy do not suffer from increased acute treatment-related toxicity during the first months. More experience with particle therapy will be needed during the next years to help to thoroughly evaluate the high potential of ion therapy.
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Affiliation(s)
- Juliane G. Rieber
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology, Germany
| | - Kerstin A. Kessel
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology, Germany
| | - Olaf Witt
- CCU Pediatric Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Pediatric Hematology and Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Wolfgang Behnisch
- Department of Pediatric Hematology and Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas E. Kulozik
- Department of Pediatric Hematology and Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology, Germany
| | - Stephanie E. Combs
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technische Universität München (TUM), Munich, Germany
- Heidelberg Institute of Radiation Oncology, Germany
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McMullen KP, Hanson T, Bratton J, Johnstone PAS. Parameters of anesthesia/sedation in children receiving radiotherapy. Radiat Oncol 2015; 10:65. [PMID: 25889312 PMCID: PMC4362639 DOI: 10.1186/s13014-015-0363-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 02/18/2015] [Indexed: 11/25/2022] Open
Abstract
Background Previous reports establish low risk of complications in pediatric treatments under anesthesia/sedation (A/S) in the outpatient setting. Here, we present our institutional experience with A/S by age and gender in children receiving daily proton RT. Methods After Institutional Review Board approval, we reviewed our center’s records between 9/9/2004 and 6/30/2013 with respect to age and gender of A/S requirement in our pediatric patients (defined as patients ≤18 years of age). Results Of 390 patients treated in this era, 182 were girls. Children aged ≤3 invariably required A/S; and by age 7–8, approximately half of patients do not. For pediatric patients ≥ 12 years of age, approximately 10% may require A/S for different reasons. There was no difference by gender. Conclusions Beyond age 3, the requirement for A/S decreases in an age-dependent fashion, with a small cadre of older children having difficulty enough with sustained immobilization that A/S is necessary. In our experience, there is no difference in A/S requirement by gender.
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Affiliation(s)
- Kevin P McMullen
- IU Health Proton Therapy Center, Bloomington, Indiana. .,Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
| | - Tara Hanson
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
| | | | - Peter A S Johnstone
- IU Health Proton Therapy Center, Bloomington, Indiana. .,Department of Radiation Oncology, Moffitt Cancer Center & Research Institute, Tampa, Florida, USA.
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Risk assessment of radio-chemotherapy in pediatric soft tissue sarcomas. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2015. [DOI: 10.1016/j.jrras.2014.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Rombi B, Timmermann B. Proton Beam Therapy for Pediatric Chordomas: State of the Art. Int J Part Ther 2014. [DOI: 10.14338/ijpt.13.00008.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Abstract
Densely ionizing radiation has always been a main topic in radiobiology. In fact, α-particles and neutrons are sources of radiation exposure for the general population and workers in nuclear power plants. More recently, high-energy protons and heavy ions attracted a large interest for two applications: hadrontherapy in oncology and space radiation protection in manned space missions. For many years, studies concentrated on measurements of the relative biological effectiveness (RBE) of the energetic particles for different end points, especially cell killing (for radiotherapy) and carcinogenesis (for late effects). Although more recently, it has been shown that densely ionizing radiation elicits signalling pathways quite distinct from those involved in the cell and tissue response to photons. The response of the microenvironment to charged particles is therefore under scrutiny, and both the damage in the target and non-target tissues are relevant. The role of individual susceptibility in therapy and risk is obviously a major topic in radiation research in general, and for ion radiobiology as well. Particle radiobiology is therefore now entering into a new phase, where beyond RBE, the tissue response is considered. These results may open new applications for both cancer therapy and protection in deep space.
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Affiliation(s)
- M Durante
- GSI Helmholtz Center for Heavy Ion Research, Biophysics Department, Darmstadt, Germany
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Carbon ion beam radiotherapy for sinonasal malignant tumors invading skull base. Case Rep Otolaryngol 2014; 2014:241856. [PMID: 25013734 PMCID: PMC4070444 DOI: 10.1155/2014/241856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 05/20/2014] [Indexed: 12/19/2022] Open
Abstract
Objective. To evaluate the treatment outcome and prognostic factors in patients with sinonasal malignant tumors invading skull base. Study Design and Setting. A retrospective clinical study at the Yamagata University School of Medicine. Subjects and Methods. Three patients with sinonasal malignant tumors invading skull base were presented in present study. All patients were treated with carbon ion beam radiotherapy. The prescribed dose to the center of the clinical target volume was 64.0 GyE/16 fractions over 4 weeks at 4.0 GyE/fraction per day. Results. All patients completed carbon ion beam radiotherapy without an interval. The mean observation period was 39.6 months (range: 11–54 months). There were no local or regional recurrences in all cases; however, one patient had a metastasis in distant organs. Regarding the complications, visual loss was observed in one eye of one patient whose optic nerve was entirely involved by the tumor and field of carbon ion beam radiotherapy. Radiation induced brain injury was observed in two patients; however, these patients do not complain about neurological abnormality and had no treatment for radiation induced brain necrosis. Conclusions. Carbon ion beam radiotherapy for sinonasal malignant tumors invading the skull base showed therapeutic effectiveness.
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Kessel KA, Bohn C, Engelmann U, Oetzel D, Bougatf N, Bendl R, Debus J, Combs SE. Five-year experience with setup and implementation of an integrated database system for clinical documentation and research. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2014; 114:206-217. [PMID: 24629596 DOI: 10.1016/j.cmpb.2014.02.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 01/30/2014] [Accepted: 02/06/2014] [Indexed: 06/03/2023]
Abstract
In radiation oncology, where treatment concepts are elaborated in interdisciplinary collaborations, handling distributed, large heterogeneous amounts of data efficiently is very important, yet challenging, for an optimal treatment of the patient as well as for research itself. This becomes a strong focus, as we step into the era of modern personalized medicine, relying on various quantitative data information, thus involving the active contribution of multiple medical specialties. Hence, combining patient data from all involved information systems is inevitable for analyses. Therefore, we introduced a documentation and data management system integrated in the clinical environment for electronic data capture. We discuss our concept and five-year experience of a precise electronic documentation system, with special focus on the challenges we encountered. We specify how such a system can be designed and implemented to plan, tailor and conduct (multicenter) clinical trials, ultimately reaching the best clinical performance, and enhancing interdisciplinary and clinical research.
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Affiliation(s)
- Kerstin A Kessel
- Heidelberg University Hospital, Department of Radiation Oncology, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
| | - Christian Bohn
- CHILI GmbH, Friedrich-Ebert-Str. 2, 69221 Dossenheim, Germany
| | - Uwe Engelmann
- CHILI GmbH, Friedrich-Ebert-Str. 2, 69221 Dossenheim, Germany
| | - Dieter Oetzel
- Heidelberg University Hospital, Department of Radiation Oncology, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Nina Bougatf
- Heidelberg University Hospital, Department of Radiation Oncology, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Rolf Bendl
- Heilbronn University, Department of Medical Informatics, Max-Planck-Str. 39, 74081 Heilbronn, Germany
| | - Jürgen Debus
- Heidelberg University Hospital, Department of Radiation Oncology, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Stephanie E Combs
- Heidelberg University Hospital, Department of Radiation Oncology, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Technical University of Munich (TUM), Department of Radiation Oncology, Ismaninger Straße 122, Munich, Germany
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Höss A, Lampe C, Panse R, Ackermann B, Naumann J, Jäkel O. First experiences with the implementation of the European standard EN 62304 on medical device software for the quality assurance of a radiotherapy unit. Radiat Oncol 2014; 9:79. [PMID: 24655818 PMCID: PMC3994433 DOI: 10.1186/1748-717x-9-79] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 03/09/2014] [Indexed: 12/27/2022] Open
Abstract
Background According to the latest amendment of the Medical Device Directive standalone software qualifies as a medical device when intended by the manufacturer to be used for medical purposes. In this context, the EN 62304 standard is applicable which defines the life-cycle requirements for the development and maintenance of medical device software. A pilot project was launched to acquire skills in implementing this standard in a hospital-based environment (in-house manufacture). Methods The EN 62304 standard outlines minimum requirements for each stage of the software life-cycle, defines the activities and tasks to be performed and scales documentation and testing according to its criticality. The required processes were established for the pre-existent decision-support software FlashDumpComparator (FDC) used during the quality assurance of treatment-relevant beam parameters. As the EN 62304 standard implicates compliance with the EN ISO 14971 standard on the application of risk management to medical devices, a risk analysis was carried out to identify potential hazards and reduce the associated risks to acceptable levels. Results The EN 62304 standard is difficult to implement without proper tools, thus open-source software was selected and integrated into a dedicated development platform. The control measures yielded by the risk analysis were independently implemented and verified, and a script-based test automation was retrofitted to reduce the associated test effort. After all documents facilitating the traceability of the specified requirements to the corresponding tests and of the control measures to the proof of execution were generated, the FDC was released as an accessory to the HIT facility. Conclusions The implementation of the EN 62304 standard was time-consuming, and a learning curve had to be overcome during the first iterations of the associated processes, but many process descriptions and all software tools can be re-utilized in follow-up projects. It has been demonstrated that a standards-compliant development of small and medium-sized medical software can be carried out by a small team with limited resources in a clinical setting. This is of particular relevance as the upcoming revision of the Medical Device Directive is expected to harmonize and tighten the current legal requirements for all European in-house manufacturers.
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Affiliation(s)
- Angelika Höss
- Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany.
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Combs SE, Debus J. Treatment with heavy charged particles: systematic review of clinical data and current clinical (comparative) trials. Acta Oncol 2013; 52:1272-86. [PMID: 23964656 DOI: 10.3109/0284186x.2013.818254] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND To analyze relevant data on carbon ion radiotherapy for different tumor indications and to review current clinical trials. MATERIAL AND METHODS All published data on carbon ion radiotherapy were searched for with specific criteria in PUBMED. The terms for search were 'carbon ion and (radiotherapy OR radiation therapy) and (nirs OR chiba OR japan OR itep OR st. petersburg OR PSI OR dubna OR uppsala OR clatterbridge OR loma linda OR nice OR orsay OR itemba OR mpri OR himac OR triumf OR GSI OR HMI OR NCC OR ibmc OR pmrc OR MGH OR infn-lns OR shizuoka OR werc OR zibo OR md anderson OR fpti OR ncc ilsan OR boston OR heidelberg OR tsukuba) NOT in vitro NOT cell culture NOT review[Publication Type] Filters: Humans, English'. The search delivered 273 hits, of which only articles in English including 20 or more patients were included. Case reports were not considered. We subdivided into disease- and site-specific groups. RESULTS AND CONCLUSION To date, several studies have been performed, however, no randomized trials have been conducted. Therefore, carbon ion radiotherapy must be considered an experimental treatment, and randomized trials comparing modern photon as well as proton treatments are necessary.
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Affiliation(s)
- Stephanie E Combs
- University Hospital of Heidelberg, Department of Radiation Oncology , Heidelberg , Germany
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Abstract
The use of charged particle therapy to control tumours non-invasively offers advantages over conventional radiotherapy. Protons and heavy ions deposit energy far more selectively than X-rays, allowing a higher local control of the tumour, a lower probability of damage to healthy tissue, low risk of complications and the chance for a rapid recovery after therapy. Charged particles are also useful for treating tumours located in areas that surround tissues that are radiosensitive and in anatomical sites where surgical access is limited. Current trial outcomes indicate that accelerated ions can potentially replace surgery for radical cancer treatments, which might be beneficial as the success of surgical cancer treatments are largely dependent on the expertise and experience of the surgeon and the location of the tumour. However, to date, only a small number of controlled randomized clinical trials have made comparisons between particle therapy and X-rays. Therefore, although the potential advantages are clear and supported by data, the cost:benefit ratio remains controversial. Research in medical physics and radiobiology is focusing on reducing the costs and increasing the benefits of this treatment.
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