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Hoffmann L, Mortensen H, Shamshad M, Berbee M, Bizzocchi N, Bütof R, Canters R, Defraene G, Lykkegaard Ehmsen M, Fiorini F, Haustermans K, Hulley R, Korevaar EW, Clarke M, Makocki S, Muijs CT, Murray L, Nicholas O, Nordsmark M, Radhakrishna G, Thomas M, Troost EGC, Vilches-Freixas G, Visser S, Weber DC, Sloth Møller D. Treatment planning comparison in the PROTECT-trial randomising proton versus photon beam therapy in oesophageal cancer: results from eight european centres. Radiother Oncol 2022; 172:32-41. [PMID: 35513132 DOI: 10.1016/j.radonc.2022.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/06/2022] [Accepted: 04/28/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare dose distributions and robustness in treatment plans from eight European centres in preparation for the European randomized phase-III PROTECT-trial investigating the effect of proton therapy (PT) versus photon therapy (XT) for oesophageal cancer. MATERIALS AND METHODS All centres optimized one PT and one XT nominal plan using delineated 4DCT scans for four patients receiving 50.4Gy(RBE) in 28 fractions. Target volume receiving 95% of prescribed dose (V95%iCTVtotal) should be >99%. Robustness towards setup, range, and respiration was evaluated. The plans were recalculated on a surveillance 4DCT (sCT) acquired at fraction ten and robustness evaluation was performed to evaluate the effect of respiration and inter-fractional anatomical changes. RESULTS All PT and XT plans complied with V95%iCTVtotal>99% for the nominal plan and V95%iCTVtotal>97% for all respiratory and robustness scenarios. Lung and heart dose varied considerably between centres for both modalities. The difference in mean lung dose and mean heart dose between each pair of XT and PT plans was in median [range] 4.8Gy [1.1;7.6] and 8.4Gy [1.9;24.5], respectively. Patients B and C showed large inter-fractional anatomical changes on sCT. For patient B, the minimum V95%iCTVtotal in the worst-case robustness scenario was 45% and 94% for XT and PT, respectively. For patient C, the minimum V95%iCTVtotal was 57% and 72% for XT and PT, respectively. Patient A and D showed minor inter-fractional changes and the minimum V95%iCTVtotal was >85%. CONCLUSION Large variability in dose to the lungs and heart was observed for both modalities. Inter-fractional anatomical changes led to larger target dose deterioration for XT than PT plans.
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Affiliation(s)
- Lone Hoffmann
- Department of Medical Physics, Aarhus University Hospital, Denmark; Dept. of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark.
| | - Hanna Mortensen
- Danish Center for Particle Therapy, Aarhus University Hospital, Denmark
| | - Muhammad Shamshad
- Department of Medical Physics, Aarhus University Hospital, Denmark; Dept. of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark; Danish Center for Particle Therapy, Aarhus University Hospital, Denmark
| | - Maaike Berbee
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, The Netherlands
| | - Nicola Bizzocchi
- Center for Proton Therapy, Paul Scherrer Institut, Villigen, Switzerland
| | - Rebecca Bütof
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
| | - Richard Canters
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, The Netherlands
| | - Gilles Defraene
- KU Leuven - University of Leuven - Department of Oncology - Laboratory of Experimental Radiotherapy, Leuven, Belgium
| | | | | | - Karin Haustermans
- KU Leuven - University of Leuven - Department of Oncology - Laboratory of Experimental Radiotherapy, Leuven, Belgium; University Hospitals Leuven, Department of Radiation Oncology, Leuven, Belgium
| | - Ryan Hulley
- South West Wales Cancer Centre, Swansea University Board, UL AND Swansea University Medical School, United Kingdom
| | - Erik W Korevaar
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Matthew Clarke
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Sebastian Makocki
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
| | - Christina T Muijs
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Luke Murray
- Rutherford Cancer Centre, Shinfield, Reading, United Kingdom
| | - Owen Nicholas
- South West Wales Cancer Centre, Swansea University Board, UL AND Swansea University Medical School, United Kingdom
| | | | | | - Melissa Thomas
- KU Leuven - University of Leuven - Department of Oncology - Laboratory of Experimental Radiotherapy, Leuven, Belgium; University Hospitals Leuven, Department of Radiation Oncology, Leuven, Belgium
| | - Esther G C Troost
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany; Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden-Rossendorf, Rossendorf, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany; National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz Association / Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany
| | - Gloria Vilches-Freixas
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, The Netherlands
| | - Sabine Visser
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institut, Villigen, Switzerland; Radiation Oncology Department, University Hospital Zurich, Zurich, Switzerland
| | - Ditte Sloth Møller
- Department of Medical Physics, Aarhus University Hospital, Denmark; Dept. of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
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Ryan ÉJ, Creavin B, Sheahan K. Delivery of Personalized Care for Locally Advanced Rectal Cancer: Incorporating Pathological, Molecular Genetic, and Immunological Biomarkers Into the Multimodal Paradigm. Front Oncol 2020; 10:1369. [PMID: 32923389 PMCID: PMC7456909 DOI: 10.3389/fonc.2020.01369] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 06/29/2020] [Indexed: 12/13/2022] Open
Abstract
Approximately one-third of all newly diagnosed colorectal cancer (CRC) is composed of rectal cancer, with the incidence rising in younger patients. The principal neoadjuvant treatments consist of neoadjuvant short-course radiotherapy and long-course chemoradiation. Locally advanced rectal cancer (LARC) is particularly challenging to manage given the anatomical constrictions of the pelvis and the risk for local recurrence. In appropriately treated patients, 5- and 10-year overall survival is estimated at 60 and 50%, respectively. The prognosis for LARC has improved in recent years with more access to screening, advances in surgical techniques, and perioperative care. Furthermore, the refinement of the multidisciplinary team with combined-modality management strategies has improved outcomes. These advancements have been augmented by significant improvements in the understanding of the underlying tumor biology. However, there are many instances where patient outcomes do not match those for their tumor stage and accurate prognostic information for individual patients can be difficult to estimate owing to the heterogeneous nature of LARC. Many new combinations of chemotherapy with radiotherapy, including total neoadjuvant therapy with targeted therapies that aim to diminish toxicity and increase survival, are being evaluated in clinical trials. Despite these advances, local recurrence and distant metastasis remain an issue, with one-third of LARC patients dying within 5 years of initial treatment. Although much of the new pathological, molecular genetics, and immunological biomarkers allow refinement in the classification and prognostication of CRC, the relative importance of each of these factors with regards to the development and progression of LARC remains incompletely understood. These factors are often insufficiently validated and seldom consider the individual characteristics of the host, the tumor and its location, the local available expertise, or the probable location of recurrence. Appreciating the mechanisms behind these differences will allow for a more comprehensive, personalized approach and more informed treatment options, leading to ultimately superior outcomes. This review aims to first outline the current multidisciplinary context in which LARC care should be delivered and then discuss how some key prognosticators, including novel histopathological, molecular genetics, and immunological biomarkers, might fit into the wider context of personalized LARC management in the coming years.
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Affiliation(s)
- Éanna J. Ryan
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ben Creavin
- School of Medicine, University College Dublin, Dublin, Ireland
- Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Kieran Sheahan
- School of Medicine, University College Dublin, Dublin, Ireland
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