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Azemar N, Fontbonne C, Claude Quintyn J, Lebertz D, Marc Fontbonne J, Thariat J. Assessment of gaze direction during head and neck irradiation and dosimetric impact on the retina, macula and papilla in a cohort of 240 patients with paraoptic tumors. Radiother Oncol 2024; 197:110342. [PMID: 38782302 DOI: 10.1016/j.radonc.2024.110342] [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: 01/13/2024] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
In a prospective cohort of 240 paraoptic tumors patients treated with protons, there was 10° inter-individual gaze angle variability (up to 30°). In a random 21-patient subset with initial CTs versus and adaptive CTs, 6 (28.57 %) patients had at least twice a 10°-difference in their gaze angle, with > 5 Gy difference on the retina/macula or papilla in 2/21 (9.52 %) and 1/21 (4.76 %) based on cumulative dose from rescans, respectively.
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Affiliation(s)
- Nathan Azemar
- Université de Caen Normandie, ENSICAEN, CNRS/IN2P3, LPC Caen UMR6534, Caen F-14000, France.
| | - Cathy Fontbonne
- Université de Caen Normandie, ENSICAEN, CNRS/IN2P3, LPC Caen UMR6534, Caen F-14000, France
| | | | - Dorothee Lebertz
- Université de Caen Normandie, ENSICAEN, CNRS/IN2P3, LPC Caen UMR6534, Caen F-14000, France; Department of Radiation Therapy, Centre François Baclesse, Caen, France
| | - Jean Marc Fontbonne
- Université de Caen Normandie, ENSICAEN, CNRS/IN2P3, LPC Caen UMR6534, Caen F-14000, France
| | - Juliette Thariat
- Université de Caen Normandie, ENSICAEN, CNRS/IN2P3, LPC Caen UMR6534, Caen F-14000, France; Department of Radiation Therapy, Centre François Baclesse, Caen, France.
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2
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Chow JCH, Ho JCS, Cheung KM, Johnson D, Ip BYM, Beitler JJ, Strojan P, Mäkitie AA, Eisbruch A, Ng SP, Nuyts S, Mendenhall WM, Babighian S, Ferlito A. Neurological complications of modern radiotherapy for head and neck cancer. Radiother Oncol 2024; 194:110200. [PMID: 38438018 DOI: 10.1016/j.radonc.2024.110200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/21/2024] [Accepted: 02/29/2024] [Indexed: 03/06/2024]
Abstract
Radiotherapy is one of the mainstay treatment modalities for the management of non-metastatic head and neck cancer (HNC). Notable improvements in treatment outcomes have been observed in the recent decades. Modern radiotherapy techniques, such as intensity-modulated radiotherapy and charged particle therapy, have significantly improved tumor target conformity and enabled better preservation of normal structures. However, because of the intricate anatomy of the head and neck region, multiple critical neurological structures such as the brain, brainstem, spinal cord, cranial nerves, nerve plexuses, autonomic pathways, brain vasculature, and neurosensory organs, are variably irradiated during treatment, particularly when tumor targets are in close proximity. Consequently, a diverse spectrum of late neurological sequelae may manifest in HNC survivors. These neurological complications commonly result in irreversible symptoms, impair patients' quality of life, and contribute to a substantial proportion of non-cancer deaths. Although the relationship between radiation dose and toxicity has not been fully elucidated for all complications, appropriate application of dosimetric constraints during radiotherapy planning may reduce their incidence. Vigilant surveillance during the course of survivorship also enables early detection and intervention. This article endeavors to provide a comprehensive review of the various neurological complications of modern radiotherapy for HNC, summarize the current incidence data, discuss methods to minimize their risks during radiotherapy planning, and highlight potential strategies for managing these debilitating toxicities.
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Affiliation(s)
- James C H Chow
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region.
| | - Jason C S Ho
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
| | - Ka Man Cheung
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
| | - David Johnson
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong Special Administrative Region
| | - Bonaventure Y M Ip
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Jonathan J Beitler
- Harold Alfond Center for Cancer Care, Maine General Hospital, Augusta, ME, USA
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Antti A Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan Medicine, Ann Arbor, MI, USA
| | - Sweet Ping Ng
- Department of Radiation Oncology, Olivia Newton-John Cancer Centre, Austin Health, Melbourne, Australia
| | - Sandra Nuyts
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, KU Leuven - University of Leuven, Leuven, Belgium; Laboratory of Experimental Radiotherapy, Department of Oncology, University of Leuven, Leuven, Belgium
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Silvia Babighian
- Department of Ophthalmology, Ospedale Sant'Antonio, Azienda Ospedaliera, Padova, Italy
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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Yazol M, Ozer H, Asfuroglu BB, Kurt G, Emmez ÖH, Öner AY. Investigation of the effects of Gamma Knife radiosurgery on optic pathways using diffusion tensor MRI within the first year after treatment. Neuroradiology 2024; 66:609-620. [PMID: 38363336 DOI: 10.1007/s00234-024-03296-0] [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: 10/06/2023] [Accepted: 01/25/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE To investigate the radiation-induced effects of Gamma Knife radiosurgery (GKRS) for sellar-parasellar tumors on optic pathways using DTI parameters within the first year after treatment. METHODS Twenty-five patients with sellar-parasellar tumors underwent MRI before and 3 months after GKRS, including T1WI, DTI, T2WI. Moreover, 21 patients underwent follow-up DTI 6-8 months after radiosurgery. ROIs were set on optic nerves, optic radiations, and control localizations; DTI parameters for each were calculated. Pre- and post-radiosurgery differences in DTI values were statistically compared and assessed with respect to tumor size changes. RESULTS Following GKRS, DTI parameters, notably ADC, FA, and RD, showed statistically significant changes in optic nerves and anterior optic radiations. DTI changes were more significant in the group of cases with tumor shrinkage. In this group, DTI of the anterior optic radiations further deteriorated 3 months post-GKRS, whereas acute changes in DTI parameters of the optic nerves resolved within 6-8 months. DTI of central and posterior optic radiations did not differ significantly following radiosurgery; 6-8 months after radiosurgery, visual function was stable in 14 (56%) patients and improved in 11 (44%), showing no correlation with tumor size changes or DTI parameters. CONCLUSION White Matter (WM) injury in the optic pathways can be induced by Gamma Knife radiosurgery targeted to sellar and parasellar tumors. Following GKRS, microstructural abnormalities occurred in the optic radiations as well as the optic nerves within the first post-treatment year. Our findings could support modifications to radiosurgical treatment strategies to minimize the risk of permanent WM injury.
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Affiliation(s)
- Merve Yazol
- Department of Radiology, Gazi University School of Medicine, 06560, Ankara, Turkey.
| | - Halil Ozer
- Department of Radiology, Gazi University School of Medicine, 06560, Ankara, Turkey
| | | | - Gökhan Kurt
- Department of Neurosurgery, Gazi University School of Medicine, 06560, Ankara, Turkey
| | - Ömer Hakan Emmez
- Department of Neurosurgery, Gazi University School of Medicine, 06560, Ankara, Turkey
| | - Ali Yusuf Öner
- Department of Radiology, Gazi University School of Medicine, 06560, Ankara, Turkey
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4
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Kinaci-Tas B, Alderliesten T, Verbraak FD, Rasch CRN. Radiation-Induced Retinopathy and Optic Neuropathy after Radiation Therapy for Brain, Head, and Neck Tumors: A Systematic Review. Cancers (Basel) 2023; 15:cancers15071999. [PMID: 37046660 PMCID: PMC10093581 DOI: 10.3390/cancers15071999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/02/2023] [Accepted: 03/09/2023] [Indexed: 03/30/2023] Open
Abstract
Background: Patients with brain, head, and neck tumors experience a decline in their quality of life due to radiation retinopathy and optic neuropathy. Little is known about the dose–response relationship and patient characteristics. We aimed to systematically review the prevalence of radiation retinopathy and optic neuropathy. Method: The primary outcome was the pooled prevalence of radiation retinopathy and optic neuropathy. The secondary outcome included the effect of the total radiation dose prescribed for the tumor according to the patient’s characteristics. Furthermore, we aimed to evaluate the radiation dose parameters for organs at risk of radiation retinopathy and optic neuropathy. Results: The pooled prevalence was 3.8%. No retinopathy was reported for the tumor’s prescribed dose of <50 Gy. Optic neuropathy was more prevalent for a prescribed dose of >50 Gy than <50 Gy. We observed a higher prevalence rate for retinopathy (6.0%) than optic neuropathy (2.0%). Insufficient data on the dose for organs at risk were reported. Conclusion: The prevalence of radiation retinopathy was higher compared to optic neuropathy. This review emphasizes the need for future studies considering retinopathy and optic neuropathy as primary objective parameters.
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Affiliation(s)
- Buket Kinaci-Tas
- Department of Radiation Oncology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
- Correspondence:
| | - Tanja Alderliesten
- Department of Radiation Oncology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
| | - Frank D. Verbraak
- Department of Ophthalmology, Amsterdam University Medical Centers, Location VU Medical Center, 1081 HV Amsterdam, The Netherlands
| | - Coen R. N. Rasch
- Department of Radiation Oncology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands
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5
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Holtzman AL, Dagan R, Mendenhall WM. Proton Radiotherapy for Skull-Base Malignancies. Oral Maxillofac Surg Clin North Am 2023:S1042-3699(23)00005-5. [PMID: 37005171 DOI: 10.1016/j.coms.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
Proton therapy (PT) is a form of highly conformal external-beam radiotherapy used to mitigate acute and late effects following radiotherapy. Indications for treatment include both benign and malignant skull-base and central nervous system pathologies. Studies have demonstrated that PT shows promising results in minimizing neurocognitive decline and reducing second malignancies with low rates of central nervous system necrosis. Future directions and advances in biologic optimization may provide additional benefits beyond the physical properties of particle dosimetry.
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Affiliation(s)
- Adam L Holtzman
- Department of Radiation Oncology, University of Florida College of Medicine, 2015 North Jefferson Street, Jacksonville, FL 32206, USA.
| | - Roi Dagan
- Department of Radiation Oncology, University of Florida College of Medicine, 2015 North Jefferson Street, Jacksonville, FL 32206, USA
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, 2015 North Jefferson Street, Jacksonville, FL 32206, USA
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Bachtiary B, Veraguth D, Roos N, Pfiffner F, Leiser D, Pica A, Walser M, von Felten S, Weber DC. Hearing Loss in Cancer Patients with Skull Base Tumors Undergoing Pencil Beam Scanning Proton Therapy: A Retrospective Cohort Study. Cancers (Basel) 2022; 14:cancers14163853. [PMID: 36010847 PMCID: PMC9405884 DOI: 10.3390/cancers14163853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 11/16/2022] Open
Abstract
To assess the incidence and severity of changes in hearing threshold in patients undergoing high-dose pencil-beam-scanning proton therapy (PBS-PT). This retrospective cohort study included fifty-one patients (median 50 years (range, 13–68)) treated with PBS-PT for skull base tumors. No chemotherapy was delivered. Pure tone averages (PTAs)were determined before (baseline) and after PBS-PT as the average hearing thresholds at frequencies of 0.5, 1, 2, and 4 kHz. Hearing changes were calculated as PTA differences between pre-and post-PBS-PT. A linear mixed-effects model was used to assess the relationship between the PTA at the follow-up and the baseline, the cochlea radiation dose intensity, the increased age, and the years after PBS-PT. Included patients were treated for chordoma (n = 24), chondrosarcoma (n = 9), head and neck tumors (n = 9), or meningioma (n = 3), with a mean tumor dose of 71.1 Gy (RBE) (range, 52.0–77.8), and a mean dose of 37 Gy (RBE) (range, 0.0–72.7) was delivered to the cochleas. The median time to the first follow-up was 11 months (IQR, 5.5–33.7). The PTA increased from a median of 15 dB (IQR 10.0–25) at the baseline to 23.8 (IQR 11.3–46.3) at the first follow-up. In the linear mixed-effect model, the baseline PTA (estimate 0.80, 95%CI 0.64 to 0.96, p ≤ 0.001), patient’s age (0.30, 0.03 to 0.57, p = 0.029), follow-up time (2.07, 0.92 to 3.23, p ≤ 0.001), and mean cochlear dose in Gy (RBE) (0.34, 0.21 to 0.46, p ≤ 0.001) were all significantly associated with an increase in PTA at follow-up. The applied cochlear dose and baseline PTA, age, and time after treatment were significantly associated with hearing loss after proton therapy.
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Affiliation(s)
- Barbara Bachtiary
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland
- Correspondence: ; Tel.: +41-56-310-2319
| | - Dorothe Veraguth
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Nicolaas Roos
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
| | - Flurin Pfiffner
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Dominic Leiser
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland
| | - Alessia Pica
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland
| | - Marc Walser
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland
| | - Stefanie von Felten
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, 8001 Zurich, Switzerland
| | - Damien C. Weber
- Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, 5232 Villigen, Switzerland
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, 8091 Zurich, Switzerland
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Crouzen JA, Petoukhova AL, Wiggenraad RGJ, Hutschemaekers S, Gadellaa-van Hooijdonk CGM, van der Voort van Zyp NCMG, Mast ME, Zindler JD. Development and evaluation of an automated EPTN-consensus based organ at risk atlas in the brain on MRI. Radiother Oncol 2022; 173:262-268. [PMID: 35714807 DOI: 10.1016/j.radonc.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 04/29/2022] [Accepted: 06/08/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND PURPOSE During radiotherapy treatment planning, avoidance of organs at risk (OARs) is important. An international consensus-based delineation guideline was recently published with 34 OARs in the brain. We developed an MR-based OAR autosegmentation atlas and evaluated its performance compared to manual delineation. MATERIALS AND METHODS Anonymized cerebral T1-weighted MR scans (voxel size 0.9x0.9x0.9mm 3) were available. OARs were manually delineated according to international consensus. Fifty MR scans were used to develop the autosegmentation atlas in a commercially available treatment planning system (Raystation®). The performance of this atlas was tested on another 40 MR scans by automatically delineating 34 OARs, as defined by the 2018 EPTN consensus. Spatial overlap between manual and automated delineations was determined by calculating the Dice similarity coefficient (DSC). Two radiation oncologists determined the quality of each automatically delineated OAR. The time needed to delineate all OARs manually or to adjust automatically delineated OARs was determined. RESULTS DSC was ≥0.75 in 31 (91%) out of 34 automated OAR delineations. Delineations were rated by radiation oncologists as excellent or good in 29 (85%) out 34 OAR delineations, while 4 were rated fair (12%) and 1 was rated poor (3%). Interobserver agreement between the radiation oncologists ranged from 77-100% per OAR. The time to manually delineate all OARs was 88.5 minutes, while the time needed to adjust automatically delineated OARs was 15.8 minutes. CONCLUSION Autosegmentation of OARs enables high-quality contouring within a limited time. Accurate OAR delineation helps to define OAR constraints to mitigate serious complications and helps with the development of NTCP models.
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Affiliation(s)
- Jeroen A Crouzen
- Haaglanden Medical Center, Department of Radiotherapy, BA Leidschendam, The Netherlands.
| | - Anna L Petoukhova
- Haaglanden Medical Center, Department of Medical Physics, BA Leidschendam, The Netherlands.
| | - Ruud G J Wiggenraad
- Haaglanden Medical Center, Department of Radiotherapy, BA Leidschendam, The Netherlands
| | - Stefan Hutschemaekers
- Haaglanden Medical Center, Department of Radiotherapy, BA Leidschendam, The Netherlands.
| | | | | | - Mirjam E Mast
- Haaglanden Medical Center, Department of Radiotherapy, BA Leidschendam, The Netherlands.
| | - Jaap D Zindler
- Haaglanden Medical Center, Department of Radiotherapy, BA Leidschendam, The Netherlands.
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Köthe A, Feuvret L, Weber DC, Safai S, Lomax AJ, Fattori G. Assessment of Radiation-Induced Optic Neuropathy in a Multi-Institutional Cohort of Chordoma and Chondrosarcoma Patients Treated with Proton Therapy. Cancers (Basel) 2021; 13:cancers13215327. [PMID: 34771490 PMCID: PMC8582447 DOI: 10.3390/cancers13215327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Proton therapy is an effective therapeutic option for the treatment of skull-base tumors that require high radiation doses to be controlled. On rare occasions, patients suffer from radiation-induced optic neuropathy (RION) to the detriment of their post-treatment quality-of-life. We have collected multi-institutional data of 289 skull-base patients having received high doses to the optic apparatus from proton therapy or proton–photon mixed treatments and have observed a RION incidence rate (all grades) of 4.2% (12). We have furthermore confirmed older age and hypertension as risk factors for the onset of this side effect, with tumor involvement or its proximity to the optic apparatus and repeated surgical procedures showing moderate association. Our findings were consolidated into a NTCP model that can support pre-treatment patient segmentation into risk groups and the planning of necessary treatment countermeasures. However, further data and validation are necessary to confirm validity of the model. Abstract Radiation-induced optic neuropathy (RION) is a rare side effect following radiation therapy involving the optic structures whose onset is, due to the low amount of available data, challenging to predict. We have analyzed a multi-institutional cohort including 289 skull-base cancer patients treated with proton therapy who all received >45 GyRBE to the optic apparatus. An overall incidence rate of 4.2% (12) was observed, with chordoma patients being at higher risk (5.8%) than chondrosarcoma patients (3.2%). Older age and arterial hypertension, tumor involvement, and repeated surgeries (>3) were found to be associated with RION. Based on bootstrapping and cross-validation, a NTCP model based on age and hypertension was determined to be the most robust, showing good classification ability (AUC-ROC 0.77) and calibration on our dataset. We suggest the application of this model with a threshold of 6% to segment patients into low and high-risk groups before treatment planning. However, further data and external validation are warranted before clinical application.
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Affiliation(s)
- Andreas Köthe
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland; (D.C.W.); (S.S.); (A.J.L.); (G.F.)
- Department of Physics, ETH Zürich, 8093 Zürich, Switzerland
- Correspondence:
| | - Loïc Feuvret
- Center for Proton Therapy, Institut Curie, 91400 Orsay, France;
- Department of Radiation Oncology, AP-HP, Hôpitaux Universitaires La Salpêtrière Charles Foix, Sorbonne Université, 75013 Paris, France
| | - Damien Charles Weber
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland; (D.C.W.); (S.S.); (A.J.L.); (G.F.)
- Department of Radiation Oncology, University Hospital Zürich, 8091 Zürich, Switzerland
- Department of Radiation Oncology, University Hospital Bern, 3010 Bern, Switzerland
| | - Sairos Safai
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland; (D.C.W.); (S.S.); (A.J.L.); (G.F.)
| | - Antony John Lomax
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland; (D.C.W.); (S.S.); (A.J.L.); (G.F.)
- Department of Physics, ETH Zürich, 8093 Zürich, Switzerland
| | - Giovanni Fattori
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland; (D.C.W.); (S.S.); (A.J.L.); (G.F.)
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Press RH, Bakst RL, Sharma S, Kabarriti R, Garg MK, Yeh B, Gelbum DY, Hasan S, Choi JI, Barker CA, Chhabra AM, Simone CB, Lee NY. Clinical Review of Proton Therapy in the Treatment of Unilateral Head and Neck Cancers. Int J Part Ther 2021; 8:248-260. [PMID: 34285951 PMCID: PMC8270109 DOI: 10.14338/ijpt-d-20-00055.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/21/2020] [Indexed: 11/25/2022] Open
Abstract
Radiotherapy is a common treatment modality in the management of head and neck malignancies. In select clinical scenarios of well-lateralized tumors, radiotherapy can be delivered to the primary tumor or tumor bed and the ipsilateral nodal regions, while intentional irradiation of the contralateral neck is omitted. Proton beam therapy is an advanced radiotherapy modality that allows for the elimination of exit-dose through nontarget tissues such as the oral cavity. This dosimetric advantage is apt for unilateral treatments. By eliminating excess dose to midline and contralateral organs at risk and conforming dose around complex anatomy, proton beam therapy can reduce the risk of iatrogenic toxicities. Currently, there is no level I evidence comparing proton beam therapy to conventional photon radiation modalities for unilateral head and neck cancers. However, a growing body of retrospective and prospective evidence is now available describing the dosimetric and clinical advantages of proton beam therapy. Subsequently, the intent of this clinical review is to summarize the current evidence supporting the use of proton beam therapy in unilateral irradiation of head and neck cancers, including evaluation of disease site-specific evidence, unique challenging clinical scenarios, and ongoing clinical trials.
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Affiliation(s)
- Robert H Press
- Department of Radiation Oncology, New York Proton Center, New York, New York, USA
| | - Richard L Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sonam Sharma
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rafi Kabarriti
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Madhur K Garg
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Brian Yeh
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daphna Y Gelbum
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Shaakir Hasan
- Department of Radiation Oncology, New York Proton Center, New York, New York, USA
| | - J Isabelle Choi
- Department of Radiation Oncology, New York Proton Center, New York, New York, USA
| | - Chris A Barker
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Arpit M Chhabra
- Department of Radiation Oncology, New York Proton Center, New York, New York, USA
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, New York, USA
| | - Nancy Y Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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10
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Nakajima K, Iwata H, Hattori Y, Nomura K, Hashimoto S, Toshito T, Hayashi K, Kuroda Y, Fukano H, Ogino H, Shibamoto Y. Spot Scanning Proton Therapy for Sinonasal Malignant Tumors. Int J Part Ther 2021; 8:189-199. [PMID: 34285946 PMCID: PMC8270097 DOI: 10.14338/ijpt-d-20-00043.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/12/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose Treatment of sinonasal malignant tumors is challenging, and evidence to establish a standard treatment is limited. Our objective was to evaluate the efficacy and safety of spot scanning proton therapy (SSPT) for sinonasal malignant tumors. Patients and Methods We retrospectively analyzed patients with sinonasal malignant tumors (T1-4bN0-2M0) who underwent SSPT between May 2014 and September 2019. The prescription dose was typically either 60 GyRBE in 15 fractions or 60.8 GyRBE in 16 fractions for mucosal melanoma and 70.2 GyRBE in 26 fractions for other histologic subtypes. Endpoints included local control (LC), progression-free survival, overall survival (OS), and incidence of toxicity. Prognostic factors were analyzed using the Kaplan-Meier method and log-rank test. Results Of 62 enrolled patients, the common histologic subtypes were mucosal melanoma (35%), squamous cell carcinoma (27%), adenoid cystic carcinoma (16%), and olfactory neuroblastoma (10%). Locally advanced stages were common (T3 in 42% and T4 in 53%). Treatment-naïve tumors and postsurgical recurrent tumors accounted for 73% and 27%, respectively. No patient had previous radiotherapy. The median follow-up was 17 months (range, 6-66) for all patients and 21.5 months (range, 6-66) for survivors. The 2-year LC, progression-free survival, and OS rates of all patients were 92%, 50%, and 76%, respectively. Univariate analysis revealed histology as a prognostic factor for OS, being higher in adenoid cystic carcinoma and olfactory neuroblastoma than in other tumors. Sixteen grade ≥3 late toxicities were observed in 12 patients (19%), including 11 events resulting in visual impairment; the most common was cataract. There was 1 grade 4 toxicity, and there were no grade 5 toxicities. Conclusion SSPT was well tolerated and yielded good LC for sinonasal malignant tumors. Although we consider SSPT to be a leading treatment modality, further studies are required to establish its status as a standard treatment.
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Affiliation(s)
- Koichiro Nakajima
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan.,Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiromitsu Iwata
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan.,Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yukiko Hattori
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan
| | - Kento Nomura
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan.,Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shingo Hashimoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Toshiyuki Toshito
- Department of Proton Therapy Physics, Nagoya Proton Therapy Center, Nagoya, Japan
| | - Kensuke Hayashi
- Department of Proton Therapy Technology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan
| | - Yo Kuroda
- Department of Otorhinolaryngology, Nagoya City West Medical Center, Nagoya, Japan
| | - Hideo Fukano
- Department of Oral and Maxillofacial Surgery, Nagoya City West Medical Center, Nagoya, Japan
| | - Hiroyuki Ogino
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan.,Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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11
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Lecornu M, Lesueur P, Salleron J, Balosso J, Stefan D, Kao W, Plouhinec T, Vela A, Dutheil P, Bouter J, Marty PA, Thariat J, Quintyn JC. Prospective Assessment of Early Proton Therapy-Induced Optic Neuropathy in Patients With Intracranial, Orbital or Sinonasal Tumors: Impact of A Standardized Ophthalmological Follow Up. Front Oncol 2021; 11:673886. [PMID: 34211847 PMCID: PMC8239302 DOI: 10.3389/fonc.2021.673886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/27/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Proton therapy (PT) can be a good option to achieve tumor control while reducing the probability of radiation induced toxicities compared to X-ray-based radiotherapy. However, there are still uncertainties about the effects of PT on the organs in direct contact with the irradiated volume. The aim of this prospective series was to report 6-month follow-up of clinical and functional optic neuropathy rates of patients treated by proton therapy using a standardized comprehensive optic examination. METHODS AND MATERIALS Standardized ophthalmological examinations were performed to analyze subclinical anomalies in a systematic way before treatment and 6 months after the end of proton therapy with: Automatic visual field, Visual evoked potential (VEP) and optic coherence of tomography (OCT). RESULTS From October 2018 to July 2020 we analyzed 81 eyes. No significant differences were found in the analysis of the clinical examination of visual functions by the radiation oncologist. However, considering VEP, the impairment was statistically significant for both fibers explored at 30'angle (p:0.007) and 60'angle (p <0.001). In patients with toxicity, the distance of the target volume from the optical pathways was more important with a p-value for 30'VEP at 0.035 and for 60'VEP at 0.039. CONCLUSIONS These results confirm uncertainties concerning relative biological effectiveness of proton therapy, linear energy transfer appears to be more inhomogeneous especially in areas close to the target volumes. The follow-up of patients after proton therapy is not an easy process to set up but it is necessary to improve our knowledges about the biological effects of proton therapy in real life. Our study which will continue during the coming years, suggests that follow-up with in-depth examinations such as VEP as a biomarker could improve the detection of early abnormalities.
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Affiliation(s)
- Marie Lecornu
- Radiation Oncology Department, Centre François Baclesse, Caen, France
| | - Paul Lesueur
- Radiation Oncology Department, Centre François Baclesse, Caen, France
- Radiation Oncology Department, Centre Guillaume le Conquérant, Caen, France
- ISTCT UMR6030-CNRS, CEA, Université de Caen-Normandie, Equipe CERVOxy, Caen, France
| | - Julia Salleron
- Cellule Data Biostatistique, Instistut de Cancerologie de Lorraine, Nancy, France
| | - Jacques Balosso
- Radiation Oncology Department, Centre François Baclesse, Caen, France
| | - Dinu Stefan
- Radiation Oncology Department, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - William Kao
- Radiation Oncology Department, Centre François Baclesse, Caen, France
| | | | - Anthony Vela
- Radiation Oncology Department, Centre François Baclesse, Caen, France
| | - Pauline Dutheil
- Radiation Oncology Department, Centre François Baclesse, Caen, France
| | - Jordan Bouter
- Radiation Oncology Department, Centre François Baclesse, Caen, France
| | | | - Juliette Thariat
- Radiation Oncology Department, Centre François Baclesse, Caen, France
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12
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Köthe A, van Luijk P, Safai S, Kountouri M, Lomax AJ, Weber DC, Fattori G. Combining Clinical and Dosimetric Features in a PBS Proton Therapy Cohort to Develop a NTCP Model for Radiation-Induced Optic Neuropathy. Int J Radiat Oncol Biol Phys 2021; 110:587-595. [DOI: 10.1016/j.ijrobp.2020.12.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 10/30/2020] [Accepted: 12/31/2020] [Indexed: 01/17/2023]
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13
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Nesteruk KP, Bolsi A, Lomax AJ, Meer D, van de Water S, Schippers JM. A static beam delivery device for fast scanning proton arc-therapy. Phys Med Biol 2021; 66:055018. [PMID: 33498040 DOI: 10.1088/1361-6560/abe02b] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Arc-therapy is a dose delivery technique regularly applied in photon radiation therapy, and is currently subject of great interest for proton therapy as well. In this technique, proton beams are aimed at a tumor from different continuous ranges of incident directions (so called 'arcs'). This technique can potentially yield a better dose conformity around the tumor and a very low dose in the surrounding healthy tissue. Currently, proton-arc therapy is performed by rotating a proton gantry around the patient, adapting the normally used dose-delivery method to the arc-specific motion of the gantry. Here we present first results from a feasibility study of the conceptual design of a new static fast beam delivery device/system for proton-arc therapy, which could be used instead of a gantry. In this novel concept, the incident angle of proton beams can be set rapidly by only changing field strengths of small magnets. This device eliminates the motion of the heavy gantry and related hardware. Therefore, a reduction of the total treatment time is expected. In the feasibility study presented here, we concentrate on the concept of the beam transport. Based on several simple, but realistic assumptions and approximations, proton tracking calculations were performed in a 3D magnetic field map, to calculate the beam transport in this device and to investigate and address several beam-optics challenges. We propose and simulate corresponding solutions and discuss their outcomes. To enable the implementation of some usually applied techniques in proton therapy, such as pencil beam scanning, energy modulation and beam shaping, we present and discuss our proposals. Here we present the concept of a new idea to perform fast proton arc-scanning and we report on first results of a feasibility study. Based on these results, we propose several options and next steps in the design.
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Affiliation(s)
- K P Nesteruk
- Paul Scherrer Institute, Villigen PSI, Switzerland
| | - A Bolsi
- Paul Scherrer Institute, Villigen PSI, Switzerland
| | - A J Lomax
- Paul Scherrer Institute, Villigen PSI, Switzerland.,Department of Physics, ETH Zurich, Switzerland
| | - D Meer
- Paul Scherrer Institute, Villigen PSI, Switzerland
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14
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Vision loss following high-dose proton-based radiotherapy for skull-base chordoma and chondrosarcoma. Radiother Oncol 2021; 158:125-130. [PMID: 33610625 DOI: 10.1016/j.radonc.2021.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/20/2021] [Accepted: 02/08/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND & PURPOSE Dose escalation for skull-based chordoma and chondrosarcoma can put critical adjacent structures at risk, specifically the anterior optic pathway. We report the incidence of vision loss following high-dose conformal proton-based radiotherapy. MATERIALS AND METHODS We reviewed patients with skull-base chordoma or chondrosarcoma treated with proton-based therapy between 2007 and 2018. We analyzed 148 patients and 283 individual eyes with functional vision at baseline who received a minimum 30GyRBE to 0.1 cm3 of the anterior optic pathway. Eyes were classified as "functionally blind" if visual acuity was 20/200 or worse. Kaplan-Meier and normal tissue complication probability modeling were used to establish the relationship between radiation dose and risk of functional vision loss. RESULTS At last follow-up, 110 of 148 patients were alive with no evidence of disease progression. With a median follow-up of 4.1 years (range, 0.5-12.8), 5 eyes in 3 patients developed functional blindness, with 2 patients developing bilateral blindness. Median time to blindness was 15.2 months. The 5-year incidence of vision loss was 2.1% (95% CI: 0.9-4.9%). On univariate analysis, development of blindness was associated with presence of multiple medical comorbidities (p = 0.0040). While there were no events with a maximum dose < 60GyRBE delivered to the anterior optic pathway, the crude rate was 3.6% over 60GyRBE, with all events occurring between 60-65GyRBE. CONCLUSIONS Despite the high radiotherapy dose delivered to patients with skull-base chordoma and chondrosarcoma, the rate of vision loss is low and no events occurred in those who received a maximum dose under 60GyRBE.
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15
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Zhang T, Xu M, Mi J, Yang H, Liu Z, Huang L, Hu K, Wang R. Loosening Neuro-Optic Structures Dosimetric Constraints Provides High 5-Year Local Recurrence-Free Survival With Acceptable Toxicity in T4 Nasopharyngeal Carcinoma Patients Treated With Intensity-Modulated Radiotherapy. Front Oncol 2021; 11:598320. [PMID: 33692949 PMCID: PMC7937960 DOI: 10.3389/fonc.2021.598320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/05/2021] [Indexed: 11/14/2022] Open
Abstract
Objective Whether the original dosimetric constraints of neuro-optic structures (NOS) are appropriate for patients with nasopharyngeal carcinoma (NPC) undergoing intensity-modulated radiotherapy (IMRT) remains controversial. The present study compared the survival rates and radiation-induced optic neuropathy (RION) occurrence between T4 NPC patients whose NOS were irradiated with a near maximum dose received by 2% of the volume (D2%) >55 Gy and ≤55 Gy. Moreover, the NOS dosimetric parameters and their correlation with RION occurrence were also evaluated. Methods In this retrospective study, 256 T4 NPC patients treated with IMRT between May 2009 and December 2013 were included. Patient characteristics, survival rates, dosimetric parameters, and RION incidence were compared between the D2% ≤55 Gy and D2% >55 Gy groups. Results The median follow-up durations were 87 and 83 months for patients in the D2% >55 Gy and D2% ≤55 Gy groups, respectively. The 5-year local recurrence-free survival rates were 92.0 and 84.0% in the D2% >55 Gy and D2% ≤55 Gy groups (P = 0.043), respectively. There was no significant difference in the 5-year overall survival (OS) between both groups (D2% >55 Gy, 81.6%; D2% ≤55 Gy, 79.4%; P = 0.586). No patients developed severe RION (Grades 3–5), and there was no significant difference (P = 0.958) in the incidence of RION between the two groups. The maximum dose of NOS significantly affected the RION incidence, with a cutoff point of 70.77 Gy. Conclusion Appropriately loosening NOS dosimetric constraints in order to ensure a more sufficient dose to the target volume can provide a better 5-year local recurrence-free survival and acceptable neuro-optic toxicity in T4 NPC patients undergoing IMRT.
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Affiliation(s)
- Tingting Zhang
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Meng Xu
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jinglin Mi
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hui Yang
- Department of Oncology, Liuzhou Worker Hospital, Liuzhou, China
| | - Zhengchun Liu
- Department of Radiotherapy, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Lulu Huang
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Kai Hu
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Rensheng Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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16
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Voshart DC, Wiedemann J, van Luijk P, Barazzuol L. Regional Responses in Radiation-Induced Normal Tissue Damage. Cancers (Basel) 2021; 13:cancers13030367. [PMID: 33498403 PMCID: PMC7864176 DOI: 10.3390/cancers13030367] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 12/16/2022] Open
Abstract
Normal tissue side effects remain a major concern in radiotherapy. The improved precision of radiation dose delivery of recent technological developments in radiotherapy has the potential to reduce the radiation dose to organ regions that contribute the most to the development of side effects. This review discusses the contribution of regional variation in radiation responses in several organs. In the brain, various regions were found to contribute to radiation-induced neurocognitive dysfunction. In the parotid gland, the region containing the major ducts was found to be critical in hyposalivation. The heart and lung were each found to exhibit regional responses while also mutually affecting each other's response to radiation. Sub-structures critical for the development of side effects were identified in the pancreas and bladder. The presence of these regional responses is based on a non-uniform distribution of target cells or sub-structures critical for organ function. These characteristics are common to most organs in the body and we therefore hypothesize that regional responses in radiation-induced normal tissue damage may be a shared occurrence. Further investigations will offer new opportunities to reduce normal tissue side effects of radiotherapy using modern and high-precision technologies.
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Affiliation(s)
- Daniëlle C. Voshart
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (D.C.V.); (J.W.)
- Department of Biomedical Sciences of Cells & Systems–Section Molecular Cell Biology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
| | - Julia Wiedemann
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (D.C.V.); (J.W.)
- Department of Biomedical Sciences of Cells & Systems–Section Molecular Cell Biology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
| | - Peter van Luijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (D.C.V.); (J.W.)
- Department of Biomedical Sciences of Cells & Systems–Section Molecular Cell Biology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
- Correspondence: (P.v.L.); (L.B.)
| | - Lara Barazzuol
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands; (D.C.V.); (J.W.)
- Department of Biomedical Sciences of Cells & Systems–Section Molecular Cell Biology, University of Groningen, University Medical Center Groningen, 9700 RB Groningen, The Netherlands
- Correspondence: (P.v.L.); (L.B.)
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17
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Held KD, Lomax AJ, Troost EGC. Proton therapy special feature: introductory editorial. Br J Radiol 2020; 93:20209004. [PMID: 32081045 DOI: 10.1259/bjr.20209004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Kathryn D Held
- Department of Radiation Oncology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Antony J Lomax
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland.,Department of Physics, ETH Zürich, Zürich, Switzerland
| | - 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, Dresden, Germany
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18
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High-dose conformal proton therapy for clinical perineural invasion in cutaneous head and neck cancer. Oral Oncol 2020; 100:104486. [DOI: 10.1016/j.oraloncology.2019.104486] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 11/20/2019] [Indexed: 12/19/2022]
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