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Mazzola G, Bergamaschi L, Pedone C, Vincini M, Pepa M, Zaffaroni M, Volpe S, Rombi B, Doyen J, Fossati P, Haustermans K, Høyer M, Langendijk J, Matute R, Orlandi E, Rylander H, Troost E, Orecchia R, Alterio D, Jereczek-Fossa B. Patients' needs in proton therapy: A survey among ten European facilities. Clin Transl Radiat Oncol 2023; 43:100670. [PMID: 37736140 PMCID: PMC10509656 DOI: 10.1016/j.ctro.2023.100670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 07/30/2023] [Accepted: 08/19/2023] [Indexed: 09/23/2023] Open
Abstract
Aims The number of Proton Therapy (PT) facilities is still limited worldwide, and the access to treatment could be characterized by patients' logistic and economic challenges. Aim of the present survey is to assess the support provided to patients undergoing PT across Europe. Methods Through a personnel contact, an online questionnaire (62 multiple-choice and open-ended questions) via Microsoft Forms was administered to 10 European PT centers. The questionnaire consisted of 62 questions divided into 6 sections: i) personal data; ii) general information on clinical activity; iii) fractionation, concurrent systemic treatments and technical aspects of PT facility; iv) indication to PT and reimbursement policies; v) economic and/ or logistic support to patients vi) participants agreement on statements related to the possible limitation of access to PT. A qualitative analysis was performed and reported. Results From March to May 2022 all ten involved centers filled the survey. Nine centers treat from 100 to 500 patients per year. Paediatric patients accounted for 10-30%, 30-50% and 50-70% of the entire cohort for 7, 2 and 1 center, respectively. The most frequent tumours treated in adult population were brain tumours, sarcomas and head and neck carcinomas; in all centers, the mean duration of PT is longer than 3 weeks. In 80% of cases, the treatment reimbursement for PT is supplied by the respective country's Health National System (HNS). HNS also provides economic support to patients in 70% of centers, while logistic and meal support is provided in 20% and 40% of centers, respectively. PT facilities offer economic and/or logistic support in 90% of the cases. Logistic support for parents of pediatric patients is provided by HNS only in one-third of centers. Overall, 70% of respondents agree that geographic challenges could limit a patient's access to proton facilities and 60% believe that additional support should be given to patients referred for PT care. Conclusions Relevant differences exist among European countries in supporting patients referred to PT in their logistic and economic challenges. Further efforts should be made by HNSs and PT facilities to reduce the risk of inequities in access to cancer care with protons.
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Affiliation(s)
- G.C. Mazzola
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - L. Bergamaschi
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - C. Pedone
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - M.G. Vincini
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - M. Pepa
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - M. Zaffaroni
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - S. Volpe
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - B. Rombi
- Proton Therapy Center, Trento, Italy
| | - J. Doyen
- Centre Antoine Lacassagne, Nice, France
| | - P. Fossati
- MedAustron Ion Therapy Center, Wiener Neustadt, Austria
| | | | - M. Høyer
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - J.A. Langendijk
- University Medical Center Groningen, Groningen, The Netherlands
| | - R. Matute
- Centro de Protonterapia Quironsalud, Madrid, Spain
| | - E. Orlandi
- CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
| | | | - E.G.C. Troost
- Faculty of Medicine and University Hospital Carl Gustav Carus, Department of Radiotherapy and Radiation Oncology, Dresden, Germany
- OncoRay - National Center for Radiation Research in Oncology: Faculty of Medicine and University Hospital Carl Gustav Carus, Dresden; Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- Institute of Radiooncology - OncoRay, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - R. Orecchia
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - D. Alterio
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | - B.A. Jereczek-Fossa
- Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Dionisi F, Scartoni D, Rombi B, Vennarini S, Righetto R, Farace P, Lorentini S, Schwarz M, Di Murro L, Demofonti C, D'Angelillo RM, Petrongari MG, Sanguineti G, Amichetti M. Consolidative active scanning proton therapy for mediastinal lymphoma: selection criteria, treatment implementation and clinical feasibility. Strahlenther Onkol 2022; 198:558-565. [PMID: 35394144 DOI: 10.1007/s00066-022-01918-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/22/2022] [Indexed: 11/27/2022]
Abstract
AIMS Proton therapy (PT) represents an advanced form of radiotherapy with unique physical properties which could be of great advantage in reducing long-term radiation morbidity for cancer survivors. Here, we aim to describe the whole process leading to the clinical implementation of consolidative active scanning proton therapy treatment (PT) for mediastinal lymphoma. METHODS The process included administrative, technical and clinical issues. Authorization of PT is required in all cases as mediastinal lymphoma is currently not on the list of diseases reimbursable by the Italian National Health Service. Technically, active scanning PT treatment for mediastinal lymphoma is complex, due to the interaction between actively scanned protons and the usually irregular and large volumes to be irradiated, the nearby healthy tissues and the target motion caused by breathing. A road map to implement the technical procedures was prepared. The clinical selection of patients was of utmost importance and took into account both patient and tumor characteristics. RESULTS The first mediastinal lymphoma was treated at our PT center in 2018, four years after the start of the clinical activities. The treatment technique implementation included mechanical deep inspiration breath-hold simulation computed tomography (CT), clinical target volume (CTV)-based multifield optimization planning and plan robustness analysis. The ultimate authorization rate was 93%. In 4 cases a proton-photon plan comparison was required. Between May 2018 and February, 2021, 14 patients were treated with consolidative PT. The main clinical reasons for choosing PT over photons was a bulky disease in 8 patients (57%), patient's age in 11 patients (78%) and the proximity of the lymphoma to cardiac structures in 10 patients (71%). With a median follow-up of 15 months (range, 1-33 months) all patients but one (out-of-field relapse) are without evidence of disease, all are alive and no late toxicities were observed during the follow-up period. CONCLUSIONS The clinical implementation of consolidative active scanning PT for mediastinal lymphoma required specific technical procedures and a prolonged experience with PT treatments. An accurate selection of patients for which PT could be of advantage in comparison with photons is mandatory.
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Affiliation(s)
- F Dionisi
- Department of Radiation Oncology, IRCSS Regina Elena National Cancer Institute, Rome, Italy.
| | - D Scartoni
- Proton Therapy unit, APSS, Trento, Italy
| | - B Rombi
- Proton Therapy unit, APSS, Trento, Italy
| | | | - R Righetto
- Proton Therapy unit, APSS, Trento, Italy
| | - P Farace
- Proton Therapy unit, APSS, Trento, Italy
| | | | - M Schwarz
- Proton Therapy unit, APSS, Trento, Italy
| | - L Di Murro
- Department of Radiotherapy, University of Tor Vergata, Rome, Italy
| | - C Demofonti
- Department of Radiotherapy, University of Tor Vergata, Rome, Italy
| | - R M D'Angelillo
- Department of Radiotherapy, University of Tor Vergata, Rome, Italy
| | - M G Petrongari
- Department of Radiation Oncology, IRCSS Regina Elena National Cancer Institute, Rome, Italy
| | - G Sanguineti
- Department of Radiation Oncology, IRCSS Regina Elena National Cancer Institute, Rome, Italy
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CortesI A, Galietta E, Alfieri M, Buwenge M, Donati C, Bisello S, Boriani M, Ghigi G, Romeo A, Bianchi G, Gambarotti M, Righi A, Macchia G, Deodato F, Cilla S, Rombi B, Morganti A, Cammelli S. PO-1429 Long term results of neoadjuvant radiotherapy in soft tissue sarcomas of the extremities. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07880-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ronchi L, Donati C, Donati C, Mondardini M, Prete A, Alfieri M, Rombi B, Bertini F, Buwenge M, Morganti A, Cammelli S. PO-1445 Pediatric palliative radiotherapy: a systematic review. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07896-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Turkaj A, Giacomelli I, Cianchetti M, Scartoni D, Amelio D, Vennarini S, Rombi B, Dionisi F, Amichetti M. PO-0883: Early outcomes in patients with skull base chordomas and chondrosarcomas treated with proton therapy. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00900-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rombi B, Ruggi A, Ronchi L, Buwenge M, Ammendolia I, Cammelli S, Melchionda F, Prete A, Fracchiolla F, Zucchelli M, Morganti G, Amichetti M. PO-1241: Clinical results and toxicities in pediatric CNS tumors treated with proton pencil-beam scanning. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01259-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Huijskens S, Kroon P, Demiroz Abakay C, Timmermann B, Giralt J, Gaze M, Harrabi S, Scarzello G, Alexopoulou A, Padovani L, Escande A, Gandola L, Supiot S, Chojnacka M, Bokun J, Napieralska A, Rombi B, Maduro J, Bolle S, Mussano A, Mandeville H, Claude L, Seravalli E, Janssens G. OC-0454: Current radiotherapy practice for children with metastases from solid tumors: SIOPE survey analysis. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00476-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Cianchetti M, Giacomelli I, Scartoni D, Dionisi F, Amelio D, Rombi B, Vennarini S, Amichetti M. Spine Chordoma, Chondrosarcomas, and Other Sarcomas: The Initial Experience of 1 Institution. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.2408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Seravalli E, Bosman M, Smyth G, Alapetite C, Christiaens M, Gandola L, Hoeben B, Horan G, Koutsouveli E, Kusters M, Lassen Y, Losa S, Magelssen H, Marchant T, Mandeville H, Oldenburger F, Padovani L, Paraskevopoulou C, Rombi B, Visser J, Whitfield G, Schwarz M, Vestergaard A, Janssens G. OC-0345: Comparing cranio spinal irradiation planning for photon and proton techniques at 15 European centers. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30787-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bizzocchi N, Rombi B, Farace P, Algranati C, Righetto R, Schwarz M, Amichetti M. EP-1691: A planning approach for lens sparing proton craniospinal irradiation in pediatric patients. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32942-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Albertini F, Casiraghi M, Lorentini S, Rombi B, Lomax AJ. Experimental verification of IMPT treatment plans in an anthropomorphic phantom in the presence of delivery uncertainties. Phys Med Biol 2011; 56:4415-31. [PMID: 21709345 DOI: 10.1088/0031-9155/56/14/012] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Clinically relevant intensity modulated proton therapy (IMPT) treatment plans were measured in a newly developed anthropomorphic phantom (i) to assess plan accuracy in the presence of high heterogeneity and (ii) to measure plan robustness in the case of treatment uncertainties (range and spatial). The new phantom consists of five different tissue substitute materials simulating different tissue types and was cut into sagittal planes so as to facilitate the verification of co-planar proton fields. GafChromic films were positioned in the different planes of the phantom, and 3D-IMPT and distal edge tracking (DET) plans were delivered to a volume simulating a skull base chordoma. In addition, treatments planned on CTs of the phantom with HU units modified were delivered to simulate systematic range uncertainties (range-error treatments). Finally, plans were delivered with the phantom rotated to simulate spatial errors. Results show excellent agreement between the calculated and the measured dose distribution: >99% and 98% of points with a gamma value <1 (3%/3 mm) for the 3D-IMPT and the DET plan, respectively. For both range and spatial errors, the 3D-IMPT plan was more robust than the DET plan. Both plans were more robust to range than to the spatial uncertainties. Finally, for range error treatments, measured distributions were compared to a model for predicting delivery errors in the treatment planning system. Good agreement has been found between the model and the measurements for both types of IMPT plan.
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Affiliation(s)
- F Albertini
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen PSI, Switzerland
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