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Grau C, Dasu A, Troost EGC, Haustermans K, Weber DC, Langendijk JA, Gregoire V, Orlandi E, Thariat J, Journy N, Chaikh A, Isambert A, Alicja Jereczek-Fossa B, Vaniqui A, Vitek P, Kopec R, Fijten R, Luetgendorf-Caucig C, Olko P. Towards a European prospective data registry for particle therapy. Radiother Oncol 2024; 196:110293. [PMID: 38653379 DOI: 10.1016/j.radonc.2024.110293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/18/2024] [Accepted: 04/18/2024] [Indexed: 04/25/2024]
Abstract
The evidence for the value of particle therapy (PT) is still sparse. While randomized trials remain a cornerstone for robust comparisons with photon-based radiotherapy, data registries collecting real-world data can play a crucial role in building evidence for new developments. This Perspective describes how the European Particle Therapy Network (EPTN) is actively working on establishing a prospective data registry encompassing all patients undergoing PT in European centers. Several obstacles and hurdles are discussed, for instance harmonization of nomenclature and structure of technical and dosimetric data and data protection issues. A preferred approach is the adoption of a federated data registry model with transparent and agile governance to meet European requirements for data protection, transfer, and processing. Funding of the registry, especially for operation after the initial setup process, remains a major challenge.
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Affiliation(s)
- Cai Grau
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark.
| | - Alexandru Dasu
- The Skandion Clinic, Uppsala, Sweden; Department of Immunology, Genetics and Pathology, Uppsala University, Sweden.
| | - 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; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany.
| | - Karin Haustermans
- Department of Radiation Oncology, University Hospital, KU Leuven, Leuven, Belgium.
| | - Damien C Weber
- Proton Therapy Center, Paul Scherrer Institute, ETH Domain, Switzerland; Radiation Oncology Department, University Hospital Zürich, Switzerland; Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | | | - Ester Orlandi
- Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy; Clinical Department, National Center for Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy.
| | - Juliette Thariat
- Université de Caen Normandie, ENSICAEN, CNRS/IN2P3, LPC Caen UMR6534, F-14000, Centre François Baclesse, Caen, France
| | - Neige Journy
- 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.
| | - Abdulhamid Chaikh
- Institut de Radioprotection et de Sûreté Nucléaire IRSN/PSE-SANTE/SER/UEM, France.
| | - Aurelie Isambert
- Institut de Radioprotection et de Sûreté Nucléaire IRSN/PSE-SANTE/SER/UEM, France.
| | - Barbara Alicja Jereczek-Fossa
- Dept. of Oncology and Hemato-oncology, University of Milan, Milan, Italy; Dept. of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, Italy.
| | - Ana Vaniqui
- Belgian Nuclear Research Center (SCK CEN), Mol, Belgium.
| | - Pavel Vitek
- Proton Therapy Center Czech, Prague, Czech Republic.
| | - Renata Kopec
- Institute of Nuclear Physics Polish Academy of Sciences, Kraków, Poland.
| | - Rianne Fijten
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre, Maastricht, the Netherlands.
| | | | - Pawel Olko
- Institute of Nuclear Physics Polish Academy of Sciences, Kraków, Poland.
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Zukauskaite R, Horsholt Kristensen M, Grau Eriksen J, Johansen J, Samsøe E, Johnsen L, Kjær Lønkvist C, Grau C, Rønn Hansen C. Comparison of 3-year local control using DAHANCA radiotherapy guidelines before and after implementation of five millimetres geometrical GTV to high-dose CTV margin. Radiother Oncol 2024; 196:110284. [PMID: 38636711 DOI: 10.1016/j.radonc.2024.110284] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/26/2024] [Accepted: 04/11/2024] [Indexed: 04/20/2024]
Abstract
INTRODUCTION Treatment planning using a five-millimetre geometrical margin from GTV to high-dose CTV (CTV1) has been used in DAHANCA treatment centres since 2013. We aimed to evaluate changes in CTV1 volumes, local control (LC), and recurrence pattern after the implementation of five-millimetre geometrical margins nationally. MATERIALS AND METHODS 1,948 patients with pharyngeal, and laryngeal squamous cell carcinomas completed definitive IMRT-based treatment in 2010-2012 and 2013-2015 in three centres. The patient-specific margin was calculated as median surface distance from primary tumour GTV (GTV-T) to CTV1. Radiologically verified local recurrences were analysed using a centre of mass (COM) of the delineated recurrence volume, measuring the shortest distance between COM to GTV-T and CTV1 boundaries. RESULTS Median GTV-CTV1 was 0.9 (0.0-0.97) and 0.47 cm (0.4-0.5) for 2010-2012 and 2013-2015, respectively. Median CTV1 changed in three centres from 76, 28, 42 cm3 to 61, 53, 62 cm3 for 2010-2012 and 2013-2015, respectively. Local failures occurred at 247 patients during first three years after radiotherapy. The 3-year LC rate for 2010-2012 and 2013-2015 was 0.84 and 0.87 (p = 0.06). Out of 146 radiology-verified analysable local recurrences, 102 (69.9%) were inside the CTV1. In 74.6% and 91% of cases, the LRs were covered by 95% isodose in 2010-2012 and 2013-2015, respectively. CONCLUSION DAHANCA radiotherapy guidelines based on a geometrically generated isotropic CTV1 margin led to less variation in treatment volumes and between centres than previous guidelines. The transition towards consensus GTV-CTV1 margins did not influence local tumour control. The majority of local recurrences were inside CTV1 and covered by the prescription dose.
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Affiliation(s)
- Ruta Zukauskaite
- Department of Oncology, Odense University Hospital, Odense, Denmark.
| | | | - Jesper Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Eva Samsøe
- Department of Oncology, Zealand University Hospital, Næstved, Denmark
| | - Lars Johnsen
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - Camilla Kjær Lønkvist
- Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark
| | - Cai Grau
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Rønn Hansen
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark; Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Orlandi E, Fontana G, Licitra L, Tinelli C, Camarda AM, Grau C, Frank SJ. Comprehensive insights on the underlying potential and advantage of proton therapy over intensity-modulated photon radiation therapy as highlighted in a wide real world data analysis. Radiother Oncol 2024; 193:110122. [PMID: 38309585 DOI: 10.1016/j.radonc.2024.110122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/30/2024] [Indexed: 02/05/2024]
Affiliation(s)
- Ester Orlandi
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy; Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy.
| | - Giulia Fontana
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Lisa Licitra
- Scientific Directorate, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy; Department of Head & Neck Medical Oncology 3, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; Department of Oncology & Haemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Carmine Tinelli
- CNAO National Center for Oncological Hadrontherapy, Scientific Direction Office, Pavia, Italy
| | - Anna Maria Camarda
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, 27100 Pavia, Italy
| | - Cai Grau
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Steven Jay Frank
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX 77030, USA
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Poulsen PR, Johansen JG, Sitarz MK, Kanouta E, Kristensen L, Grau C, Sørensen BS. Oxygen Enhancement Ratio-Weighted Dose Quantitatively Describes Acute Skin Toxicity Variations in Mice After Pencil Beam Scanning Proton FLASH Irradiation With Changing Doses and Time Structures. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00358-4. [PMID: 38462015 DOI: 10.1016/j.ijrobp.2024.02.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 02/12/2024] [Accepted: 02/24/2024] [Indexed: 03/12/2024]
Abstract
PURPOSE The aim of this work was to investigate the ability of a biological oxygen enhancement ratio-weighted dose, DOER, to describe acute skin toxicity variations observed in mice after proton pencil beam scanning irradiations with changing doses and beam time structures. METHODS AND MATERIALS In five independent experiments, the right hind leg of a total of 621 CDF1 mice was irradiated previously in the entrance plateau of a pencil beam scanning proton beam. The incidence of acute skin toxicity (of level 1.5-2.0-2.5-3.0-3.5) was scored for 47 different mouse groups that mapped toxicity as function of dose for conventional and FLASH dose rate, toxicity as function of field dose rate with and without repainting, and toxicity when splitting the treatment into 1 to 6 identical deliveries separated by 2 minutes. DOER was calculated for all mouse groups using a simple oxygen kinetics model to describe oxygen depletion. The three independent model parameters (oxygen-depletion rate, oxygen-recovery rate, oxygen level without irradiation) were fitted to the experimental data. The ability of DOER to describe the toxicity variations across all experiments was investigated by comparing DOER-response curves across the five independent experiments. RESULTS After conversion from the independent variable tested in each experiment to DOER, all five experiments had similar MDDOER50 (DOER giving 50% toxicity incidence) with standard deviations of 0.45 - 1.6 Gy for the five toxicity levels. DOER could thus describe the observed toxicity variations across all experiments. CONCLUSIONS DOER described the varying FLASH-sparing effect observed for a wide range of conditions. Calculation of DOER for other irradiation conditions can quantitatively estimate the FLASH-sparing effect for arbitrary irradiations for the investigated murine model. With appropriate fitting parameters DOER also may be able to describe FLASH effect variations with dose and dose rate for other assays and endpoints.
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Affiliation(s)
- Per Rugaard Poulsen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Jacob Graversen Johansen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mateusz Krzysztof Sitarz
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Eleni Kanouta
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Line Kristensen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Cai Grau
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Brita Singers Sørensen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
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Wilhøft Kristensen A, Lunde Jensen A, Jensen K, Oksbjerre Dalton S, Friborg J, Grau C. Exploring patient-reported barriers to participating in proton therapy clinical trials. Tech Innov Patient Support Radiat Oncol 2024; 29:100230. [PMID: 38186677 PMCID: PMC10767209 DOI: 10.1016/j.tipsro.2023.100230] [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: 09/13/2023] [Revised: 11/07/2023] [Accepted: 12/11/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction Clinical trials lead the progress in healthcare. To ensure reliable research conclusions, it is essential to enroll diverse patient groups. Identifying and understanding patient-reported barriers to clinical trials may help enhance recruitment among diverse patient groups.The clinical potential of proton therapy (PT) to reduce late effects is being investigated in clinical trials worldwide. Thus, for some patients, PT is only accessible by participating in clinical trials.Individuals with smoking-related head and neck cancer (HNC) are sometimes socioeconomically deprived, leading to barriers to trial participation. This study aims to identify barriers to their participation in a randomised controlled trial (RCT) involving PT. Method Interviews were conducted with 14 HNC patients declining participation in an RCT involving PT. The interviews were transcribed and systematically analysed using an inductive approach identifying categories and themes. Results The identified barriers to RCT-participation are: (1) existential distress, which influenced participants' mental and cognitive capacities, (2) insufficient RCT-related knowledge arising from information overload during clinical consultations, (3) the wish for safety and familiarity during the treatment trajectory, particularly for participants needing accommodation during radiotherapy, and (4) the motivation for study participation was impacted by uncertainty due to randomisation and clinical equipoise. Existential distress is identified as an overarching theme because it influences and amplifies the other three themes. Conclusion Existential distress is a central theme that influences and amplifies other participation barriers in PT RCTs. It affects participants' comprehension of trial information, their preference for familiar environments, and their motivation to participate in clinical trials.
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Affiliation(s)
- Anne Wilhøft Kristensen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Palle Juul Jensens Boulevard 25, 8200 Aarhus N, Denmark
| | - Annesofie Lunde Jensen
- Steno Diabetes Centre, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Kenneth Jensen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Palle Juul Jensens Boulevard 25, 8200 Aarhus N, Denmark
| | | | - Jeppe Friborg
- Department of Clinical Oncology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Cai Grau
- Danish Centre for Particle Therapy, Aarhus University Hospital, Palle Juul Jensens Boulevard 25, 8200 Aarhus N, Denmark
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Tvilum M, Knap MM, Hoffmann L, Khalil AA, Appelt AL, Haraldsen A, Alber M, Grau C, Schmidt HH, Kandi M, Holt MI, Lutz CM, Møller DS. Early radiologic and metabolic tumour response assessment during combined chemo-radiotherapy for locally advanced NSCLC. Clin Transl Radiat Oncol 2024; 45:100737. [PMID: 38317680 PMCID: PMC10839576 DOI: 10.1016/j.ctro.2024.100737] [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: 11/02/2023] [Revised: 01/20/2024] [Accepted: 01/21/2024] [Indexed: 02/07/2024] Open
Abstract
Background The role of early treatment response for patients with locally advanced non-small cell lung cancer (LA-NSCLC) treated with concurrent chemo-radiotherapy (cCRT) is unclear. The study aims to investigate the predictive value of response to induction chemotherapy (iCX) and the correlation with pattern of failure (PoF). Materials and methods Patients with LA-NSCLC treated with cCRT were included for analyses (n = 276). Target delineations were registered from radiotherapy planning PET/CT to diagnostic PET/CT, in between which patients received iCX. Volume, sphericity, and SUVpeak were extracted from each scan. First site of failure was categorised as loco-regional (LR), distant (DM), or simultaneous LR+M (LR+M). Fine and Gray models for PoF were performed: a baseline model (including performance status (PS), stage, and histology), an image model for squamous cell carcinoma (SCC), and an image model for non-SCC. Parameters included PS, volume (VOL) of tumour, VOL of lymph nodes, ΔVOL, sphericity, SUVpeak, ΔSUVpeak, and oligometastatic disease. Results Median follow-up was 7.6 years. SCC had higher sub-distribution hazard ratio (sHR) for LRF (sHR = 2.771 [1.577:4.87], p < 0.01) and decreased sHR for DM (sHR = 0.247 [0.125:0.485], p < 0.01). For both image models, high diagnostic SUVpeak increased risk of LRF (sHR = 1.059 [1.05:1.106], p < 0.01 for SCC, sHR = 1.12 [1.03:1.21], p < 0.01 for non-SCC). Patients with SCC and less decrease in VOL had higher sHR for DM (sHR = 1.025[1.001:1.048] pr. % increase, p = 0.038). Conclusion Poor response in disease volume was correlated with higher sHR of DM for SCC, no other clear correlation of response and PoF was observed. Histology significantly correlated with PoF with SCC prone to LRF and non-SCC prone to DM as first site of failure. High SUVpeak at diagnosis increased the risk of LRF for both histologies.
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Affiliation(s)
- Marie Tvilum
- Department of Oncology, Aarhus University Hospital, Denmark
- Danish Center for Particle Therapy, Aarhus University Hospital, Denmark
| | | | - Lone Hoffmann
- Department of Oncology, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Denmark
| | | | - Ane L. Appelt
- Leeds Institute of Medical Research at St James’s, University of Leeds, United Kingdom
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Ate Haraldsen
- Department of Nuclear Medicine and PET-centre, Aarhus University Hospital, Denmark
| | - Markus Alber
- Department of Radiation Oncology, Heidelberg University Hospital, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg University Hospital, Germany
| | - Cai Grau
- Danish Center for Particle Therapy, Aarhus University Hospital, Denmark
| | | | - Maria Kandi
- Department of Oncology, Aarhus University Hospital, Denmark
| | | | | | - Ditte Sloth Møller
- Department of Oncology, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Denmark
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Hansen CR, Jensen K, Smulders B, Holm AIS, Samsøe E, Nielsen MS, Sibolt P, Skyt P, Elstrøm UV, Nielsen CP, Johansen J, Zukauskaite R, Eriksen JG, Farhadi M, Andersen M, Andersen E, Overgaard J, Grau C, Friborg J. Evaluation of decentralised model-based selection of head and neck cancer patients for a proton treatment study. DAHANCA 35. Radiother Oncol 2024; 190:109812. [PMID: 37479061 DOI: 10.1016/j.radonc.2023.109812] [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: 11/09/2022] [Revised: 06/22/2023] [Accepted: 07/12/2023] [Indexed: 07/23/2023]
Abstract
INTRODUCTION Proton treatment can potentially spare patients with H&N cancer for substantial treatment-related toxicities. The current study investigated the reproducibility of a decentralised model-based selection of patients for a proton treatment study when the selection plans were compared to the clinical treatment plans performed at the proton centre. METHODS Sixty-three patients were selected for proton treatment in the six Danish Head and Neck Cancer (DAHANCA) centres. The patients were selected based on normal tissue complication probability (NTCP) estimated from local photon and proton treatment plans, which showed a ΔNTCP greater than 5%-point for either grade 2 + dysphagia or grade 2 + xerostomia at six months. The selection plans were compared to the clinical treatment plans performed at the proton centre. RESULTS Of the 63 patients, 49 and 25 were selected based on an estimated benefit in risk of dysphagia and xerostomia, respectively. Eleven patients had a potential gain in both toxicities. The mean ΔNTCP changed from the local selection plan comparison to the clinical comparison from 6.9 to 5.3 %-points (p = 0.01) and 7.3 to 4.9 %-points (p = 0.03) for dysphagia and xerostomia, respectively. Volume differences in both CTV and OAR could add to the loss in ΔNTCP. 61 of the 63 clinical plans had a positive ΔNTCP, and 38 had a ΔNTCP of 5%-points for at least one of the two endpoints. CONCLUSION A local treatment plan comparison can be used to select candidates for proton treatment. The local comparative proton plan overestimates the potential benefit of the clinical proton plan. Continuous quality assurance of the delineation procedures and planning is crucial in the subsequent randomised clinical trial setting.
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Affiliation(s)
- Christian Rønn Hansen
- Laboratory of Radiation Physics, Odense University Hospital, Denmark; Institute of Clinical Research, University of Southern Denmark, Denmark; Danish Center of Particle Therapy, Aarhus University Hospital, Denmark.
| | - Kenneth Jensen
- Danish Center of Particle Therapy, Aarhus University Hospital, Denmark
| | - Bob Smulders
- Danish Center of Particle Therapy, Aarhus University Hospital, Denmark; Department of Oncology, Rigshospitalet, Denmark
| | | | - Eva Samsøe
- Danish Center of Particle Therapy, Aarhus University Hospital, Denmark; Department of Oncology, Zealand University Hospital, Naestved, Denmark
| | | | - Patrik Sibolt
- Department of Oncology, Copenhagen University Hospital - Herlev & Gentofte, Herlev, Denmark
| | - Peter Skyt
- Danish Center of Particle Therapy, Aarhus University Hospital, Denmark
| | | | - Camilla Panduro Nielsen
- Laboratory of Radiation Physics, Odense University Hospital, Denmark; Institute of Clinical Research, University of Southern Denmark, Denmark
| | | | - Ruta Zukauskaite
- Institute of Clinical Research, University of Southern Denmark, Denmark; Department of Oncology, Odense University Hospital, Denmark
| | - Jesper Grau Eriksen
- Department of Oncology, Aarhus University Hospital, Denmark; Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
| | - Mohamma Farhadi
- Department of Oncology, Zealand University Hospital, Naestved, Denmark
| | - Maria Andersen
- Department of Oncology, Aalborg University Hospital, Denmark
| | - Elo Andersen
- Department of Oncology, Copenhagen University Hospital - Herlev & Gentofte, Herlev, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
| | - Cai Grau
- Danish Center of Particle Therapy, Aarhus University Hospital, Denmark; Department of Oncology, Aarhus University Hospital, Denmark
| | - Jeppe Friborg
- Danish Center of Particle Therapy, Aarhus University Hospital, Denmark; Department of Oncology, Rigshospitalet, Denmark
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Mortensen HR, Populaire P, Hoffmann L, Moeller DS, Appelt A, Nafteux P, Muijs CT, Grau C, Hawkins MA, Troost EGC, Defraene G, Canters R, Clarke CS, Weber DC, Korevaar EW, Haustermans K, Nordsmark M, Gebski V, Achiam MP, Markar SR, Radhakrishna G, Berbee M, Scartoni D, Orlandi E, Doyen J, Gregoire V, Crehange G, Langendijk J, Lorgelly P, Blommenstein HM, Byskov CS, Ehmsen ML, Jensen MF, Freixas GV, Bütof R. Proton versus photon therapy for esophageal cancer - A trimodality strategy (PROTECT) NCT050555648: A multicenter international randomized phase III study of neoadjuvant proton versus photon chemoradiotherapy in locally advanced esophageal cancer. Radiother Oncol 2024; 190:109980. [PMID: 37935284 DOI: 10.1016/j.radonc.2023.109980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 10/29/2023] [Accepted: 10/29/2023] [Indexed: 11/09/2023]
Affiliation(s)
- H R Mortensen
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
| | - P Populaire
- University Hospitals Leuven, Department of Radiation Oncology, Belgium; KU Leuven- University of Leuven, Department of Oncology, Laboratory of Experimental Radiotherapy, Leuven, Belgium
| | - L Hoffmann
- Department of Oncology and Medical Physics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
| | - D S Moeller
- Department of Oncology and Medical Physics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Aarhus, Denmark
| | | | - P Nafteux
- University Hospitals Leuven, Department of Thoracic Surgery, Belgium
| | - C T Muijs
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - C Grau
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - M A Hawkins
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - E G C Troost
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, and Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology - OncoRay Helmholtz-Zentrum Dresden-Rossendorf, Germany
| | - G Defraene
- KU Leuven- University of Leuven, Department of Oncology, Laboratory of Experimental Radiotherapy, Leuven, Belgium
| | - R Canters
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, the Netherlands
| | - C S Clarke
- Research Dept. of Primary Care and Population Health, University College London, London, UK
| | - D C Weber
- Center for Proton Therapy, Paul Scherrer Institut, Villigen, Switzerland; Radiation Oncology Department, University Hospital Zurich, Zurich, Switzerland
| | - E W Korevaar
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - K Haustermans
- University Hospitals Leuven, Department of Radiation Oncology, Belgium; KU Leuven- University of Leuven, Department of Oncology, Laboratory of Experimental Radiotherapy, Leuven, Belgium
| | - M Nordsmark
- Department of Oncology and Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - M P Achiam
- Dept. Surgery and Transplantation, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Sheraz R Markar
- Department of General Surgery, Oxford University Hospitals, Oxford, UK; Nuffield Department of Surgery, University of Oxford, Oxford, UK
| | | | - Maaike Berbee
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Daniele Scartoni
- Proton Therapy Center, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - Ester Orlandi
- National Center for Oncological Hadrontherapy (CNAO), Radiation Oncology Clinical Department, Pavia, Italy
| | | | | | - Gilles Crehange
- PSL Research University, RadiationOncology Department, Institut Curie, Paris/Orsay, France
| | - Johannes Langendijk
- Department of Radiation Oncology, UniversityMedicalCentreGroningen, Groningen, The Netherlands
| | - Paula Lorgelly
- University of Auckland, Waipara Taumata Rau, Auckland, New Zealand
| | - Hedwig M Blommenstein
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, 3000 DR, The Netherlands; Erasmus Centre for Health Economics Rotterdam, Erasmus University, Rotterdam, The Netherlands
| | - Camilla S Byskov
- Department of Oncology and Medical physics, Aarhus University Hospital, Aarhus, Denmark
| | - Mai L Ehmsen
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Gloria Vilches Freixas
- Maastro Proton Therapy, Department of Radiation Oncology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Rebecca Bütof
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden and OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, and Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology - OncoRay Helmholtz-Zentrum Dresden-Rossendorf, Germany
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9
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Friborg J, Jensen K, Eriksen JG, Samsøe E, Maare C, Farhadi M, Sibolt P, Nielsen M, Andersen M, Holm AIS, Skyt P, Smulders B, Johansen J, Overgaard J, Grau C, Hansen CR. Considerations for study design in the DAHANCA 35 trial of protons versus photons for head and neck cancer. Radiother Oncol 2024; 190:109958. [PMID: 37871751 DOI: 10.1016/j.radonc.2023.109958] [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: 11/09/2022] [Revised: 08/10/2023] [Accepted: 09/26/2023] [Indexed: 10/25/2023]
Abstract
Proton radiotherapy offers a dosimetric advantage compared to photon therapy in sparing normal tissue, but the clinical evidence for toxicity reductions in the treatment of head and neck cancer is limited. The Danish Head and Neck Cancer Group (DAHANCA) has initiated the DAHANCA 35 randomised trial to clarify the value of proton therapy (NCT04607694). The DAHANCA 35 trial is performed in an enriched population of patients selected by an anticipated benefit of proton therapy to reduce the risk of late dysphagia or xerostomia based on normal tissue complication probability (NTCP) modelling. We present our considerations on the trial design and a test of the selection procedure conducted before initiating the randomised study.
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Affiliation(s)
- J Friborg
- Danish Center of Particle Therapy, Aarhus University Hospital, Denmark; Department of Oncology, Rigshospitalet, Denmark. %
| | - K Jensen
- Danish Center of Particle Therapy, Aarhus University Hospital, Denmark
| | - J G Eriksen
- Department of Oncology, Aarhus University Hospital, Denmark; Aarhus University Hospital, Department of Experimental Clinical Oncology, Denmark
| | - E Samsøe
- Department of Oncology, Zealand University Hospital Næstved, Denmark
| | - C Maare
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Denmark
| | - M Farhadi
- Department of Oncology, Zealand University Hospital Næstved, Denmark
| | - P Sibolt
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Denmark
| | - M Nielsen
- Department of Oncology, Aalborg University Hospital, Denmark
| | - M Andersen
- Department of Oncology, Aalborg University Hospital, Denmark
| | - A I S Holm
- Department of Oncology, Aarhus University Hospital, Denmark
| | - P Skyt
- Danish Center of Particle Therapy, Aarhus University Hospital, Denmark
| | - B Smulders
- Danish Center of Particle Therapy, Aarhus University Hospital, Denmark; Department of Oncology, Rigshospitalet, Denmark
| | - J Johansen
- Department of Oncology, Odense University Hospital, Denmark
| | - J Overgaard
- Aarhus University Hospital, Department of Experimental Clinical Oncology, Denmark
| | - C Grau
- Danish Center of Particle Therapy, Aarhus University Hospital, Denmark
| | - C R Hansen
- Danish Center of Particle Therapy, Aarhus University Hospital, Denmark; Department of Oncology, Odense University Hospital, Denmark; Institute of Clinical Research, University of Southern Denmark, Denmark
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10
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Overgaard CB, Reaz F, Sitarz M, Poulsen P, Overgaard J, Bassler N, Grau C, Sørensen BS. An experimental setup for proton irradiation of a murine leg model for radiobiological studies. Acta Oncol 2023; 62:1566-1573. [PMID: 37603112 DOI: 10.1080/0284186x.2023.2246641] [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: 06/14/2023] [Accepted: 08/03/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND The purpose of this study was to introduce an experimental radiobiological setup used for in vivo irradiation of a mouse leg target in multiple positions along a proton beam path to investigate normal tissue- and tumor models with varying linear energy transfer (LET). We describe the dosimetric characterizations and an acute- and late-effect assay for normal tissue damage. METHODS The experimental setup consists of a water phantom that allows the right hind leg of three to five mice to be irradiated at the same time. Absolute dosimetry using a thimble (Semiflex) and a plane parallel (Advanced Markus) ionization chamber and Monte Carlo simulations using Geant4 and SHIELD-HIT12A were applied for dosimetric validation of positioning along the spread-out Bragg peak (SOBP) and at the distal edge and dose fall-off. The mice were irradiated in the center of the SOBP delivered by a pencil beam scanning system. The SOBP was 2.8 cm wide, centered at 6.9 cm depth, with planned physical single doses from 22 to 46 Gy. The biological endpoint was acute skin damage and radiation-induced late damage (RILD) assessed in the mouse leg. RESULTS The dose-response curves illustrate the percentage of mice exhibiting acute skin damage, and at a later point, RILD as a function of physical doses (Gy). Each dose-response curve represents a specific severity score of each assay, demonstrating a higher ED50 (50% responders) as the score increases. Moreover, the results reveal the reversible nature of acute skin damage as a function of time and the irreversible nature of RILD as time progresses. CONCLUSIONS We want to encourage researchers to report all experimental details of their radiobiological setups, including experimental protocols and model descriptions, to facilitate transparency and reproducibility. Based on this study, more experiments are being performed to explore all possibilities this radiobiological experimental setup permits.
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Affiliation(s)
- Cathrine Bang Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Fardous Reaz
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish Centre for Particle Therapy, Aarhus University Hospital, Denmark
| | - Mateusz Sitarz
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish Centre for Particle Therapy, Aarhus University Hospital, Denmark
| | - Per Poulsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish Centre for Particle Therapy, Aarhus University Hospital, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Niels Bassler
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish Centre for Particle Therapy, Aarhus University Hospital, Denmark
| | - Cai Grau
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish Centre for Particle Therapy, Aarhus University Hospital, Denmark
| | - Brita Singers Sørensen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish Centre for Particle Therapy, Aarhus University Hospital, Denmark
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11
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Nielsen CP, Lorenzen EL, Jensen K, Sarup N, Brink C, Smulders B, Holm AIS, Samsøe E, Nielsen MS, Sibolt P, Skyt PS, Elstrøm UV, Johansen J, Zukauskaite R, Eriksen JG, Farhadi M, Andersen M, Maare C, Overgaard J, Grau C, Friborg J, Hansen CR. Consistency in contouring of organs at risk by artificial intelligence vs oncologists in head and neck cancer patients. Acta Oncol 2023; 62:1418-1425. [PMID: 37703300 DOI: 10.1080/0284186x.2023.2256958] [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: 05/21/2023] [Accepted: 09/04/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND In the Danish Head and Neck Cancer Group (DAHANCA) 35 trial, patients are selected for proton treatment based on simulated reductions of Normal Tissue Complication Probability (NTCP) for proton compared to photon treatment at the referring departments. After inclusion in the trial, immobilization, scanning, contouring and planning are repeated at the national proton centre. The new contours could result in reduced expected NTCP gain of the proton plan, resulting in a loss of validity in the selection process. The present study evaluates if contour consistency can be improved by having access to AI (Artificial Intelligence) based contours. MATERIALS AND METHODS The 63 patients in the DAHANCA 35 pilot trial had a CT from the local DAHANCA centre and one from the proton centre. A nationally validated convolutional neural network, based on nnU-Net, was used to contour OARs on both scans for each patient. Using deformable image registration, local AI and oncologist contours were transferred to the proton centre scans for comparison. Consistency was calculated with the Dice Similarity Coefficient (DSC) and Mean Surface Distance (MSD), comparing contours from AI to AI and oncologist to oncologist, respectively. Two NTCP models were applied to calculate NTCP for xerostomia and dysphagia. RESULTS The AI contours showed significantly better consistency than the contours by oncologists. The median and interquartile range of DSC was 0.85 [0.78 - 0.90] and 0.68 [0.51 - 0.80] for AI and oncologist contours, respectively. The median and interquartile range of MSD was 0.9 mm [0.7 - 1.1] mm and 1.9 mm [1.5 - 2.6] mm for AI and oncologist contours, respectively. There was no significant difference in Δ NTCP. CONCLUSIONS The study showed that OAR contours made by the AI algorithm were more consistent than those made by oncologists. No significant impact on the Δ NTCP calculations could be discerned.
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Affiliation(s)
- Camilla Panduro Nielsen
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ebbe Laugaard Lorenzen
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Kenneth Jensen
- Danish Centre of Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Nis Sarup
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - Carsten Brink
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bob Smulders
- Danish Centre of Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Oncology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | | | - Eva Samsøe
- Danish Centre of Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Oncology, Zealand University Hospital, Naestved, Denmark
| | | | - Patrik Sibolt
- Department of Oncology, University Hospital Herlev, Herlev, Denmark
| | | | | | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Ruta Zukauskaite
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Jesper Grau Eriksen
- Department of Oncology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - Mohammad Farhadi
- Department of Oncology, Zealand University Hospital, Naestved, Denmark
| | - Maria Andersen
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - Christian Maare
- Department of Oncology, University Hospital Herlev, Herlev, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
| | - Cai Grau
- Danish Centre of Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Jeppe Friborg
- Danish Centre of Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Oncology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Christian Rønn Hansen
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Danish Centre of Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
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12
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Eriksen JG, Vrou Offersen B, Høyer M, Grau C, Overgaard J. Think big-think BiGART. The 21st Acta Oncologica Symposium-BiGART 2023. Acta Oncol 2023; 62:1357-1359. [PMID: 37796148 DOI: 10.1080/0284186x.2023.2263149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 09/20/2023] [Indexed: 10/06/2023]
Affiliation(s)
- Jesper Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Birgitte Vrou Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Høyer
- Danish Centre for Particle Therapy, Aarhus University Hospital, Denmark
| | - Cai Grau
- Danish Centre for Particle Therapy, Aarhus University Hospital, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
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13
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Krogh SL, Brink C, Lorenzen EL, Samsøe E, Vogelius IR, Zukauskaite R, Vrou Offersen B, Eriksen JG, Hansen O, Johansen J, Olloni A, Ruhlmann CH, Hoffmann L, Nissen HD, Skovmos Nielsen M, Andersen K, Grau C, Hansen CR. A national repository of complete radiotherapy plans: design, Results, and experiences. Acta Oncol 2023; 62:1161-1168. [PMID: 37850659 DOI: 10.1080/0284186x.2023.2270143] [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: 04/19/2023] [Accepted: 10/04/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Previously, many radiotherapy (RT) trials were based on a few selected dose measures. Many research questions, however, rely on access to the complete dose information. To support such access, a national RT plan database was created. The system focuses on data security, ease of use, and re-use of data. This article reports on the development and structure, and the functionality and experience of this national database. METHODS AND MATERIALS A system based on the DICOM-RT standard, DcmCollab, was implemented with direct connections to all Danish RT centres. Data is segregated into any number of collaboration projects. User access to the system is provided through a web interface. The database has a finely defined access permission model to support legal requirements. RESULTS Currently, data for more than 14,000 patients have been submitted to the system, and more than 50 research projects are registered. The system is used for data collection, trial quality assurance, and audit data set generation.Users reported that the process of submitting data, waiting for it to be processed, and then manually attaching it to a project was resource intensive. This was accommodated with the introduction of triggering features, eliminating much of the need for users to manage data manually. Many other features, including structure name mapping, RT plan viewer, and the Audit Tool were developed based on user input. CONCLUSION The DcmCollab system has provided an efficient means to collect and access complete datasets for multi-centre RT research. This stands in contrast with previous methods of collecting RT data in multi-centre settings, where only singular data points were manually reported. To accommodate the evolving legal environment, DcmCollab has been defined as a 'data processor', meaning that it is a tool for other research projects to use rather than a research project in and of itself.
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Affiliation(s)
- Simon Long Krogh
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Carsten Brink
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ebbe Laugaard Lorenzen
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Eva Samsøe
- Department of Oncology, Radiotherapy, Zealand University Hospital, Naestved, Denmark
| | | | - Ruta Zukauskaite
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Birgitte Vrou Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Danish Center for Particle Therapy, Aarhus, Denmark
| | - Jesper Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Olfred Hansen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Agon Olloni
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | | | - Lone Hoffmann
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Dahl Nissen
- Department of Oncology, University Hospital of Southern Denmark, Vejle, Denmark
| | | | - Karen Andersen
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - Cai Grau
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Rønn Hansen
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Danish Center for Particle Therapy, Aarhus, Denmark
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14
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Tvilum M, Lutz C, Hoffmann L, Khalil A, Appelt A, Alber M, Grau C, Schmidt H, Kandi M, Haraldsen A, Mortensen L, Holt M, Knap M, Moller D. Prognostic Image Biomarkers in the Treatment of Patients with Locally Advanced NSCLC. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1551] [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: 10/31/2022]
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15
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Laskar SG, Sinha S, Krishnatry R, Grau C, Mehta M, Agarwal JP. Access to Radiation Therapy: From Local to Global and Equality to Equity. JCO Glob Oncol 2022; 8:e2100358. [PMID: 35960905 PMCID: PMC9470145 DOI: 10.1200/go.21.00358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The discipline of radiation oncology is the most resource-intensive component of comprehensive cancer care because of significant initial investments required for machines, the requirement of dedicated construction, a multifaceted workforce, and recurring maintenance costs. This review focuses on the challenges associated with accessible and affordable radiation therapy (RT) across the globe and the possible solutions to improve the current scenario. Most common cancers globally, including breast, prostate, head and neck, and cervical cancers, have a RT utilization rate of > 50%. The estimated annual incidence of cancer is 19,292,789 for 2020, with > 70% occurring in low-income countries and low-middle–income countries. There are approximately 14,000 teletherapy machines globally. However, the distribution of these machines is distinctly nonuniform, with low-income countries and low-middle–income countries having access to < 10% of the global teletherapy machines. The Directory of Radiotherapy Centres enlists 3,318 brachytherapy facilities. Most countries with a high incidence of cervical cancer have a deficit in brachytherapy facilities, although formal estimates for the same are not available. The deficit in simulators, radiation oncologists, and medical physicists is even more challenging to quantify; however, the inequitable distribution is indisputable. Measures to ensure equitable access to RT include identifying problems specific to region/country, adopting indigenous technology, encouraging public-private partnership, relaxing custom duties on RT equipment, global/cross-country collaboration, and quality human resources training. Innovative research focusing on the most prevalent cancers aiming to make RT utilization more cost-effective while maintaining efficacy will further bridge the gap. Improving global access to Radiotherapy: The current scenario and the road ahead
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Affiliation(s)
- Sarbani Ghosh Laskar
- Department of Radiation Oncology, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, India
| | - Shwetabh Sinha
- Department of Radiation Oncology, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, India
| | - Rahul Krishnatry
- Department of Radiation Oncology, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, India
| | - Cai Grau
- Department of Radiation Oncology and Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Minesh Mehta
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Homi Bhabha National Institute, Tata Memorial Centre, Mumbai, India
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16
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Argota-Perez R, Sharma MB, Elstrøm UV, Møller DS, Grau C, Jensen K, Holm AIS, Korreman SS. Dose and robustness comparison of nominal, daily and accumulated doses for photon and proton treatment of sinonasal cancer. Radiother Oncol 2022; 173:102-108. [PMID: 35667574 DOI: 10.1016/j.radonc.2022.05.038] [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: 10/04/2021] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The aim was to evaluate and compare the dosimetric effect and robustness towards day-to-day anatomical and setup variations in the delivered dose for photon and proton treatments of sinonasal cancer (SNC) patients. MATERIALS AND METHODS Photon (VMAT) and proton (IMPT) plans were optimized retrospectively for 24 SNC patients. Synthetic CTs (synCT) were obtained by deforming the planning CT (pCT) to the anatomy of every daily cone-beam CT. Both VMAT and IMPT plans were recalculated on the synCTs. The recalculated daily dose was accumulated over the whole treatment on the pCT. Target coverage and dose to organs and risk (OARs) were evaluated for all patients for the nominal, daily and accumulated dose distribution. RESULTS In general, dose to OARs farther away from the target, including brain, chiasm and contralateral optic nerve, was lower for proton plans than photon plans. Whereas, OARs in proximity of the target received a lower dose for photon plans. For proton plans, the target coverage (volume of CTV receiving 95% of prescribed dose), V95%, fell below 99% for 9/24 patients in one or more fractions. For photon plans, 4/24 patients had one or more fractions where V95% fell below 99%. For accumulated doses, V95% was below 99% only in two cases, but above 98% for all patients. CONCLUSION Photon and proton treatment have different strengths regarding OAR sparing. The robustness was high for both treatment modalities. Patient selection for either proton or photon radiation therapy of SNC patients should be based on a case-by-case comparison.
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Affiliation(s)
- R Argota-Perez
- Department of Oncology, Aarhus University Hospital, Denmark
| | - M B Sharma
- Department of Oncology, Aarhus University Hospital, Denmark
| | - U V Elstrøm
- Danish Center for Particle Therapy, Aarhus University Hospital, Denmark
| | - D S Møller
- Department of Oncology, Aarhus University Hospital, Denmark
| | - C Grau
- Department of Oncology, Aarhus University Hospital, Denmark; Danish Center for Particle Therapy, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - K Jensen
- Danish Center for Particle Therapy, Aarhus University Hospital, Denmark
| | - A I S Holm
- Department of Oncology, Aarhus University Hospital, Denmark.
| | - S S Korreman
- Department of Oncology, Aarhus University Hospital, Denmark; Danish Center for Particle Therapy, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
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17
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Sørensen BS, Sitarz MK, Ankjærgaard C, Johansen JG, Andersen CE, Kanouta E, Grau C, Poulsen P. Pencil beam scanning proton FLASH maintains tumor control while normal tissue damage is reduced in a mouse model. Radiother Oncol 2022; 175:178-184. [PMID: 35595175 DOI: 10.1016/j.radonc.2022.05.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 01/16/2023]
Abstract
PURPOSE Preclinical studies indicate a normal tissue sparing effect when ultra-high dose rate (FLASH) radiation is used, while tumor response is maintained. This differential response has promising perspectives for improved clinical outcome. This study investigates tumor control and normal tissue toxicity of pencil beam scanning (PBS) proton FLASH in a mouse model. METHODS AND MATERIALS Tumor bearing hind limbs of non-anaesthetized CDF1 mice were irradiated in a single fraction with a PBS proton beam using either conventional (CONV) dose rate (0.33-0.63 Gy/s field dose rate, 244 MeV) or FLASH (71-89 Gy/s field dose rate, 250 MeV). 162 mice with a C3H mouse mammary carcinoma subcutaneously implanted in the foot were irradiated with physical doses of 40-60 Gy (8-14 mice per dose point). The endpoints were tumor control (TC) assessed as no recurrent tumor at 90 days after treatment, the level of acute moist desquamation (MD) to the skin of the foot within 25 days post irradiation, and radiation induced fibrosis (RIF) within 24 weeks post irradiation. RESULTS TCD50 (dose for 50% tumor control) was similar for CONV and FLASH with values (and 95% confidence intervals) of 49.1 (47.0-51.4) Gy for CONV and 51.3 (48.6-54.2) Gy for FLASH. RIF analysis was restricted to mice with tumor control. Both endpoints showed distinct normal tissue sparing effect of proton FLASH with MDD50 (dose for 50% of mice displaying moist desquamation) of <40.1 Gy for CONV and 52.3 (50.0-54.6) Gy for FLASH, (dose modifying factor at least 1.3) and FD50 (dose for 50% of mice displaying fibrosis) of 48.6 (43.2-50.8) Gy for CONV and 55.6 (52.5-60.1) Gy for FLASH (dose modifying factor of 1.14). CONCLUSIONS FLASH had the same tumor control as CONV, but reduced normal tissue damage assessed as acute skin damage and radiation induced fibrosis.
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Affiliation(s)
- Brita Singers Sørensen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark.
| | | | | | - Jacob G Johansen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Eleni Kanouta
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Cai Grau
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Per Poulsen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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Sørensen B, Sitarz M, Ankjærgaard C, Johansen J, Andersen C, Kanouta E, Grau C, Poulsen P. OC-0507 Differential effect of PBS Proton FLASH on tumor control and skin toxicity in a mouse leg model. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02607-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: 10/18/2022]
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Zukauskaite R, Grau Eriksen J, Andersen E, Johansen J, Samsøe E, Long Krogh S, Overgaard J, Grau C, Rønn Hansen C. MO-0480 Risk of acute mucositis following an increase in high dose CTV1 in HNSCC patients. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02374-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: 11/30/2022]
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Nowicka-Matus K, Friborg J, Hansen C, Andersen E, Bernsdorf M, Elstrøm U, Farhadi M, Grau C, Eriksen J, Johansen J, Nielsen M, Petersen J, Samsøe E, Sibolt P, Smulders B, Jensen K. OC-0089 Acute toxicities in proton therapy of head-neck cancer – a matched analysis of DAHANCA 35 pilot data. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02465-3] [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: 11/30/2022]
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21
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Tvilum M, Knap M, Lutz C, Hoffmann L, Khalil A, Haraldsen A, Alber M, Grau C, Schmidt H, Kandi M, Mortensen L, Holt M, Appelt A, Moeller D. PO-1262 Early response to chemotherapy as predictor of locoregional and distant failure in NSCLC. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03226-1] [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: 10/18/2022]
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22
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Høyer M, Grau C, Overgaard J. No time to die - BiGART is back. The 20th Acta Oncologica Symposium - BIGART 2021. Acta Oncol 2022; 61:117-119. [PMID: 34991422 DOI: 10.1080/0284186x.2021.2022206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Morten Høyer
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Cai Grau
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
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23
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Sørensen B, Sitarz M, Ankjærgaard C, Johansen J, Andersen C, Kanouta E, Overgaard C, Grau C, Poulsen P. FLASH Modalities Track (Oral Presentations) THE EFFECT OF PBS PROTON FLASH ON ACUTE SKIN TOXICITY AND TUMOR CONTROL IN A MOUSE MODEL. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01531-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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24
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Sharma MB, Jensen K, Friborg J, Smulders B, Andersen E, Samsøe E, Johansen J, Hansen CR, Andersen M, Nielsen MS, Filtenborg MV, Ren J, Korreman SS, Overgaard J, Grau C. Target coverage and local recurrences after radiotherapy for sinonasal cancer in Denmark 2008-2015. A DAHANCA study. Acta Oncol 2022; 61:120-126. [PMID: 34979878 DOI: 10.1080/0284186x.2021.2022199] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
PURPOSE The study aimed to investigate the pattern of failure and describe compromises in the definition and coverage of the target for patients treated with curatively intended radiotherapy (RT) for sinonasal cancer (SNC). METHODS AND MATERIAL Patients treated with curatively intended RT in 2008-2015 in Denmark for SNC were eligible for the retrospective cohort study. Information regarding diagnosis and treatment was retrieved from the national database of the Danish Head and Neck Cancer Group (DAHANCA). Imaging from the diagnosis of recurrences was collected, and the point of origin (PO) of the recurrent tumour was estimated. All treatment plans were collected and reviewed with the focus on target coverage, manual modifications of target volumes, and dose to organs at risk (OARs) above defined constraints. RESULTS A total of 184 patients were included in the analysis, and 76 (41%) relapsed. The majority of recurrences involved T-site (76%). Recurrence imaging of 39 patients was evaluated, and PO was established. Twenty-nine POs (74%) were located within the CTV, and the minimum dose to the PO was median 64.1 Gy (3.1-70.7). The criteria for target coverage (V95%) was not met in 89/184 (48%) of the CTV and 131/184 (71%) of the PTV. A total of 24% of CTVs had been manually modified to spare OARs of high-dose irradiation. No difference in target volume modifications was observed between patients who suffered recurrence and patients with lasting remission. CONCLUSION The majority of relapses after radical treatment of SNC were located in the T-site (the primary tumour site). Multiple compromises with regards to target coverage and tolerance levels for OARs in the sinonasal region, as defined from RT guidelines, were taken. No common practice in this respect could be derived from the study.
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Affiliation(s)
- Maja B. Sharma
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Kenneth Jensen
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Jeppe Friborg
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Bob Smulders
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Elo Andersen
- Department of Oncology, Herlev Hospital, Copenhagen, Denmark
| | - Eva Samsøe
- Department of Oncology, Herlev Hospital, Copenhagen, Denmark
- Department of Oncology, Zealand University Hospital, Naestved, Denmark
| | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Christian R. Hansen
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Maria Andersen
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - Martin S. Nielsen
- Department of Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - Mads V. Filtenborg
- Department of Otorhinolaryngology, Head and Neck Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Jintao Ren
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Stine S. Korreman
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Overgaard
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Cai Grau
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
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Singers Sørensen B, Krzysztof Sitarz M, Ankjærgaard C, Johansen J, Andersen CE, Kanouta E, Overgaard C, Grau C, Poulsen P. In vivo validation and tissue sparing factor for acute damage of pencil beam scanning proton FLASH. Radiother Oncol 2021; 167:109-115. [PMID: 34953933 DOI: 10.1016/j.radonc.2021.12.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE Preclinical studies indicate a normal tissue sparing effect using ultra-high dose rate (FLASH) radiation with comparable tumor response. Most data so far are based on electron beams with limited utility for human treatments. This study validates the effect of proton FLASH delivered with pencil beam scanning (PBS) in a mouse leg model of acute skin damage and quantifies the normal tissue sparing factor, the FLASH factor, through full dose response curves. MATERIALS AND METHODS The right hind limb of CDF1 mice was irradiated with a single fraction of proton PBS in the entrance plateau of either a 244MeV conventional dose rate field or a 250MeV FLASH field. In total, 301 mice were irradiated in four separate experiments, with 7-21 mice per dose point. The endpoints were the level of acute moist desquamation to the skin of the foot within 25 days post irradiation. RESULTS The field duration and field dose rate were 61-107s and 0.35-0.40 Gy/s for conventional dose rate and 0.35-0.73s and 65-92 Gy/s for FLASH. Full dose response curves for five levels of acute skin damage for both conventional and FLASH dose rate revealed a distinct normal tissue sparing effect with FLASH: across all scoring levels, a 44-58% higher dose was required to give the same biological response with FLASH as compared to the conventional dose rate. CONCLUSIONS The normal tissue sparing effect of PBS proton FLASH was validated. The FLASH factor was quantified through full dose response curves.
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Affiliation(s)
- Brita Singers Sørensen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark.
| | | | | | - Jacob Johansen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Eleni Kanouta
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Cathrine Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
| | - Cai Grau
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Per Poulsen
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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26
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Hansen C, Friborg J, Skyt P, Smulders B, Sibolt P, Nielsen M, Samsøe E, Petersen J, Johansen J, Zukauskaite R, Andersen E, Andersen M, Farhadi M, Eriksen J, Overgaard J, Grau C, Jensen K. Photon-proton dose plan comparison in the pilot phase of the randomized clinical DAHANCA 35 trial. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00106-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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27
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Khalil AA, Hau E, Gebski V, Grau C, Gee H, Nyeng TB, West K, Kramer S, Farlow D, Knap M, Møller DS, Hoffmann L, Farr KP. Personal innovative approach in radiation therapy of lung cancer- functional lung avoidance SPECT-guided (ASPECT) radiation therapy: a study protocol for phase II randomised double-blind clinical trial. BMC Cancer 2021; 21:940. [PMID: 34418994 PMCID: PMC8379730 DOI: 10.1186/s12885-021-08663-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/03/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Radiation therapy (RT) plays a key role in curative-intent treatment for locally advanced lung cancer. Radiation induced pulmonary toxicity can be significant for some patients and becomes a limiting factor for radiation dose, suitability for treatment, as well as post treatment quality of life and suitability for the newly introduced adjuvant immunotherapy. Modern RT techniques aim to minimise the radiation dose to the lungs, without accounting for regional distribution of lung function. Many lung cancer patients have significant regional differences in pulmonary function due to smoking and chronic lung co-morbidity. Even though reduction of dose to functional lung has shown to be feasible, the method of preferential functional lung avoidance has not been investigated in a randomised clinical trial. METHODS In this study, single photon emission computed tomography (SPECT/CT) imaging technique is used for functional lung definition, in conjunction with advanced radiation dose delivery method in randomised, double-blind trial. The study aims to assess the impact of functional lung avoidance technique on pulmonary toxicity and quality of life in patients receiving chemo-RT for lung cancer. Eligibility criteria are biopsy verified lung cancer, scheduled to receive (chemo)-RT with curative intent. Every patient will undergo a pre-treatment perfusion SPECT/CT to identify functional lung. At radiation dose planning, two plans will be produced for all patients on trial. Standard reference plan, without the use of SPECT imaging data, and functional avoidance plan, will be optimised to reduce the dose to functional lung within the predefined constraints. Both plans will be clinically approved. Patients will then be randomised in a 2:1 ratio to be treated according to either the functional avoidance or the standard plan. This study aims to accrue a total of 200 patients within 3 years. The primary endpoint is symptomatic radiation-induced lung toxicity, measured serially 1-12 months after RT. Secondary endpoints include: a quality of life and patient reported lung symptoms assessment, overall survival, progression-free survival, and loco-regional disease control. DISCUSSION ASPECT trial will investigate functional avoidance method of radiation delivery in clinical practice, and will establish toxicity outcomes for patients with lung cancer undergoing curative chemo-RT. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT04676828 . Registered 1 December 2020.
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Affiliation(s)
| | - Eric Hau
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney West Radiation Oncology Network, Westmead, Australia
- Westmead Clinical School, University of Sydney, Sydney, NSW Australia
- Westmead Institute for Medical Research, Westmead, NSW Australia
| | - Val Gebski
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney West Radiation Oncology Network, Westmead, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, 2050 Australia
| | - Cai Grau
- Aarhus University Hospital, Aarhus, Denmark
| | - Harriet Gee
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney West Radiation Oncology Network, Westmead, Australia
- Westmead Institute for Medical Research, Westmead, NSW Australia
| | | | - Katrina West
- Department of Radiation Oncology, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney West Radiation Oncology Network, Westmead, Australia
| | | | | | | | | | | | - Katherina P. Farr
- Aarhus University Hospital, Aarhus, Denmark
- Faculty of Medicine, University of New South Wales, Sydney, NSW Australia
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Argota Perez R, Sharma M, Elstroem U, Moeller D, Grau C, Jensen K, Korreman S, Holm A. OC-0203 Nominal, daily and accumulated target coverage for photon and proton treatment of sinonasal cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06818-3] [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: 10/20/2022]
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Prades J, Borras J, Bibault J, Grau C, Jereczek-Fossa B, Lambrecht M, Slotman B, Troost E, Lievens Y. PO-1493 Opening the angle: the role played by National Societies for Radiation Oncology during the COVID-19. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07944-5] [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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30
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Sørensen B, Sitarz M, Ankjærgaard C, Johansen J, Andersen C, Kanouta E, Overgaard C, Grau C, Poulsen P. OC-0561 In vivo validation and tissue sparing factor for acute damage of pencil beam scanning proton FLASH. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06968-1] [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: 10/20/2022]
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31
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Overgaard C, Sitarz M, Bassler N, Spejlborg H, Johansen J, Kanouta E, Grau C, Overgaard J, Poulsen P, Sørensen B. OC-0283 LET dependence of proton RBE in early normal tissue damage in vivo. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06833-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: 11/15/2022]
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Zukauskaite R, Grau Eriksen J, Andersen E, Johansen J, Samsøe Hinsby E, Long Krogh S, Overgaard J, Grau C, Rønn Hansen C. OC-0516 Local control in HNSCC after introduction of geometric margins in DAHANCA radiotherapy guidelines. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06942-5] [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: 11/28/2022]
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Sharma MB, Jensen K, Friborg J, Smulders B, Andersen E, Samsoee E, Johansen J, Hansen CR, Andersen M, Nielsen MS, Filtenborg MV, Ren J, Korreman SS, Overgaard J, Grau C. P-70 Recurrence analysis of Danish patients with sinonasal cancer treated with IMRT in 2008–2015. A DAHANCA study. Oral Oncol 2021. [DOI: 10.1016/s1368-8375(21)00357-2] [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: 11/30/2022]
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Petit C, Lacas B, Pignon JP, Le QT, Grégoire V, Grau C, Hackshaw A, Zackrisson B, Parmar MKB, Lee JW, Ghi MG, Sanguineti G, Temam S, Cheugoua-Zanetsie M, O'Sullivan B, Posner MR, Vokes EE, Cruz Hernandez JJ, Szutkowski Z, Lartigau E, Budach V, Suwiński R, Poulsen M, Kumar S, Ghosh Laskar S, Mazeron JJ, Jeremic B, Simes J, Zhong LP, Overgaard J, Fortpied C, Torres-Saavedra P, Bourhis J, Aupérin A, Blanchard P. Chemotherapy and radiotherapy in locally advanced head and neck cancer: an individual patient data network meta-analysis. Lancet Oncol 2021; 22:727-736. [PMID: 33862002 DOI: 10.1016/s1470-2045(21)00076-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Randomised, controlled trials and meta-analyses have shown the survival benefit of concomitant chemoradiotherapy or hyperfractionated radiotherapy in the treatment of locally advanced head and neck cancer. However, the relative efficacy of these treatments is unknown. We aimed to determine whether one treatment was superior to the other. METHODS We did a frequentist network meta-analysis based on individual patient data of meta-analyses evaluating the role of chemotherapy (Meta-Analysis of Chemotherapy in Head and Neck Cancer [MACH-NC]) and of altered fractionation radiotherapy (Meta-Analysis of Radiotherapy in Carcinomas of Head and Neck [MARCH]). Randomised, controlled trials that enrolled patients with non-metastatic head and neck squamous cell cancer between Jan 1, 1980, and Dec 31, 2016, were included. We used a two-step random-effects approach, and the log-rank test, stratified by trial to compare treatments, with locoregional therapy as the reference. Overall survival was the primary endpoint. The global Cochran Q statistic was used to assess homogeneity and consistency and P score to rank treatments (higher scores indicate more effective therapies). FINDINGS 115 randomised, controlled trials, which enrolled patients between Jan 1, 1980, and April 30, 2012, yielded 154 comparisons (28 978 patients with 19 253 deaths and 20 579 progression events). Treatments were grouped into 16 modalities, for which 35 types of direct comparisons were available. Median follow-up based on all trials was 6·6 years (IQR 5·0-9·4). Hyperfractionated radiotherapy with concomitant chemotherapy (HFCRT) was ranked as the best treatment for overall survival (P score 97%; hazard ratio 0·63 [95% CI 0·51-0·77] compared with locoregional therapy). The hazard ratio of HFCRT compared with locoregional therapy with concomitant chemoradiotherapy with platinum-based chemotherapy (CLRTP) was 0·82 (95% CI 0·66-1·01) for overall survival. The superiority of HFCRT was robust to sensitivity analyses. Three other modalities of treatment had a better P score, but not a significantly better HR, for overall survival than CLRTP (P score 78%): induction chemotherapy with taxane, cisplatin, and fluorouracil followed by locoregional therapy (ICTaxPF-LRT; 89%), accelerated radiotherapy with concomitant chemotherapy (82%), and ICTaxPF followed by CLRT (80%). INTERPRETATION The results of this network meta-analysis suggest that further intensifying chemoradiotherapy, using HFCRT or ICTaxPF-CLRT, could improve outcomes over chemoradiotherapy for the treatment of locally advanced head and neck cancer. FUNDINGS French Institut National du Cancer, French Ligue Nationale Contre le Cancer, and Fondation ARC.
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Affiliation(s)
- Claire Petit
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Oncostat U1018, Ligue Contre le Cancer, INSERM, Université Paris-Saclay, Villejuif, France; Department of Radiation Oncology, Gustave Roussy Cancer Campus, Université Paris-Sud, Université Paris-Saclay, F-94805 Villejuif, France; Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France
| | - Benjamin Lacas
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Oncostat U1018, Ligue Contre le Cancer, INSERM, Université Paris-Saclay, Villejuif, France; Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France
| | - Jean-Pierre Pignon
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Oncostat U1018, Ligue Contre le Cancer, INSERM, Université Paris-Saclay, Villejuif, France; Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France
| | - Quynh Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Cai Grau
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Allan Hackshaw
- Cancer Research UK and University College London Cancer Trials Centre, Cancer Institute, University College London Hospital, London, UK
| | - Björn Zackrisson
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Mahesh K B Parmar
- Medical Research Council Clinical Trials Unit, University College London, London, UK
| | - Ju-Whei Lee
- ECOG-ACRIN Biostatistics Center, Dana Farber Cancer Institute, Boston, MA, USA
| | - Maria Grazia Ghi
- Oncology Unit 2, Veneto Institute of Oncology-IRCCS, Padua, Italy
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Stéphane Temam
- Service de Cancérologie Cervico-faciale, Gustave Roussy, Université Paris-Saclay, F-94805 Villejuif, France
| | - Maurice Cheugoua-Zanetsie
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Oncostat U1018, Ligue Contre le Cancer, INSERM, Université Paris-Saclay, Villejuif, France
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Marshall R Posner
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Everett E Vokes
- Section of Hematology-Oncology, The University of Chicago Medical Center, Chicago, IL, USA
| | | | - Zbigniew Szutkowski
- Department of Radiotherapy, Cancer Center, Marie Curie-Sklodowska Memorial Institute, Warsaw, Poland
| | - Eric Lartigau
- Department of Radiotherapy, Centre Oscar Lambret, Lille, France
| | - Volker Budach
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Rafal Suwiński
- Radiotherapy and Chemotherapy Clinic and Teaching Hospital, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Michael Poulsen
- Radiation Oncology Services, Mater Centre, Brisbane, QLD, Australia
| | - Shaleen Kumar
- Department of Radiotherapy, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | | | | | - John Simes
- NHMRC Clinical Trials Center, Camperdown, NSW, Australia
| | - Lai-Ping Zhong
- Department of Oral and Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jens Overgaard
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Pedro Torres-Saavedra
- NRG Oncology Statistics and Data Management Center, American College of Radiology, Philadelphia, PA, USA
| | - Jean Bourhis
- Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France; Department of Radiotherapy, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Anne Aupérin
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Oncostat U1018, Ligue Contre le Cancer, INSERM, Université Paris-Saclay, Villejuif, France; Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France
| | - Pierre Blanchard
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Oncostat U1018, Ligue Contre le Cancer, INSERM, Université Paris-Saclay, Villejuif, France; Department of Radiation Oncology, Gustave Roussy Cancer Campus, Université Paris-Sud, Université Paris-Saclay, F-94805 Villejuif, France; Groupe d'Oncologie Radiothérapie Tête Et Cou, Tours, France.
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35
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Gerlach S, Pinto M, Kurichiyanil N, Grau C, Hérault J, Hillbrand M, Poulsen PR, Safai S, Schippers JM, Schwarz M, Søndergaard CS, Tommasino F, Verroi E, Vidal M, Yohannes I, Schreiber J, Parodi K. Corrigendum: Beam characterization and feasibility study for a small animal irradiation platform at clinical proton therapy facilities (2020 Phys. Med. Biol.65 245045). Phys Med Biol 2021; 66. [PMID: 34037545 DOI: 10.1088/1361-6560/abf00e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 03/18/2021] [Indexed: 11/11/2022]
Affiliation(s)
- S Gerlach
- Department for Medical Physics, Ludwig-Maximilians-Universität München, Am Coulombwall 1, D-85748 Garching, Germany
| | - M Pinto
- Department for Medical Physics, Ludwig-Maximilians-Universität München, Am Coulombwall 1, D-85748 Garching, Germany
| | - N Kurichiyanil
- Department for Medical Physics, Ludwig-Maximilians-Universität München, Am Coulombwall 1, D-85748 Garching, Germany
| | - C Grau
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.,Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - J Hérault
- Centre Antoine Lacassagne, Nice, France.,Fédération Claude Lalanne-Université Côte d'Azur, Nice, France
| | - M Hillbrand
- Rinecker Proton Therapy Center, München, Germany
| | - P R Poulsen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.,Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - S Safai
- Paul Scherrer Institute, Villigen, Switzerland
| | | | - M Schwarz
- Trento Institute for Fundamental Physics and Applications, National Institute for Nuclear Physics, Povo, Italy.,Protontherapy Department, Azienda Provinciale per i Servizi Sanitari, Trento, Italy
| | - C S Søndergaard
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - F Tommasino
- Trento Institute for Fundamental Physics and Applications, National Institute for Nuclear Physics, Povo, Italy.,Department of Physics, University of Trento, Povo, Italy
| | - E Verroi
- Trento Institute for Fundamental Physics and Applications, National Institute for Nuclear Physics, Povo, Italy
| | - M Vidal
- Centre Antoine Lacassagne, Nice, France.,Fédération Claude Lalanne-Université Côte d'Azur, Nice, France
| | - I Yohannes
- Rinecker Proton Therapy Center, München, Germany
| | - J Schreiber
- Department for Medical Physics, Ludwig-Maximilians-Universität München, Am Coulombwall 1, D-85748 Garching, Germany
| | - K Parodi
- Department for Medical Physics, Ludwig-Maximilians-Universität München, Am Coulombwall 1, D-85748 Garching, Germany
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Nyeng TB, Møller DS, Farr K, Kramer S, Khalil AA, Grau C, Hoffmann L. A comparison of two methods for segmentation of functional volumes in radiotherapy planning of lung cancer patients. Acta Oncol 2021; 60:353-360. [PMID: 33522851 DOI: 10.1080/0284186x.2021.1877811] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND In radiotherapy (RT) of lung cancer, dose to functional lung (FL) volumes segmented with two different methods (perfusion SPECT (Q-SPECT) and 4D-CT (4D) ventilation (V)) have been shown to correlate with the incidence of radiation pneumonitis (RP). This study aims to compare the FL volumes identified by both methods. MATERIAL AND METHODS Thirty lung cancer patients had a 4D and Q-SPECT prior to treatment. Seventeen of these patients also had a ventilation SPECT (V-SPECT). FL sub-volumes were segmented automatically, using cut-off values. The volumes were compared in terms of overlap fraction (OF) relative to the minimal volume, and intersection fraction (IF) of the FL volume relative to the total lung volume (VLung). RESULTS Cut-off values suggested in literature for Q-SPECT and 4D-V resulted in volumes differing in size by a median 18% [6%;31%], and a median OF and IF of 0.48 [0.23;0.70] and 0.09 [0.02;0.25], respectively. Segmenting volumes of comparable size of about 1/3 of VLung (FL-m(1/3), m = method) resulted in a median OF and IF of 0.43 [0.23;0.58] and 0.12 [0.06;0.19], respectively. Twenty-five patients (83%) had a reasonable overlap between FL-Q(1/3) and FL-4D-V(1/3) volumes, with OF values above 0.33. IF increased significantly (p = .036) compared to using fixed cut-off values. Similarly, volumes of comparable size of about 1/3 VLung were produced for V-SPECT, and FL-Q(1/3), FL-V(1/3), and FL-4D-V(1/3) were compared. The overlaps and intersections of FL-V(1/3) with FL-Q(1/3) volumes were significantly (p<.001) larger than the corresponding overlaps and intersections of FL-Q(1/3) with FL-4D(1/3) and FL-V(1/3) with FL-4D(1/3). CONCLUSION The Q-SPECT and 4D-V methods do not segment entirely the same FL volumes. A reasonable overlap of the volumes along with the findings of other studies that both correlate to RP incidence, suggests that a combination of both volumes, e.g. using the IF, may be useful in RT treatment planning.
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Affiliation(s)
- T. B. Nyeng
- Department of Oncology, Section for Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - D. S. Møller
- Department of Oncology, Section for Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - K. Farr
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - S. Kramer
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus, Denmark
| | - A. A. Khalil
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - C. Grau
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - L. Hoffmann
- Department of Oncology, Section for Medical Physics, Aarhus University Hospital, Aarhus, Denmark
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Affiliation(s)
- Morten Høyer
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Cai Grau
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
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Sharma M, Argota Perez R, Holm A, Korreman S, Jensen K, Elstrøm U, Grau C. Air variability in maxillary sinus during radiotherapy for sinonasal carcinoma. Clin Transl Radiat Oncol 2021; 27:36-43. [PMID: 33490653 PMCID: PMC7809099 DOI: 10.1016/j.ctro.2020.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 09/02/2020] [Revised: 12/26/2020] [Accepted: 12/28/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The aim was to characterise patterns and predictability of aeration changes in the ipsilateral maxillary sinus during intensity-modulated radiotherapy (IMRT) for sinonasal cancer (SNC), and in a sample evaluate the dosimetric effects of aeration changes for both photon and proton therapy. MATERIALS AND METHODS The study included patients treated with IMRT for SNC in a single institution in 2009-2017. The volume of air in the ipsilateral maxillary sinus was recorded in 1578 daily cone beam computer tomography (CBCT) from 53 patients. Patterns of changing air volumes were categorised as 'stable', increasing', 'decreasing', or 'erratic'. For the prediction analysis, categorisation was performed based both on the entire treatment course and the first five fractions (F1-5). Photon and proton therapy plans were generated for four patients, the one from each category with the largest aeration variation. Synthetic CT images were generated for each CBCT and all plans were recalculated on the daily synthetic CTs. RESULTS The absolute volume of air varied considerably during the treatment course, ranging from 0 to 25.9 cm3. Changes within a single participant varied in the range of 0-18.7 cm3. In the categorisation of patterns, most patients had increasing aeration of the sinus. Generally, patterns of aeration could not be predicted from F1-5. Patients categorised as increasing in F1-5 had the best prediction, with 78% predicted correctly as increasing for the entire treatment course. The numeric correlation coefficients for target coverage and air volume were low for 3/4 scenarios (photons 0.03-0.23, protons 0.26-0.48). No straightforward correlation between the dosimetric effect and the volume changes could be detected in the sample test of four patients for neither photon nor proton therapy. CONCLUSION The variation of aeration was large and unpredictable. No clear dosimetric consequences of the aeration variation were evident for neither IMRT nor proton therapy for the patients investigated.
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Affiliation(s)
- M.B. Sharma
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - R. Argota Perez
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - A.I.S. Holm
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - S.S. Korreman
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - K. Jensen
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - U.V. Elstrøm
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - C. Grau
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Lacas B, Carmel A, Landais C, Wong SJ, Licitra L, Tobias JS, Burtness B, Ghi MG, Cohen EEW, Grau C, Wolf G, Hitt R, Corvò R, Budach V, Kumar S, Laskar SG, Mazeron JJ, Zhong LP, Dobrowsky W, Ghadjar P, Fallai C, Zakotnik B, Sharma A, Bensadoun RJ, Ruo Redda MG, Racadot S, Fountzilas G, Brizel D, Rovea P, Argiris A, Nagy ZT, Lee JW, Fortpied C, Harris J, Bourhis J, Aupérin A, Blanchard P, Pignon JP. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): An update on 107 randomized trials and 19,805 patients, on behalf of MACH-NC Group. Radiother Oncol 2021; 156:281-293. [PMID: 33515668 DOI: 10.1016/j.radonc.2021.01.013] [Citation(s) in RCA: 124] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/22/2020] [Accepted: 01/08/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE The Meta-Analysis of Chemotherapy in squamous cell Head and Neck Cancer (MACH-NC) demonstrated that concomitant chemotherapy (CT) improved overall survival (OS) in patients without distant metastasis. We report the updated results. MATERIALS AND METHODS Published or unpublished randomized trials including patients with non-metastatic carcinoma randomized between 1965 and 2016 and comparing curative loco-regional treatment (LRT) to LRT + CT or adding another timing of CT to LRT + CT (main question), or comparing induction CT + radiotherapy to radiotherapy + concomitant (or alternating) CT (secondary question) were eligible. Individual patient data were collected and combined using a fixed-effect model. OS was the main endpoint. RESULTS For the main question, 101 trials (18951 patients, median follow-up of 6.5 years) were analyzed. For both questions, there were 16 new (2767 patients) and 11 updated trials. Around 90% of the patients had stage III or IV disease. Interaction between treatment effect on OS and the timing of CT was significant (p < 0.0001), the benefit being limited to concomitant CT (HR: 0.83, 95%CI [0.79; 0.86]; 5(10)-year absolute benefit of 6.5% (3.6%)). Efficacy decreased as patients age increased (p_trend = 0.03). OS was not increased by the addition of induction (HR = 0.96 [0.90; 1.01]) or adjuvant CT (1.02 [0.92; 1.13]). Efficacy of induction CT decreased with poorer performance status (p_trend = 0.03). For the secondary question, eight trials (1214 patients) confirmed the superiority of concomitant CT on OS (HR = 0.84 [0.74; 0.95], p = 0.005). CONCLUSION The update of MACH-NC confirms the benefit and superiority of the addition of concomitant CT for non-metastatic head and neck cancer.
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Affiliation(s)
- Benjamin Lacas
- Cleveland Clinic Foundation, OH, USA; Institut Saint Catherine, France
| | | | | | | | | | | | | | | | | | - Cai Grau
- H. Lee Moffitt Cancer Center & Research Institute, USA
| | | | | | - Renzo Corvò
- Tata Memorial Centre Advanced Centre for Treatment, Research and Education in Cancer, India
| | - Volker Budach
- State University of New York Downstate Medical Center, USA
| | | | | | | | | | | | - Pirus Ghadjar
- Johns Hopkins Univ/Sidney Kimmel Cancer Center, MD, USA
| | - Carlo Fallai
- Centre Hospitalier Universitaire de Tours, France
| | | | - Atul Sharma
- Cancer Research UK & UCL Cancer Trials Centre, UK
| | | | | | - Séverine Racadot
- Princess Margaret Cancer Centre/University of Toronto, Ontario, Canada
| | | | | | - Paolo Rovea
- Kragulevac University Hospital, Yugoslavia, Serbia
| | | | | | | | | | | | - Jean Bourhis
- Institut Saint Catherine, France; Stanford University School of Medicine, CA, USA
| | - Anne Aupérin
- Cleveland Clinic Foundation, OH, USA; Institut Saint Catherine, France
| | - Pierre Blanchard
- Cleveland Clinic Foundation, OH, USA; Institut Saint Catherine, France; University of Texas-MD Anderson Cancer Center, USA.
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Korreman S, Eriksen JG, Grau C. The changing role of radiation oncology professionals in a world of AI - Just jobs lost - Or a solution to the under-provision of radiotherapy? Clin Transl Radiat Oncol 2020; 26:104-107. [PMID: 33364449 PMCID: PMC7752957 DOI: 10.1016/j.ctro.2020.04.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/24/2020] [Accepted: 04/27/2020] [Indexed: 02/07/2023] Open
Affiliation(s)
- Stine Korreman
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.,Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | - Jesper Grau Eriksen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.,Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | - Cai Grau
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.,Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
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Gerlach S, Pinto M, Kurichiyanil N, Grau C, Hérault J, Hillbrand M, Poulsen PR, Safai S, Schippers JM, Schwarz M, Søndergaard CS, Tommasino F, Verroi E, Vidal M, Yohannes I, Schreiber J, Parodi K. Beam characterization and feasibility study for a small animal irradiation platform at clinical proton therapy facilities. Phys Med Biol 2020; 65:245045. [DOI: 10.1088/1361-6560/abc832] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Machiels JP, René Leemans C, Golusinski W, Grau C, Licitra L, Gregoire V. Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2020; 31:1462-1475. [PMID: 33239190 DOI: 10.1016/j.annonc.2020.07.011] [Citation(s) in RCA: 290] [Impact Index Per Article: 72.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 12/25/2022] Open
Affiliation(s)
- J-P Machiels
- Service d'Oncologie Médicale, Institut Roi Albert II, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Institut de Recherche Clinique et Expérimentale, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam University Medical Centres, Cancer Centre Amsterdam, Vrije Universiteit, Amsterdam, the Netherlands
| | - W Golusinski
- Department of Head and Neck Surgery, Poznan University of Medical Sciences and The Greater Poland Cancer Centre, Poznan, Poland
| | - C Grau
- Department of Oncology and Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - L Licitra
- Head and Neck Cancer Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - V Gregoire
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
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Chan J, Friborg J, Zubizarreta E, van Eck J, Hanna T, Bourque J, Gaudet M, Dennis K, Olson R, Coleman C, Petersen A, Grau C, Abdel-Wahab M, Brundage M, Slotman B, Polo A. Geographic Accessibility to Radiotherapy in Canada and Greenland for Indigenous Populations: A Quantitative Approach to Highlighting Inequities and Exploring Solutions. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2448] [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: 10/23/2022]
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44
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Kaplan L, Hansen C, Jensen K, Friborg J, Samsøe E, Johansen J, Andersen M, Smulders B, Andersen E, Nielsen M, Eriksen J, Petersen J, Elstrøm U, Holm A, Skyt P, Vestergaard A, Lorenzen E, Nielsen M, Marseguerra R, Morthorst M, Grau C, Korreman S. OC-0107: Quantitative metrics to analyze variations and support best practices in head and neck dose plans. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00133-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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45
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Hansen C, Van den Bosch L, Van der Laan H, Friborg J, Jensen K, Samsøe E, Johnsen L, Zukauskaite R, Grau C, Maare C, Johansen J, Primdahl H, Bratland Å, Kristensen C, Andersen M, Eriksen J, Langendijk J, Overgaard J, Van der Schaaf A. OC-0575: Type 4 validation of dysphagia NTCP model for selection of HNC patients to the RCT, DAHANCA35. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00597-1] [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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Machiels JP, René Leemans C, Golusinski W, Grau C, Licitra L, Gregoire V. Reprint of "Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx: EHNS-ESMO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up". Oral Oncol 2020; 113:105042. [PMID: 33583513 DOI: 10.1016/j.oraloncology.2020.105042] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- J-P Machiels
- Service d'Oncologie Médicale, Institut Roi Albert II, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Institut de Recherche Clinique et Expérimentale, Université Catholique de Louvain (UCLouvain), Brussels, Belgium
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, Amsterdam University Medical Centres, Cancer Centre Amsterdam, Vrije Universiteit, Amsterdam, the Netherlands
| | - W Golusinski
- Department of Head and Neck Surgery, Poznan University of Medical Sciences and The Greater Poland Cancer Centre, Poznan, Poland
| | - C Grau
- Department of Oncology and Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - L Licitra
- Head and Neck Cancer Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori and University of Milan, Milan, Italy
| | - V Gregoire
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
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Jensen K, Friborg J, Hansen CR, Samsøe E, Johansen J, Andersen M, Smulders B, Andersen E, Nielsen MS, Eriksen JG, Petersen JBB, Elstrøm UV, Holm AI, Farhadi M, Morthorst MH, Skyt PS, Overgaard J, Grau C. The Danish Head and Neck Cancer Group (DAHANCA) 2020 radiotherapy guidelines. Radiother Oncol 2020; 151:149-151. [DOI: 10.1016/j.radonc.2020.07.037] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 10/23/2022]
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Abstract
In the Nordic countries, as in the rest of the world, particle therapy as a radiotherapy modality, is evolving, albeit the hard evidence for the clinical benefit still is scarce. However, a common goal for the Nordic countries is to include a minimum of 80% of the patients treated with particle therapy into clinical trials. In this paper, we summarize the current status of clinical trials involving particle therapy in the Nordic countries, with an overview of both active and coming trials. So far, one is closed for inclusion and data are being analyzed, seven trials are actively recruiting patients and several more trials are underway. No common Nordic trial has yet been designed, nor is in the planning phase, and the authors will discuss the obstacles as well as the opportunities a common Nordic platform may represent.
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Affiliation(s)
- Petra Witt Nyström
- The Skandion Clinic, Uppsala, Sweden
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Åse Bratland
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Heikki Minn
- Department of Oncology and Radiotherapy, University Hospital Turku, Turku, Finland
| | - Cai Grau
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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Sharma MB, Jensen K, Amidi A, Eskildsen SF, Johansen J, Grau C. Late toxicity in the brain after radiotherapy for sinonasal cancer: Neurocognitive functioning, MRI of the brain and quality of life. Clin Transl Radiat Oncol 2020; 25:52-60. [PMID: 33024844 PMCID: PMC7530204 DOI: 10.1016/j.ctro.2020.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 06/29/2020] [Revised: 08/31/2020] [Accepted: 09/07/2020] [Indexed: 12/12/2022] Open
Abstract
Compared with matched normative data, impaired cognitive function was substantial. Several correlations between radiation dose and cognitive impairment were present. Radiation-induced white matter hyperintensities were present in 2/27 participants. One participant displayed radiation-induced necrosis in the temporal lobe. The domains affecting quality of life the most were fatigue and quality of sleep.
Purpose The aim of the study was to evaluate neurocognitive late effects, structural alterations and associations between cognitive impairment and radiation doses as well as cerebral tissue damage after radiotherapy for sinonasal cancer. Furthermore, the aim was to report quality of life (QoL) and self-reported cognitive capacity. Materials and methods Recurrence-free patients previously treated with intensity-modulated radiotherapy with a curative intent were eligible for the study. Study examinations comprised comprehensive neurocognitive testing, MRI of the brain, and self-reported outcomes. Results A total of 27 patients were included. Median age was 67 years (range 47–83). The majority of test outcomes were below normative values in any degree, and 37% of the participants had clinically significant neurocognitive impairment when compared with normative data. Correlations between absorbed doses to specific substructures of the brain and neurocognitive outcomes were present for Wechsler’s Adult Intelligence Scale-digit span and Controlled Oral Word Association Test-S. Structural MRI revealed macroscopic abnormalities in three patients; infarction (n = 1), diffuse white matter intensities (n = 2) and necrosis (n = 1). In the analysis of atrophy of cerebral tissue, no correlations were present with neither radiation dose to cerebral substructures nor neurocognitive impairment. The global QoL of the cohort was 75. The most affected outcomes were ‘fatigue’, ‘insomnia’, and ‘drowsiness’. A total of 59% of participants reported significantly impaired quality of sleep. Self-reported cognitive function revealed that ‘memory’ was the most affected cognitive domain. For the domains of ‘memory’ and ‘language’, self-reported functioning was associated with objectively measured neurocognitive outcomes. Conclusion Cerebral toxicity after radiotherapy for sinonasal cancer was substantial. Clinically significant cognitive impairment was present in more than one third of the participants, and several dose–response associations were present. Furthermore, the presence of macroscopic radiation sequelae indicated considerable impact of radiotherapy on brain tissue.
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Affiliation(s)
- M B Sharma
- Department of Oncology, Aarhus University Hospital, Palle Juul Jensen Boulevard 99, DK-8200 Aarhus N, Denmark
| | - K Jensen
- Danish Center for Particle Therapy, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, B420, 8200 Aarhus N, Denmark
| | - A Amidi
- Unit for Psychooncology and Health Psychology, Department of Psychology, Aarhus University, Bartholins Allé 9, Build. 1351, 8000 Aarhus C, Denmark
| | - S F Eskildsen
- Center of Functionally Integrative Neuroscience, Aarhus University, Nørrebrogade 44, Build. 1A, 8000 Aarhus C, Denmark
| | - J Johansen
- Department of Oncology, Odense University Hospital, J.B. Winsløvs Vej 4, 5000 Odense, Denmark
| | - C Grau
- Department of Oncology, Aarhus University Hospital, Palle Juul Jensen Boulevard 99, DK-8200 Aarhus N, Denmark.,Danish Center for Particle Therapy, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, B420, 8200 Aarhus N, Denmark
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50
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Oliveira C, Gasparotto C, Tawk B, Rodin D, Borras JM, Grau C, Lievens Y, Defourny N. 177: Evidence-Based Hypofractionated Radiotherapy Uptake in Europe: An Explorative Giro-Hero Analysis. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(20)31069-0] [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: 10/23/2022]
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