Comparative study of dose distribution between carbon ion radiotherapy and photon radiotherapy for head and neck tumor

Islam, M. S.; Yanagi, Takeshi; Mizoe, Jun‐etsu; Mizuno, Hideyuki; Tsujii, Hirohiko

doi:10.1007/s11604-008-0252-9

Cited by 14 publications

(9 citation statements)

References 21 publications

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“…Previous experience has demonstrated that more effective dose distributions in terms of vital tissue sparing can be achieved with IMCT compared with IMRT in patients with head and neck cancer . However, to the best of our knowledge, CIRT has never been used in the treatment of patients with LR‐NPC, and there is no literature to date suggesting the proper dose of CIRT to be used for reirradiation in patients with head and neck cancer recurrences.…”

Section: Discussionmentioning

confidence: 99%

“…Accelerated beams of heavy, charged particles and protons have a finite range and a distant Bragg peak . Dosimetry studies have shown that carbon ion RT (CIRT) enables the delivery of high‐dose RT to the target volume(s) while sparing organs at risk (OAR), thereby enhancing the therapeutic ratio over IMRT in patients with head and neck cancer . Early data also have suggested that the use of proton or heavy ion (noncarbon) RT for patients with LR‐NPC is feasible and potentially effective …”

Section: Introductionmentioning

confidence: 99%

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Salvage treatment using carbon ion radiation in patients with locoregionally recurrent nasopharyngeal carcinoma: Initial results

Hu¹,

Bao

Gao³

et al. 2018

Cancer

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BACKGROUNDReirradiation for locoregionally recurrent nasopharyngeal carcinoma (NPC) after a definitive dose of radiotherapy (RT) is challenging and usually associated with severe toxicities. Intensity‐modulated carbon ion RT (IMCT) offers physical/biologic advantages over photon‐based intensity‐modulated RT. Herein, the authors report their initial experience of IMCT in previously irradiated patients with locoregionally recurrent NPC.METHODSPatients with locoregionally recurrent, poorly differentiated or undifferentiated NPC who underwent salvage therapy with IMCT at the Shanghai Proton and Heavy Ion Center between May 2015 and August 2017 were included in the current study. The IMCT doses were 50 to 66 Gray equivalent (GyE) (2.0‐3.0 GyE/daily fraction), delivered via raster scanning technology. The 1‐year overall survival, disease‐specific survival, progression‐free survival (PFS), local recurrence‐free survival, regional recurrence‐free survival, and distant metastasis‐free survival were calculated. Univariate and multivariate analyses of PFS were performed to identify possible predictive factors.RESULTSAmong the 75 patients included, 4 patients, 14 patients, 29 patients, and 28 patients, respectively, had recurrent American Joint Committee on Cancer stage I, stage II, stage III, and stage IVA/B disease. With a median follow‐up of 15.4 months (range, 2.6‐29.7 months), the 1‐year overall survival, disease‐specific survival, PFS, local recurrence‐free survival, regional recurrence‐free survival, and distant metastasis‐free survival rates were 98.1%, 98.1%, 82.2%, 86.6%, 97.9%, and 96.2%, respectively. A higher fraction size of 3 GyE (vs <3 GyE) or a higher biological equivalent dose significantly improved the PFS rate on univariate analysis, but not on multivariate analysis. No patient developed acute toxicity of grade ≥2 during IMCT. Late treatment‐induced severe (grade 3 or 4) toxicities were infrequent, but included mucosal necrosis (9.3%), xerostomia (1.3%), and temporal lobe necrosis (1.3%).CONCLUSIONSThis initial experience in the first 75 patients with locoregionally recurrent NPC was encouraging. Carbon ion RT could provide promising survival rates with infrequent severe toxicities for patients with locoregionally recurrent NPC. Cancer 2018;124:2427‐37. © 2018 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Salvage treatment using carbon ion radiation in patients with locoregionally recurrent nasopharyngeal carcinoma: Initial results

Hu¹,

Bao

Gao³

et al. 2018

Cancer

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“…In three-dimensional conformal radiotherapy and intensity modulated radiotherapy, low-dose regions are generally enlarged because multi-portals are used to ensure conformable dose distribution to the target. On the other hand, C-ion RT can deliver conformable dose distribution to the target without expanding the low-dose regions [13]. Therefore, the maxilla volumes irradiated at low doses in C-ion RT might actually correlate with those receiving higher doses.…”

Section: Discussionmentioning

confidence: 99%

Effects of the dose-volume relationship on and risk factors for maxillary osteoradionecrosis after carbon ion radiotherapy

Sasahara

Koto²,

Ikawa³

et al. 2014

Radiat Oncol

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BackgroundOsteoradionecrosis (ORN) is a critical complication after carbon ion (C-ion) or photon radiotherapy (RT) for head and neck tumors. However, the risk factors for ORN after C-ion RT remain unclear. Therefore, the present study aimed to investigate the effects of the dose-volume relationship on and risk factors for ORN development after C-ion RT. We, however, focused on the maxillary bone because most tumors treated with C-ion RT were primarily located in the sinonasal cavity.MethodsThe patients enrolled in this study received more than 10% of the prescribed total dose of 57.6 Gy equivalent (GyE) in 16 fractions to their maxilla. All patients were followed up for more than 2 years after C-ion RT. Those with tumor invasion to the maxilla before C-ion RT or local recurrence after the treatment were excluded from the study to accurately evaluate the effects of irradiation on the bone. Sixty-three patients were finally selected. The severity of ORN was assessed according to the Common Terminology Criteria for Adverse Events version 4.0. The correlation between clinical and dosimetric parameters and ORN incidence was retrospectively analyzed.ResultsThe median follow-up period was 79 months. Of the 63 enrolled patients, 26 developed ORN of grade ≥1. Multivariate analysis revealed that the maxilla volume receiving more than 50 GyE (V50) and the presence of teeth within the planning target volume were significant risk factors for ORN. Dose-volume histogram analysis revealed that V10 to V50 parameters were significantly higher in patients with ORN than in those without ORN.ConclusionsV50 and the presence of teeth within the planning target volume were independent risk factors for the development of ORN after C-ion RT using a 16-fraction protocol.

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“…Patients who receive a combined dose above 100 Gy from initial RT and re-irradiation may have a higher chance of developing SAEs including cranial neuropathy, brain injury, mucosal necrosis and massive hemorrhage, which could result in significantly reduced quality of life, or even death. Because most of its energy is deposited in the region called “Bragg peak”, CIRT is able to accurately deliver high-dose radiation to the tumors while sparing surrounding organs 6 , 24 . Meanwhile, the higher relative biological effectiveness of accelerated carbon-ion beams enable more effective elimination of resistant tumors cells frequently appeared in LR-NPC 25 , 26 .…”

Section: Discussionmentioning

confidence: 99%

Volumetric parameters derived from FLT-PET performed at completion of treatment predict efficacy of Carbon-ion Radiotherapy in patients with locally recurrent Nasopharyngeal Carcinoma

Hu¹,

Yang²,

Gao³

et al. 2020

J. Cancer

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The purpose of this study was to investigate the role of 3'-deoxy-3'-[ 18 F]fluorothymidine (FLT)-PET for predicting the outcome of patients with locally recurrent nasopharyngeal carcinoma (LR-NPC) treated by carbon-ion radiotherapy (CIRT). Patients received FLT-PET/CT scan one-week prior to or after completion of CIRT were enrolled in the study. All patients were from prospective trials or treated using a standardized protocol. Time-dependent receiver operator characteristics (ROC) were used to determine the optimal cutoff values for FLT-PET parameters. Univariable and multivariable analyses of local progression-free survival (LPFS) were performed using Cox regression, to examine the prognostic value of FLT-PET parameters, including SUV max , metabolic tumor volume (MTV) and total lesion thymidine (TLT). A total of 41 patients were enrolled. Elevated MTV and TLT were significantly associated with worse LPFS, in both univariable and multivariable analyses. ROC analysis revealed that both an MTV value higher than 8.6 and a TLT value higher than 14.9 were predictive of increased risk of developing local recurrence, the adjusted HRs were 5.59 ( p =0.009) and 7.76 ( p =0.002), respectively. In conclusion, FLT-PET was found to be a promising prognostic tool for LR-NPC patients and might play a role in the treatment guidance.

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Comparative study of dose distribution between carbon ion radiotherapy and photon radiotherapy for head and neck tumor

Cited by 14 publications

References 21 publications

Salvage treatment using carbon ion radiation in patients with locoregionally recurrent nasopharyngeal carcinoma: Initial results

Salvage treatment using carbon ion radiation in patients with locoregionally recurrent nasopharyngeal carcinoma: Initial results

Effects of the dose-volume relationship on and risk factors for maxillary osteoradionecrosis after carbon ion radiotherapy

Volumetric parameters derived from FLT-PET performed at completion of treatment predict efficacy of Carbon-ion Radiotherapy in patients with locally recurrent Nasopharyngeal Carcinoma

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