Dose–volume histogram and dose–surface histogram analysis for skin reactions to carbon ion radiotherapy for bone and soft tissue sarcoma

Yanagi, Takeshi; Kamada, Tadashi; Tsuji, Hiroshi; Imai, Reiko; Serizawa, Itsuko; Tsujii, Hirohiko

doi:10.1016/j.radonc.2009.08.041

Cited by 49 publications

(38 citation statements)

References 14 publications

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“…A decided evaluation of skin toxicity after carbon ion treatment at NIRS showed grade 3 and 4 skin toxicity only in patients which received doses ≥ 70 GyE in 16 fractions. It was indicated that severe skin reaction may not develop if the prescribed dose is 64 GyE or less like in our trial [29]. Furthermore, we limit the maximum dose of the skin to 90-95% of the prescribed dose.…”

Section: Discussionmentioning

confidence: 99%

Randomized phase II trial of hypofractionated proton versus carbon ion radiation therapy in patients with sacrococcygeal chordoma-the ISAC trial protocol

et al. 2014

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BackgroundChordomas are relatively rare lesions of the bones. About 30% occur in the sacrococcygeal region. Surgical resection is still the standard treatment. Due to the size, proximity to neurovascular structures and the complex anatomy of the pelvis, a complete resection with adequate safety margin is difficult to perform. A radical resection with safety margins often leads to the loss of bladder and rectal function as well as motoric/sensoric dysfunction. The recurrence rate after surgery alone is comparatively high, such that adjuvant radiation therapy is very important for improving local control rates. Proton therapy is still the international standard in the treatment of chordomas. High-LET beams such as carbon ions theoretically offer biologic advantages in slow-growing tumors. Data of a Japanese study of patients with unresectable sacral chordoma showed comparable high control rates after hypofractionated carbon ion therapy only.Methods and designThis clinical study is a prospective randomized, monocentric phase II trial. Patients with histologically confirmed sacrococcygeal chordoma will be randomized to either proton or carbon ion radiation therapy stratified regarding the clinical target volume. Target volume delineation will be carried out based on CT and MRI data. In each arm the PTV will receive 64 GyE in 16 fractions. The primary objective of this trial is safety and feasibility of hypofractionated irradiation in patients with sacrococygeal chordoma using protons or carbon ions in raster scan technique for primary or additive treatment after R2 resection. The evaluation is therefore based on the proportion of treatments without Grade 3–5 toxicity (CTCAE, version 4.0) up to 12 months after treatment and/or discontinuation of the treatment for any reason as primary endpoint. Local-progression free survival, overall survival and quality of life will be analyzed as secondary end points.DiscussionThe aim of this study is to confirm the toxicity results of the Japanese data in raster scan technique and to compare it with the toxicity analysis of proton therapy given in the same fractionation. Using this data, a further randomized phase III trial is planned, comparing hypofractionated proton and carbon ion irradiation.Trial registrationClinicalTrials.gov Identifier: NCT01811394.

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Section: Discussionmentioning

confidence: 99%

Randomized phase II trial of hypofractionated proton versus carbon ion radiation therapy in patients with sacrococcygeal chordoma-the ISAC trial protocol

et al. 2014

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“…Among these factors, calcium deposits in nerve roots and defective remodelling of the sacral bone structure after CIRT were observed in patients with sciatic nerve injury and symptoms (Figure 4). Yanagi et al [24] used dosesurface histogram (DSH) to analyse the skin reaction of patients with bone and soft tissue sarcoma after CIRT. The area irradiated with .60 GyE (S 60 .20 cm 2 ) on DSH was found to correlate significantly with late skin reactions that were worse than Grade 3.…”

Section: Discussionmentioning

confidence: 99%

Carbon ion radiotherapy for sacral chordoma

Imai¹,

Kamada²,

Sugahara³

et al. 2011

BJR

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ABSTRACT. The National Institute of Radiological Sciences in Chiba, Japan has offered carbon ion radiotherapy (CIRT) since 1994 using carbon ion beams generated by the heavy ion medical accelerator in Chiba (HIMAC). The total number of cases treated with the HIMAC exceeded 5000 in July 2009. Here, we present a retrospective analysis of CIRT for sacral chordoma. The study included 95 patients with medically unresectable sacral chordomas treated between 1996 and 2007. The median age of the patients was 66 years. Of all the patients, 84 had not been treated previously and 11 had a locally recurrent tumour following previous resection. The carbon ion dose ranged from 52.8 to 73.6 GyE (median 70.4 GyE) in a total of 16 fixed fractions over 4 weeks. The median clinical target volume was 370 cm 3 . The overall survival rate at 5 years for all 95 patients was 86%, and follow-up survival time was 42 months (range, 13-112 months). The 5-year local control rate was 88% and median time to local failure was 35 months (range, 13-60 months). Of the 95 patients, 91% remained ambulatory with or without a supportive device. Two patients experienced severe skin or soft tissue complications requiring skin grafts. 15 patients experienced severe sciatic nerve complications requiring continuing medication. CIRT appears effective and safe in the management of patients with sacral chordoma and offers a promising alternative to surgery.

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“…Although carbon ions exhibit favorable physical and biological properties, investigations into the effects of carbon ion radiotherapy on normal tissue have been negligible, raising some concerns about potential damage to healthy tissues (107,101). Only a few studies have been done to investigate the effects of carbon ion irradiation on cartilage in the context of chondrosarcoma treatment (2,(108)(109)(110).…”

Section: Unconventional Exposure Of the Cartilage: Hadrontherapy Withmentioning

confidence: 99%

Impact of Therapeutic Irradiation on Healthy Articular Cartilage

Saintigny¹,

Cruet-Hennequart²,

Hamdi³

et al. 2015

Radiation Research

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Radiation-induced complications in bone and cartilage are of increasing concern due to potential long-term effects in cancer survivors. Healthy articular cartilage may be exposed to radiation during either chondrosarcoma treatment or in-field radiotherapy of tumors located in close proximity to articulation. Cartilage exposed to radiation undergoes bone differentiation and senescence, which can lead to painful and disabling sequelae that can impair patient quality of life. An understanding of the biological processes involved in healthy cartilage response to radiotherapy may not only optimize the delivery of therapeutic radiation but also reduce the risk of long-term sequelae in irradiated cartilage. Over the last few decades, radiobiology studies have focused primarily on signaling and repair of DNA damage pathways induced by ionizing radiation in immortalized cells under conditions dramatically different from human homeostasis. This research needs to be continued and broadened, since the range of normal tissue responses to radiation exposure is still not fully understood, despite being recognized as the major limiting factor in the rupture of tissue homeostasis after radiotherapy. Human articular cartilage is an avascular tissue with low intracellular oxygen levels and is comprised of a single cell lineage of chondrocytes embedded in a highly dense and structured extracellular matrix. These relatively unique features may impact inherent cell radiation sensitivity and suggests that canonical cell responses to ionizing radiation may not be applicable to articular cartilage. Despite the number of studies in this field, radiation-induced modifications of chondrocyte proteome remain unclear because of the dramatic variability in reported experimental conditions. In this review, we propose to introduce cartilage tissue physiology and microenvironment concepts, and then present a comprehensive synthesis of cartilage radiation biology.

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Dose–volume histogram and dose–surface histogram analysis for skin reactions to carbon ion radiotherapy for bone and soft tissue sarcoma

Cited by 49 publications

References 14 publications

Randomized phase II trial of hypofractionated proton versus carbon ion radiation therapy in patients with sacrococcygeal chordoma-the ISAC trial protocol

Randomized phase II trial of hypofractionated proton versus carbon ion radiation therapy in patients with sacrococcygeal chordoma-the ISAC trial protocol

Carbon ion radiotherapy for sacral chordoma

Impact of Therapeutic Irradiation on Healthy Articular Cartilage

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