Methodologies to Increase the Level of Evidence of Real-life Proton Therapy in Head and Neck Tumors

Dionisi, Francesco; Widesott, L.; Vulpen, Marco van; Fuller, Clifton D.; Frondizi, Rocco; Meneguzzo, Marco; Blanchard, Pierre; Amichetti, Maurizio; Sanguineti, Giuseppe

doi:10.14338/ijpt-20-00051.1

Cited by 3 publications

(1 citation statement)

References 51 publications

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“…In brief, for each patient who may benefit from proton radiotherapy, a comparison between the most optimal photon and proton therapy plans were performed with the aim of estimating the NTCP profiles (considering the dose distribution and other clinical/treatment variables) for both techniques. The subtraction of photon-based from the proton-based NTCP (∆NTCP) gives the probability of toxicity and patients are considered eligible for proton therapy if the model predicts less clinically relevant toxicity [102,103].…”

Section: Clinical Research Trialsmentioning

confidence: 99%

Hadron Therapy Achievements and Challenges: The CNAO Experience

Rossi

2022

Physics

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Protons and carbon ions (hadrons) have useful properties for the treatments of patients affected by oncological pathologies. They are more precise than conventional X-rays and possess radiobiological characteristics suited for treating radio-resistant or inoperable tumours. This paper gives an overview of the status of hadron therapy around the world. It focusses on the Italian National Centre for Oncological Hadron therapy (CNAO), introducing operation procedures, system performance, expansion projects, methodologies and modelling to build individualized treatments. There is growing evidence that supports safety and effectiveness of hadron therapy for a variety of clinical situations. However, there is still a lack of high-level evidence directly comparing hadron therapy with modern conventional radiotherapy techniques. The results give an overview of pre-clinical and clinical research studies and of the treatments of 3700 patients performed at CNAO. The success and development of hadron therapy is strongly associated with the creation of networks among hadron therapy facilities, clinics, universities and research institutions. These networks guarantee the growth of cultural knowledge on hadron therapy, favour the efficient recruitment of patients and present available competences for R&D (Research and Development) programmes.

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Section: Clinical Research Trialsmentioning

confidence: 99%

Hadron Therapy Achievements and Challenges: The CNAO Experience

Rossi

2022

Physics

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Dosimetric and NTCP advantages of robust proton therapy over robust VMAT for Stage III NSCLC in the immunotherapy era

Dionisi,

Landoni,

Widesott

et al. 2024

Physica Medica

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Estimating the percentage of patients who might benefit from proton beam therapy instead of X-ray radiotherapy

Burnet

Mee

Gaito

et al. 2022

BJR

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Objectives: High energy Proton Beam Therapy (PBT) commenced in England in 2018 and NHS England commissions PBT for 1.5% of patients receiving radical radiotherapy. We sought expert opinion on the level of provision. Methods: Invitations were sent to 41 colleagues working in PBT, most at one UK centre, to contribute by completing a spreadsheet. 39 responded: 23 (59%) completed the spreadsheet; 16 (41%) declined, arguing that clinical outcome data are lacking, but joined six additional site-specialist oncologists for two consensus meetings. The spreadsheet was pre-populated with incidence data from Cancer Research UK and radiotherapy use data from the National Cancer Registration and Analysis Service. ‘Mechanisms of Benefit’ of reduced growth impairment, reduced toxicity, dose escalation and reduced second cancer risk were examined. Results: The most reliable figure for percentage of radical radiotherapy patients likely to benefit from PBT was that agreed by 95% of the 23 respondents at 4.3%, slightly larger than current provision. The median was 15% (range 4–92%); consensus median 13%. The biggest estimated potential benefit was from reducing toxicity, median benefit to 15% (range 4–92%), followed by dose escalation median 3% (range 0 to 47%); consensus values were 12 and 3%. Reduced growth impairment and reduced second cancer risk were calculated to benefit 0.5 and 0.1%. Conclusions: The most secure estimate of percentage benefit was 4.3% but insufficient clinical outcome data exist for confident estimates. The study supports the NHS approach of using the evidence base, and developing it through randomised trials, non-randomised studies and outcomes tracking. Advances in knowledge: Less is known about the percentage of patients who may benefit from PBT than is generally acknowledged. Expert opinion varies widely. Insufficient clinical outcome data exists to provide robust estimates. Considerable further work is needed to address this, including international collaboration; much is already underway but will take time to provide mature data.

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Methodologies to Increase the Level of Evidence of Real-life Proton Therapy in Head and Neck Tumors

Cited by 3 publications

References 51 publications

Hadron Therapy Achievements and Challenges: The CNAO Experience

Hadron Therapy Achievements and Challenges: The CNAO Experience

Dosimetric and NTCP advantages of robust proton therapy over robust VMAT for Stage III NSCLC in the immunotherapy era

Estimating the percentage of patients who might benefit from proton beam therapy instead of X-ray radiotherapy

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