Mortality of early treatment for radiation-induced brain necrosis in head and neck cancer survivors: A multicentre, retrospective, registry-based cohort study

Pan, Dong; Rong, Xiaoming; Chen, Dongping; Jiang, Jingru; Ng, Wai Tong; Mai, Hai‐Qiang; Li, Yang; Li, Honghong; Cai, Jinhua; Cheng, Jinping; Xu, Yongteng; Chua, Melvin Lee Kiang; Simone, Charles B.; Lattanzi, Simona; Tang, Yamei

doi:10.1016/j.eclinm.2022.101618

Cited by 7 publications

(3 citation statements)

References 26 publications

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“…Conventional-rate IMPT is often utilized in reirradiation to reduce toxicity [58], but it still carries toxicity risks [19,59]. PBS Bragg peak FLASH and its combination of FLASH dose rate and conformal dose sparing of OARs is appealing in this scenario to mitigate these risks, with the goal of reducing carotid injury [14,15,60] and TLI [16,61,62] and enabling more aggressive re-treatment dose-fractionation regimens that improve tumor control with similar or less toxicity.…”

Section: Discussionmentioning

confidence: 99%

“…Due to prior receipt of high-dose radiation, head and neck reirradiation can cause numerous acute and late complications, and there remains a great need for an improved therapeutic ratio [13]. Radiation dose is a risk factor for carotid intimal disease leading to rupture and stroke [14,15], and causes temporal lobe injury (TLI), temporal lobe necrosis (TLN) [16], and cognitive impairment in a volume-dependent fashion [17][18][19]. Proton therapy is often considered in this context for conformality and minimization of cumulative dose overlap [20][21][22].…”

Section: Introductionmentioning

confidence: 99%

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Proton Bragg Peak FLASH Enables Organ Sparing and Ultra-High Dose-Rate Delivery: Proof of Principle in Recurrent Head and Neck Cancer

Pennock

Wei

Cheng

et al. 2023

Cancers

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Proton pencil-beam scanning (PBS) Bragg peak FLASH combines ultra-high dose rate delivery and organ-at-risk (OAR) sparing. This proof-of-principle study compared dosimetry and dose rate coverage between PBS Bragg peak FLASH and PBS transmission FLASH in head and neck reirradiation. PBS Bragg peak FLASH plans were created via the highest beam single energy, range shifter, and range compensator, and were compared to PBS transmission FLASH plans for 6 GyE/fraction and 10 GyE/fraction in eight recurrent head and neck patients originally treated with quad shot reirradiation (14.8/3.7 CGE). The 6 GyE/fraction and 10 GyE/fraction plans were also created using conventional-rate intensity-modulated proton therapy techniques. PBS Bragg peak FLASH, PBS transmission FLASH, and conventional plans were compared for OAR sparing, FLASH dose rate coverage, and target coverage. All FLASH OAR V40 Gy/s dose rate coverage was 90–100% at 6 GyE and 10 GyE for both FLASH modalities. PBS Bragg peak FLASH generated dose volume histograms (DVHs) like those of conventional therapy and demonstrated improved OAR dose sparing over PBS transmission FLASH. All the modalities had similar CTV coverage. PBS Bragg peak FLASH can deliver conformal, ultra-high dose rate FLASH with a two-millisecond delivery of the minimum MU per spot. PBS Bragg peak FLASH demonstrated similar dose rate coverage to PBS transmission FLASH with improved OAR dose-sparing, which was more pronounced in the 10 GyE/fraction than in the 6 GyE/fraction. This feasibility study generates hypotheses for the benefits of FLASH in head and neck reirradiation and developing biological models.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Proton Bragg Peak FLASH Enables Organ Sparing and Ultra-High Dose-Rate Delivery: Proof of Principle in Recurrent Head and Neck Cancer

Pennock

Wei

Cheng

et al. 2023

Cancers

Self Cite

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“…The incidence of fRNB is estimated to be between 7-24% [3][4][5][6]. Signs and symptoms include neurological deficits, cognitive decline, increased intracranial pressure and/or seizures [7]. The primary pathogenesis of fRNB is not yet fully understood, but damage to small blood vessels is suspected to be the principal cause [8,9].…”

Section: Introductionmentioning

confidence: 99%

Low-Dose Bevacizumab for the Treatment of Focal Radiation Necrosis of the Brain (fRNB): A Single-Center Case Series

Tijtgat

Calliauw

Dirven

et al. 2023

Cancers

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Focal radiation necrosis of the brain (fRNB) is a late adverse event that can occur following the treatment of benign or malignant brain lesions with stereotactic radiation therapy (SRT) or stereotactic radiosurgery (SRS). Recent studies have shown that the incidence of fRNB is higher in cancer patients who received immune checkpoint inhibitors. The use of bevacizumab (BEV), a monoclonal antibody that targets the vascular endothelial growth factor (VEGF), is an effective treatment for fRNB when given at a dose of 5–7.5 mg/kg every two weeks. In this single-center retrospective case series, we investigated the effectiveness of a low-dose regimen of BEV (400 mg loading dose followed by 100 mg every 4 weeks) in patients diagnosed with fRNB. A total of 13 patients were included in the study; twelve of them experienced improvement in their existing clinical symptoms, and all patients had a decrease in the volume of edema on MRI scans. No clinically significant treatment-related adverse effects were observed. Our preliminary findings suggest that this fixed low-dose regimen of BEV can be a well-tolerated and cost-effective alternative treatment option for patients diagnosed with fRNB, and it is deserving of further investigation.

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Cost-effectiveness analysis of bevacizumab for cerebral radiation necrosis treatment based on real-world utility value in China

Luo,

Lai,

et al. 2024

Strahlenther Onkol

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Mortality of early treatment for radiation-induced brain necrosis in head and neck cancer survivors: A multicentre, retrospective, registry-based cohort study

Cited by 7 publications

References 26 publications

Proton Bragg Peak FLASH Enables Organ Sparing and Ultra-High Dose-Rate Delivery: Proof of Principle in Recurrent Head and Neck Cancer

Proton Bragg Peak FLASH Enables Organ Sparing and Ultra-High Dose-Rate Delivery: Proof of Principle in Recurrent Head and Neck Cancer

Low-Dose Bevacizumab for the Treatment of Focal Radiation Necrosis of the Brain (fRNB): A Single-Center Case Series

Cost-effectiveness analysis of bevacizumab for cerebral radiation necrosis treatment based on real-world utility value in China

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