New Clinical and Research Programs in Particle Beam Radiation Therapy: The University of California San Francisco Perspective

Roach, Mack; Schulte, R.; Mishra, Kavita; Faddegon, Bruce A.; Barani, Igor J.; Lazar, Ann; Blakely, Eleanor A.

doi:10.14338/ijpt-15-00025.1

Cited by 4 publications

(6 citation statements)

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“…CIRT has not been adopted in the United States because of cost and the absence of high‐level clinical evidence . A CIRT facility currently costs substantially more to build and run than a proton facility with the same number of gantries and fixed beam lines, and level I clinical data in support of CIRT is currently lacking.…”

Section: Opening Statementsmentioning

confidence: 99%

Three discipline collaborative radiation therapy (3DCRT) special debate: The United States needs at least one carbon ion facility

Blakely

Faddegon

Tinkle

et al. 2019

J Applied Clin Med Phys

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Three discipline collaborative radiation therapy (3DCRT) special debate: The United States needs at least one carbon ion facility 1 | THREE DISCIPLINE COLLABORATIVE RAD IATION THERAPY (3DCRT) DEBATE SERIESRadiation oncology is a highly multidisciplinary medical specialty, drawing significantly from three scientific disciplinesmedicine, physics, and biology. As a result, discussion of controversies or changes in practice within radiation oncology involves input from all three disciplines. For this reason, significant effort has been expended recently to foster collaborative multidisciplinary research in radiation oncology, with substantial demonstrated benefit.( 1,2 ) In light of these results, we endeavor here to adopt this "team-science" approach to the traditional debates featured in this journal. This article is part of a series of special debates entitled "Three Discipline Collaborative Radiation Therapy (3DCRT)" in which each debate team will include a radiation oncologist, medical physicist, and radiobiologist. We hope that this format will not only be engaging for the readership but will also foster further collaboration in the science and clinical practice of radiation oncology. Dominello serves as the Assistant Program Director for the RadiationOncology Residency Program and as an instructor in courses for both graduate and undergraduate students at the university. Dr.Griffin is a professor of radiation biology at the University of Arkansas for Medical Sciences. His group studies living tissue response to high-dose radiotherapy (SBRT) and spatially fractionated radiation approaches with targeted drug delivery to tumors. He served as a ---

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Section: Opening Statementsmentioning

confidence: 99%

Three discipline collaborative radiation therapy (3DCRT) special debate: The United States needs at least one carbon ion facility

Blakely

Faddegon

Tinkle

et al. 2019

J Applied Clin Med Phys

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“…We previously coined the mnemonic “RESIDUE” to call attention to 7 major challenges that need to be solved to advance this field and allow CIRT to be widely available . These 7 major “RESIDUE” challenges are as follows: Radiobiologic knowledge to address uncertainty in optimal fraction sizes and doses and relative biologic effectiveness for each tumor site (biologic); Exchange of technology, funding, and infrastructure between academic centers, health care payers, industry, and funding agencies (operational); Size/weight of accelerators and gantries (engineering/physics and cost); Integration of technology to advance key areas from beam acceleration and delivery through treatment planning and image guidance (engineering/physics to create equipoise with x‐ray–based treatment); Define the patient population to be studied—that is, identify and select patients who will benefit the most from CIRT (clinical); Uncertainties of effective dose and range at the end of the Bragg peak (physics and accuracy); and Evidence of clinical effectiveness and cost effectiveness (societal). …”

Section: Challenges and Future Directionsmentioning

confidence: 99%

“…We previously coined the mnemonic “RESIDUE” to call attention to 7 major challenges that need to be solved to advance this field and allow CIRT to be widely available. 24…”

Section: Challenges and Future Directionsmentioning

confidence: 99%

“…Issues 2 and 3 (above), represent true challenges to building new CIRT facilities in the USA, but are also an opportunity that could lead to improved cost-effectivness. Issues 4 and 6 (above) can be readily accomplished via ongoing research in existing facilitiess (such as work currently being performed by NAPTA members) 24 and future research-oriented facilities. This leaves primarily issues 5 and 7 to be addressed.…”

Section: Challenges and Future Directionsmentioning

confidence: 99%

“…Considering potential physical, biological, and cost-effective advantages have led us to pursue this field of research through the North American Particle Alliance (NAPTA), which was formed in 2013 to advance the development of therapy with carbon and other ions in the USA and world-wide. 24 Our work was predicated on the assumption that there was a sufficient body of evidence to justify the re-establishment of a CIRT Center in the USA. However, the cost of a US facility with existing CIRT technology has been estimated to be $200 to $300 million US dollars.…”

Section: Introductionmentioning

confidence: 99%

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Clinical trials involving carbon‐ion radiation therapy and the path forward

Lazar

Schulte

Faddegon

et al. 2018

Cancer

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To describe the international landscape of clinical trials in carbon ion radiotherapy (CIRT), we reviewed the current status of 63 ongoing clinical trials (median: 47 subjects) involving CIRT identified from the clinicaltrials.gov trial registry and World Health Organization International Clinical Trials Platform Registry. We evaluated the potential for these trials to define the role of this modality in the treatment of specific cancer types, and to identify major challenges and opportunities to advance this technology. A significant body of literature suggests the potential for advantageous dose distributions and in preclinical biologic studies the enhanced effectiveness for CIRT compared to photons and protons. Additionally, clinical evidence, though limited, from phase I/II trials indicates the potential for CIRT to improve cancer outcomes. However, at present, high level phase III randomized clinical trial evidence does not exist. While there has been an increase in the number of trials investigating CIRT since 2010, and the number of countries and sites offering CIRT is slowly growing, this progress has excluded other countries. We propose several recommendations to study this modality in order to accelerate progress in the field, including to (1) increase the number of multi-national randomized clinical trials (2) leveraging existing CIRT facilities to launch larger multi-national trials directed at common cancers combined with high level quality assurance; and (3) developing more compact and less expensive “next generation” treatment systems integrated with radiobiological research and pre-clinical testing.

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Charged-particle therapy in cancer: clinical uses and future perspectives

2017

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Radiotherapy with high-energy charged particles has become an attractive therapeutic option for patients with several tumour types because this approach better spares healthy tissue from radiation than conventional photon therapy. The cost associated with the delivery of charged particles, however, is higher than that of even the most elaborate photon-delivery technologies. Reliable evidence of the relative cost-effectiveness of both modalities can only come from the results of randomized clinical trials. Thus, the hurdles that currently limit direct comparisons of these two approaches in clinical trials, especially those related to insurance coverage, should be removed. Herein, we review several randomized trials of charged-particle therapies that are ongoing, with results that will enable selective delivery to patients who are most likely to benefit from them. We also discuss aspects related to radiobiology, including the immune response and hypoxia, which will need to be taken into consideration in future randomized trials to fully exploit the potential of charged particles.

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New Clinical and Research Programs in Particle Beam Radiation Therapy: The University of California San Francisco Perspective

Cited by 4 publications

References 8 publications

Three discipline collaborative radiation therapy (3DCRT) special debate: The United States needs at least one carbon ion facility

Three discipline collaborative radiation therapy (3DCRT) special debate: The United States needs at least one carbon ion facility

Clinical trials involving carbon‐ion radiation therapy and the path forward

Charged-particle therapy in cancer: clinical uses and future perspectives

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