Pencil Beam Scanning Proton Therapy Case Selection for Paediatric Abdominal Neuroblastoma: Effects of Tumour Location and Bowel Gas

Lim, P.; Rompokos, V.; Bizzocchi, Nicola; Gillies, Carl L.; Gosling, Andre F.; Royle, G.; Chang, Yen-Ching; Gaze, Mark; Gains, J.

doi:10.1016/j.clon.2020.08.012

Cited by 11 publications

(22 citation statements)

References 26 publications

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“…Other cohorts will also have unique characteristics not commonly found in the CSI cohort. For example, excessive gas in the bowel is observed commonly in abdominal neuroblastoma patients (Lim et al 2020 ), increasing the challenges in co-registering these images to a CSI-based template.…”

Section: Discussionmentioning

confidence: 99%

Atlas construction and spatial normalisation to facilitate radiation-induced late effects research in childhood cancer

et al. 2021

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Reducing radiation-induced side effects is one of the most important challenges in paediatric cancer treatment. Recently, there has been growing interest in using spatial normalisation to enable voxel-based analysis of radiation-induced toxicities in a variety of patient groups. The need to consider three-dimensional distribution of doses, rather than dose-volume histograms, is desirable but not yet explored in paediatric populations. In this paper, we investigate the feasibility of atlas construction and spatial normalisation in paediatric radiotherapy. We used planning computed tomography (CT) scans from twenty paediatric patients historically treated with craniospinal irradiation to generate a template CT that is suitable for spatial normalisation. This childhood cancer population representative template was constructed using groupwise image registration. An independent set of 53 subjects from a variety of childhood malignancies was then used to assess the quality of the propagation of new subjects to this common reference space using deformable image registration (i.e. spatial normalisation). The method was evaluated in terms of overall image similarity metrics, contour similarity and preservation of dose-volume properties. After spatial normalisation, we report a dice similarity coefficient of 0.95 ± 0.05, 0.85 ± 0.04, 0.96 ± 0.01, 0.91 ± 0.03, 0.83 ± 0.06 and 0.65 ± 0.16 for brain and spinal canal, ocular globes, lungs, liver, kidneys and bladder. We then demonstrated the potential advantages of an atlas-based approach to study the risk of second malignant neoplasms after radiotherapy. Our findings indicate satisfactory mapping between a heterogeneous group of patients and the template CT. The poorest performance was for organs in the abdominal and pelvic region, likely due to respiratory and physiological motion and to the highly deformable nature of abdominal organs. More specialised algorithms should be explored in the future to improve mapping in these regions. This study is the first step toward voxel-based analysis in radiation-induced toxicities following paediatric radiotherapy.

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Section: Discussionmentioning

confidence: 99%

Atlas construction and spatial normalisation to facilitate radiation-induced late effects research in childhood cancer

et al. 2021

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“…Twenty high-risk patients with abdominal primaries who received 3D-CRT historically at University College London Hospital were selected for this study as described in our previous publications [11,15]. Consent for data usage for research purposes was available for all cases.…”

Section: Patient Selectionmentioning

confidence: 99%

“…The male to female ratio of this cohort was 11:9 with a median age of 4 years (range; 1-9 years). Nine patients displayed midline tumours where the remaining presented with well-lateralised tumours (five right-sided and six left-sided) [15].…”

Section: Patient Selectionmentioning

confidence: 99%

“…Dose distributions from clinically acceptable 3D-CRT, IMAT and PBS-PT plans, described in previous studies were analysed [11,15]. The prescribed dose was 21 Gy(RBE) over 14 fractions as per the International Society of Paediatric Oncology European (SIOPEN) High-Risk-1 protocol for high-risk neuroblastoma [5].…”

Section: Overview Of Treatment Planning Techniquesmentioning

confidence: 99%

“…Three-dimensional Conformal (photon) Radiation Therapy (3D-CRT) with opposing anterior and posterior parallel (AP/ PA) fields is still the standard radiotherapy modality choice in many centres, despite full prescription delivery being frequently hindered by the low tolerance dose of the neighbouring liver and kidneys [10,11]. Advanced state-of-the-art modalities such as Intensity Modulated Arc Therapy (IMAT) and proton therapy have great potential to address challenges in neuroblastoma treatment [12,13] due to their increased conformity and reduced non-target high-dose regions [11,[14][15][16][17][18]. However, adopting new radiotherapy modalities in paediatric cancer management has historically been approached with caution due to the potential impact of long-term sequelae [19].…”

Section: Introductionmentioning

confidence: 99%

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Risk of radiation-induced second malignant neoplasms from photon and proton radiotherapy in paediatric abdominal neuroblastoma

Taylor

Lim

Ahmad

et al. 2021

Physics and Imaging in Radiation Oncology

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Background and Purpose: State-of-the-art radiotherapy modalities have the potential of reducing late effects of treatment in childhood cancer survivors. Our aim was to investigate the carcinogenic risk associated with 3D conformal (photon) radiation (3D-CRT), intensity modulated arc therapy (IMAT) and pencil beam scanning proton therapy (PBS-PT) in the treatment of paediatric abdominal neuroblastoma. Materials and Methods: The risk of radiation-induced second malignant neoplasm (SMN) was estimated using the concept of organ equivalent dose (OED) for eleven organs (lungs, rectum, colon, stomach, small intestine, liver, bladder, skin, central nervous system (CNS), bone, and soft tissues). The risk ratio (RR) between radiotherapy modalities and lifetime absolute risks (LAR) were reported for twenty abdominal neuroblastoma patients (median, 4y; range, 1-9y) historically treated with 3D-CRT that were also retrospectively replanned for IMAT and PBS-PT. Results: The risk of SMN due to primary radiation was reduced in PBS-PT against 3D-CRT and IMAT for most patients and organs. The RR across all organs ranged from 0.38 ± 0.22 (bladder) to 0.98 ± 0.04 (CNS) between PBS-PT and IMAT, and 0.12 ± 0.06 (rectum and bladder) to 1.06 ± 0.43 (bone) between PBS-PT and 3D-CRT. The LAR for most organs was within 0.01-1% (except the colon) with a cumulative risk of 21 ± 13%, 35 ± 14% and 35 ± 16% for PBS-PT, IMAT and 3D-CRT, respectively. Conclusions: PBS-PT was associated with the lowest risk of radiation-induced SMN compared to IMAT and 3D-CRT in abdominal neuroblastoma treatment. Other clinical endpoints and plan robustness should also be considered for optimal plan selection.

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A Randomised Phase II Trial to Evaluate the Feasibility of Radiotherapy Dose Escalation, Facilitated by Intensity-Modulated Arc Radiotherapy Techniques, in High-Risk Neuroblastoma

Gains,

Patel,

Chang

et al. 2024

Clinical Oncology

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Pencil Beam Scanning Proton Therapy Case Selection for Paediatric Abdominal Neuroblastoma: Effects of Tumour Location and Bowel Gas

Cited by 11 publications

References 26 publications

Atlas construction and spatial normalisation to facilitate radiation-induced late effects research in childhood cancer

Atlas construction and spatial normalisation to facilitate radiation-induced late effects research in childhood cancer

Risk of radiation-induced second malignant neoplasms from photon and proton radiotherapy in paediatric abdominal neuroblastoma

A Randomised Phase II Trial to Evaluate the Feasibility of Radiotherapy Dose Escalation, Facilitated by Intensity-Modulated Arc Radiotherapy Techniques, in High-Risk Neuroblastoma

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