Proton therapy for thoracic malignancies: a review of oncologic outcomes

Patel, Nirav; Koroulakis, Antony; Diwanji, Tejan; Sawant, Amit; Sio, Terence T.; Mohindra, Pranshu

doi:10.1080/14737140.2021.1844567

Cited by 3 publications

(4 citation statements)

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Section: Tablementioning

confidence: 99%

“…2 Proton beam therapy allows better delivery of radiation intensity to the target area, up to a maximum that occurs near the end of the particle's range (the Bragg peak), again depositing even less energy in surrounding healthy tissue. 3 Despite all of these advances, however, radiation-induced toxicity, side effects, f profile. 4,5 With pelvic radiation therapy, the risks are well defined by anatomical boundaries, and classification and grading of complications are defined by consensus guidelines (►Table 1).…”

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confidence: 99%

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Pelvic Radiation Disease

Sammour

Kahokehr

2022

Clin Colon Rectal Surg

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Pelvic radiation is increasingly being used for the neoadjuvant and definitive treatment of pelvic organ malignancy. While this treatment can be highly effective, and may assist in organ sparing, it is also associated with significant toxicity and devastating adverse events that need to be considered. In broad terms, pelvic radiation disease affects both the primary target organ as well as adjacent organs and soft tissue structures, with complications that can be classified and graded according to consensus criteria. The complication grade is often modality, dose, and area dependent. The most common manifestations are proctitis, cystitis, recto-urethral fistula, ureteric stricture, and bone involvement. Toxicity can be misdiagnosed for many years, resulting in significant management delays. Complications can be difficult to prevent and challenging to treat, requiring specialized multi-disciplinary input to achieve the best possible strategy to minimize impact and improve patient quality of life.

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Section: Tablementioning

confidence: 99%

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confidence: 99%

Pelvic Radiation Disease

Sammour

Kahokehr

2022

Clin Colon Rectal Surg

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“…Yet, modern advances in radiation delivery have allowed better sparing of normal tissue (15,16). Proton therapy, in particular, offers a dosimetric advantage in sparing normal tissue by minimizing exit dose that can enable delivery of curative intent re-irradiation doses (17)(18)(19). While most prior reports of proton therapy in the thorax employed passive scatter technique, intensity-modulated proton therapy (IMPT) is more conformal and enables lower doses to the normal lung, heart, and esophagus with subsequent lower rates of toxicity (20).…”

Section: Introductionmentioning

confidence: 99%

Definitive intensity modulated proton re-irradiation for lung cancer in the immunotherapy era

Janopaul‐Naylor

Cao²,

McCall³

et al. 2023

Front. Oncol.

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IntroductionAs immunotherapy has improved distant metastasis-free survival (DMFS) in Non-Small Cell Lung Cancer (NSCLC), isolated locoregional recurrences have increased. However, management of locoregional recurrences can be challenging. We report our institutional experience with definitive intent re-irradiation using Intensity Modulated Proton Therapy (IMPT).MethodRetrospective cohort study of recurrent or second primary NSCLC or LS-SCLC treated with IMPT. Kaplan-Meier method and log-rank test were used for time-to-event analyses.Results22 patients were treated from 2019 to 2021. After first course of radiation (median 60 Gy, range 45-70 Gy), 45% received adjuvant immunotherapy. IMPT re-irradiation began a median of 28.2 months (8.8-172.9 months) after initial radiotherapy. The median IMPT dose was 60 GyE (44-60 GyE). 36% received concurrent chemotherapy with IMPT and 18% received immunotherapy after IMPT. The median patient’s IMPT lung mean dose was 5.3 GyE (0.9-13.9 GyE) and 5 patients had cumulative esophagus max dose >100 GyE with 1-year overall survival (OS) 68%, 1-year local control 80%, 1-year progression free survival 45%, and 1-year DMFS 60%. Higher IMPT (HR 1.4; 95% CI 1.1-1.7, p=0.01) and initial radiotherapy mean lung doses (HR 1.3; 95% CI 1.0-1.6, p=0.04) were associated with worse OS. Two patients developed Grade 3 pneumonitis or dermatitis, one patient developed Grade 2 pneumonitis, and seven patients developed Grade 1 toxicity. There were no Grade 4 or 5 toxicities.DiscussionDefinitive IMPT re-irradiation for lung cancer can prolong disease control with limited toxicity, particularly in the immunotherapy era.

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“…There are drastic dose reductions to the contralateral lung, heart, liver, kidneys, and stomach ( 2 ). Re-irradiation, advanced disease requiring extensive cardio-pulmonary irradiated volumes, and younger patients may likely benefit from modern PBT ( 3 ). New techniques like stereotactic body radiation therapy (SBRT) and PBT are now increasingly adopted as the only radical treatment for small solitary lung tumors ( 4 ) and represent the most used non-surgical modality in treating lung cancers, permitting the improvement of treatment outcomes and favorable toxicities.…”

Section: Introductionmentioning

confidence: 99%

Imaging Strategies in Proton Therapy for Thoracic Tumors: A Mini Review

Algranati

Strigari

2022

Front. Oncol.

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Proton beam therapy (PBT) is often more attractive for its high gradient dose distributions than other treatment modalities with external photon beams. However, in thoracic lesions treated particularly with pencil beam scanning (PBS) proton beams, several dosimetric issues are addressed. The PBS approach may lead to large hot or cold spots in dose distributions delivered to the patients, potentially affecting the tumor control and/or increasing normal tissue side effects. This delivery method particularly benefits image-guided approaches. Our paper aims at reviewing imaging strategies and their technological trends for PBT in thoracic lesions. The focus is on the use of imaging strategies in simulation, planning, positioning, adaptation, monitoring, and delivery of treatment and how changes in the anatomy of thoracic tumors are handled with the available tools and devices in PBT. Starting from bibliographic research over the past 5 years, retrieving 174 papers, major key questions, and implemented solutions were identified and discussed; the results aggregated and presented following the methodology of analysis of expert interviews.

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Proton therapy for thoracic malignancies: a review of oncologic outcomes

Cited by 3 publications

References 100 publications

Pelvic Radiation Disease

Pelvic Radiation Disease

Definitive intensity modulated proton re-irradiation for lung cancer in the immunotherapy era

Imaging Strategies in Proton Therapy for Thoracic Tumors: A Mini Review

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