Protons and more: state of the art in radiotherapy

Hoskin, Peter; Bhattacharya, Indrani

doi:10.7861/clinmedicine.14-6-s61

Cited by 18 publications

(11 citation statements)

References 15 publications

(12 reference statements)

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“…Thus, in cases of meningioma recurrence after RT treatment options are limited, and a second course of RT is discussed frequently when no other alternatives are available. Although high precision photon RT modalities such as SRS/FSRT and IMRT are widely available by now, particle therapy still offers several distinct advantages due to its unique physical characteristics that allow a local dose peak (Bragg Peak) at a variably definable depth level with very little dose deposition up to and beyond that point [ 29 ]. Over the past years, several planning studies have shown repeatedly that particle therapy can deliver higher dose conformity, with maximum dose applied to the tumor and reduction of medium and low dose to the surrounding tissue, thus reducing the overall integral dose and effectively sparing OAR [ 30 – 32 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of particle radiotherapy for the re-irradiation of recurrent intracranial meningioma

et al. 2018

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BackgroundWith the advance of modern irradiation techniques, the role of radiotherapy (RT) for intracranial meningioma has increased significantly throughout the past years. Despite that tumor’s generally favorable outcome with local control rates of up to 90% after ten years, progression after RT does occur. In those cases, re-irradiation is often difficult due to the limited radiation tolerance of the surrounding tissue. The aim of this analysis is to determine the value of particle therapy with its better dose conformity and higher biological efficacy for re-irradiating recurrent intracranial meningioma. It was performed within the framework of the “clinical research group heavy ion therapy” and funded by the German Research Council (DFG, KFO 214).MethodsForty-two patients treated with particle RT (protons (n = 8) or carbon ions (n = 34)) for recurrent intracranial meningioma were included in this analysis. Location of the primary lesion varied, including skull base (n = 31), convexity (n = 5) and falx (n = 6). 74% of the patients were categorized high-risk according to histology with a WHO grading of II (n = 25) or III (n = 6), in the remaining cases histology was either WHO grade I (n = 10) or unknown (n = 1). Median follow-up was 49,7 months.ResultsIn all patients, re-irradiation could be performed safely without interruptions due to side effects. No grade IV or V toxicities according to CTCAE v4.0 were observed. Particle RT offered good overall local control rates with 71% progression-free survival (PFS) after 12 months, 56,5% after 24 months and a median PFS of 34,3 months (95% CI 11,7–56,9). Histology had a significant impact on PFS yielding a median PFS of 25,7 months (95% CI 5,8–45,5) for high-risk histology (WHO grades II and III) while median PFS was not reached for low-risk tumors (WHO grade I) (p = 0,03). Median time to local progression was 15,3 months (Q1-Q3 8,08–34,6). Overall survival (OS) after re-irradiation was 89,6% after 12 months and 71,4% after 24 months with a median OS of 61,0 months (95% CI 34,2–87,7). Again, WHO grading had an effect, as median OS for low-risk patients was not reached whereas for high-risk patients it was 45,5 months (95% CI 35,6–55,3).ConclusionRe-irradiation using particle therapy is an effective method for the treatment of recurrent meningiomas. Interdisciplinary decision making is necessary to guarantee best treatment for every patient.

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Section: Discussionmentioning

confidence: 99%

Evaluation of particle radiotherapy for the re-irradiation of recurrent intracranial meningioma

et al. 2018

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“…One of the main rationales for the use of particle therapy lies in its higher dose conformity, potentially allowing for better OAR sparing and the reduction of side effects [ 19 – 21 ]. The energy-deposition of accelerated photons occurs continuously over a comparably wide range of penetration depths through tissue [ 22 ]. The improved dose distribution of particle therapy is achieved by exploiting the physical characteristics of particle irradiation where the maximum dose deposition occurs within the sharply defined Bragg peak [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome after particle therapy for meningiomas of the skull base: toxicity and local control in patients treated with active rasterscanning

et al. 2018

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BackgroundMeningiomas of the skull base account for 25–30% of all meningiomas. Due to the complex structure of the cranial base and its close proximity to critical structures, surgery is often associated with substantial morbidity. Treatment options include observation, aggressive surgical intervention, stereotactic or conventional radiotherapy.In this analysis we evaluate the outcome of 110 patients with meningiomas of the skull base treated with particle therapy. It was performed within the framework of the “clinical research group heavy ion therapy” and supported by the German Research Council (DFG, KFO 214).MethodsBetween May 2010 and November 2014, 110 Patients with skull base meningioma were treated with particle radiotherapy at the Heidelberg Ion Therapy Center (HIT). Primary localizations included the sphenoid wing (n = 42), petroclival region (n = 23), cavernous sinus (n = 4), sella (n = 10) and olfactory nerve (n = 4). Sixty meningiomas were benign (WHO °I); whereas 8 were high-risk (WHO °II (n = 7) and °III (n = 1)). In 42 cases histology was not examined, since no surgery was performed.Proton (n = 104) or carbon ion (n = 6) radiotherapy was applied at Heidelberg Ion Therapy Center (HIT) using raster-scanning technique for active beam delivery. Fifty one patients (46.4%) received radiotherapy due to tumor progression, 17 (15.5%) after surgical resection and 42 (38.2%) as primary treatment.ResultsMedian follow-up in this analysis was 46,8 months (95% CI 39,9–53,7; Q1-Q3 34,3–61,7). Particle radiotherapy could be performed safely without toxicity-related interruptions. No grade IV or V toxicities according to CTCAE v4.0 were observed. Particle RT offered excellent overall local control rates with 100% progression-free survival (PFS) after 36 months and 96.6% after 60 months. Median PFS was not reached due to the small number of events. Histology significantly impacted PFS with superior PFS after 5 years for low-risk tumors (96.6% vs. 75.0%, p = 0,02). Overall survival was 96.2% after 60 months and 92.0% after 72 months from therapy. Of six documented deaths, five were definitely not and the sixth probably not meningioma-related.ConclusionParticle radiotherapy is an excellent treatment option for patients with meningiomas of the skull base and can lead to long-term tumor control with minimal side effects. Other prospective studies with longer follow-up will be necessary to further confirm the role of particle radiotherapy in skull base meningioma.

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“…Radiotherapy (RT) is the generally prescribed treatment for localized cancer ( 1 , 2 ). However, evidence from clinical and experimental data has suggested that there may be tumor regression at non-irradiated tumor sites in addition to at the irradiated site (so called abscopal effects) ( 3 – 5 ).…”

Section: Introductionmentioning

confidence: 99%

Abscopal effect of radiation on lymph node metastasis in esophageal carcinoma: A case report and literature review

2018

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The Abscopal effect is a rare phenomenon observed in the treatment of metastatic cancer, where localized irradiation causes a response in non-irradiated tumor sites. Due to the recent success of immunotherapies, the Abscopal effect of radiation therapy has received renewed clinical interest. However, there is limited knowledge regarding the Abscopal effect and radiotherapy treatment of patients with esophageal carcinoma. The present study reports the case of a 65-year-old male patient, who presented with esophageal carcinoma and lymph node metastasis. A transthoracic esophagectomy with left cervical, mediastinal and abdominal lymphadenectomies was performed. A total of 4 cycles of chemotherapy and maintenance therapy with Pembrolizumab was performed until September 2016. Metastases in the left retroperitoneal lymph node in addition to extensive metastases to the pelvic lymph node were observed. The patient received Cyberknife radiotherapy with a dose of 42 Gy in 6 daily fractions targeted at the left retroperitoneal lymph node. Two months after radiation therapy, a positron emission tomography-computed tomography scan revealed complete regression of all lymph node metastases. There is increasing clinical evidence supporting the efficacy of the Abscopal effect, which may be initiated by high-dose radiation. Further research is required to make the Abscopal effect clinically relevant, however it may have potential as a treatment option.

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Protons and more: state of the art in radiotherapy

Cited by 18 publications

References 15 publications

Evaluation of particle radiotherapy for the re-irradiation of recurrent intracranial meningioma

Evaluation of particle radiotherapy for the re-irradiation of recurrent intracranial meningioma

Clinical outcome after particle therapy for meningiomas of the skull base: toxicity and local control in patients treated with active rasterscanning

Abscopal effect of radiation on lymph node metastasis in esophageal carcinoma: A case report and literature review

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