Treatment planning intercomparison for spinal chordomas using intensity-modulated photon radiation therapy (IMRT) and carbon ions

Schulz-Ertner, Daniela; Nikoghosyan, Anna; Didinger, Bernd; Karger, Christian P.; Jäkel, Oliver; Wannenmacher, M; Debus, Jürgen

doi:10.1088/0031-9155/48/16/304

Cited by 17 publications

(14 citation statements)

References 35 publications

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“…Shultz-Ertner et al 36 reported on the feasibility of treating paraspinal tumors with a combination of photons and carbon ions. After surgical debulking, radiation treatment consisted of a combination of IMRT to a median dose of 50.4 Gy plus an 18 GyE carbon ion boost to the gross residual disease.…”

Section: Paraspinal Tumorsmentioning

confidence: 99%

Current status of radiotherapy with proton and light ion beams

Greco

Wolden

2007

Cancer

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Several model studies have shown potential clinical advantages with charged particles (protons and light ions) compared with 3D-conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) in many disease sites. The newly developed intensity-modulated proton therapy (IMPT) often yields superior dose distributions to photon IMRT, with the added advantage of a significant reduction in the volume of healthy normal tissues exposed to low-to-medium doses. Initially, the major emphasis in clinical research for proton and light ion therapy was dose escalation for inherently radioresistant tumors, or for lesions adjacent to critical normal structures that constrained the dose that could be safely delivered with conventional x-ray therapy. Since the advent of IMRT the interest in particle therapy has gradually shifted toward protocols aimed at morbidity reduction. Lately the emphasis has mostly been placed on the potential for reduced risk of radiation-induced carcinogenesis with protons. Compared with 3D-CRT, a 2-fold increase has been theoretically estimated with the use of IMRT due to the larger integral volumes. In the pediatric setting, due to a higher inherent susceptibility of tissues, the risk could be significant, and the benefits of protons have been strongly emphasized in the literature. There is a significant expansion of particle therapy facilities around the world. Increasing public awareness of the potential benefits of particle therapy and wider accessibility for patients require that treating physicians stay abreast of the clinical indications of this radiotherapy modality. The article reviews the available literature for various disease sites in which particle therapy has traditionally been considered to offer clinical advantages and to highlight current lines of clinical research. The issue of radiation-induced second malignancies is examined in the light of the controversial epidemiological evidence available. The cost-effectiveness of particle therapy is also discussed. Cancer 2007;109: 1227-38. 2007 American Cancer Society.KEYWORDS: radiotherapy, proton therapy, light ions, intensity modulated radiotherapy, second cancers. C harged particles (protons and light ions) have a finite range in tissues. The interaction probability to cause ionization increases as they lose velocity traversing through tissues, so that a peak of dose occurs at a depth proportional to the energy of each particle. Beyond this peak no further dose deposition occurs. This phenomenon was described by William Bragg over 100 years ago.1 The dose peak may be 'spread out' to achieve a plateau of uniform dose to precisely cover the target while sparing adjacent normal structures. Passively scattered beams of a certain aperture can be produced by means of range-shifting modulators of variable thickness providing spread-out Bragg peaks (SOBP) for clinical use. The recent introduction of the spot scanning method represents a major advance in particle therapy.2 In this method, small pencil beams of a certain

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Section: Paraspinal Tumorsmentioning

confidence: 99%

Current status of radiotherapy with proton and light ion beams

Greco

Wolden

2007

Cancer

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“…Chordomas represent only 1 to 4% of all primary malignant tumors and among their hallmark characteristics are containment and slower growth kinetics together with less frequent metastases [12]. While the first-line therapy of choice for chordoma treatment remains surgery, radiation therapy is also used [4,13,14] because of the deeply ensconced anatomical location of these tumors and the severe negative quality of life issues resulting from surgical resections [6]. Radiation therapy, especially in the case of charged particle beams involving carbon ions or protons, has been commanding much attention of late particularly in the treatment of bone and soft tissue sarcomas [6,15].…”

Section: Introductionmentioning

confidence: 99%

Comparison of human chordoma cell-kill for 290 MeV/n carbon ions versus 70 MeV protons in vitro

Fujisawa

Genik

Kitamura³

et al. 2013

Radiat Oncol

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BackgroundWhile the pace of commissioning of new charged particle radiation therapy facilities is accelerating worldwide, biological data pertaining to chordomas, theoretically and clinically optimally suited targets for particle radiotherapy, are still lacking. In spite of the numerous clinical reports of successful treatment of these malignancies with this modality, the characterization of this malignancy remains hampered by its characteristic slow cell growth, particularly in vitro.MethodsCellular lethality of U-CH1-N cells in response to different qualities of radiation was compared with immediate plating after radiation or as previously reported using the multilayered OptiCell™ system. The OptiCell™ system was used to evaluate cellular lethality over a broad dose-depth deposition range of particle radiation to anatomically mimic the clinical setting. Cells were irradiated with either 290 MeV/n accelerated carbon ions or 70 MeV accelerated protons and photons and evaluated through colony formation assays at a single position or at each depth, depending on the system.ResultsThere was a cell killing of approximately 20–40% for all radiation qualities in the OptiCell™ system in which chordoma cells are herein described as more radiation sensitive than regular colony formation assay. The relative biological effectiveness values were, however, similar in both in vitro systems for any given radiation quality. Relative biological effectiveness values of proton was 0.89, of 13–20 keV/μm carbon ions was 0.85, of 20–30 keV/μm carbon ions was 1.27, and >30 keV/μm carbon ions was 1.69. Carbon-ions killed cells depending on both the dose and the LET, while protons depended on the dose alone in the condition of our study. This is the first report and characterization of a direct comparison between the effects of charged particle carbon ions versus protons for a chordoma cell line in vitro. Our results support a potentially superior therapeutic value of carbon particle irradiation in chordoma patients.ConclusionCarbon ion therapy may have an advantage for chordoma radiotherapy because of higher cell-killing effect with high LET doses from biological observation in this study.

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“…Comparisons of heavy charged particle radiotherapy and IMRT showed that heavy charged particle radiotherapy delivered a more sophisticated conformal dose to the target than IMRT. 15) However, few establishments worldwide have heavy ion medical accelerator equipment and the cost performance is usually poor. Presumably heavy charged particle radiotherapy will not become common as standard radiotherapy at the present time.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Intensity Modulated Radiotherapy and Dynamic Three-Dimensional Conformal Radiotherapy With Regard to Dose Distribution and Sparing of Organs at Risk

Hasegawa

Iuchi

Osato

et al. 2011

Neurol. Med. Chir.(Tokyo)

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Dose escalation to the target while sparing the organs at risk near the lesion has been difficult over the last decade. However, recent radiotherapy techniques can deliver more sophisticated doses to the target. This study evaluated whether intensity modulated radiotherapy can deliver more homogeneous and conformal doses to the target than dynamic three-dimensional conformal radiotherapy while sparing organs at risk near the lesion in 13 patients with central nervous system tumors and other tumors around the central nervous system. Dynamic three-dimensional conformal radiotherapy and intensity modulated radiotherapy plans were calculated and dose distributions were compared for all patients with regard to the planning target volume and organs at risk. The plan of intensity modulated radiotherapy was significantly superior to that of dynamic three-dimensional conformal radiotherapy in target dose conformity (p ＝ 0.0006) and organs at risk sparing (p ＝ 0.0257). Intensity modulated radiotherapy could deliver more homogeneous and conformal doses to the target than dynamic three-dimensional conformal radiotherapy with sparing organs at risk near the lesion and may improve local control of radioresistant tumors via dose escalation.

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Treatment planning intercomparison for spinal chordomas using intensity-modulated photon radiation therapy (IMRT) and carbon ions

Cited by 17 publications

References 35 publications

Current status of radiotherapy with proton and light ion beams

Current status of radiotherapy with proton and light ion beams

Comparison of human chordoma cell-kill for 290 MeV/n carbon ions versus 70 MeV protons in vitro

Comparison of Intensity Modulated Radiotherapy and Dynamic Three-Dimensional Conformal Radiotherapy With Regard to Dose Distribution and Sparing of Organs at Risk

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