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Radiation, proton therapy

Yuming Wan, Jing Huang, Feng Xu
A few study has proven that about 90% of local control rates might be benefit from stereotactic body radiotherapy (SBRT) for patients with medically inoperable stage I non-small cell lung cancer (NSCLC), it is reported SBRT associated overall survival and tumor specific survival is comparable with those treated with surgery. SBRT has been accepted as the first line treatment for inoperable patients with peripheral located stage I NSCLC. However, the role of SBRT in centrally located lesions is controversial for potential toxic effects from the adjacent anatomical structure...
May 20, 2018: Zhongguo Fei Ai za Zhi, Chinese Journal of Lung Cancer
Ciprian Catana, Harald H Quick, Habib Zaidi
Whole-body hybrid PET/MR imaging has been used since its introduction in 2010 in clinical and research settings for diagnosis, staging and restaging, assessment of response to treatment and radiation therapy planning. However, the quantitative potential of PET/MRI is challenged by the lack of reliable and accurate MRI-guided attenuation correction (MRAC) owing to the lack of direct relationship between MRI signal, reflecting proton density and relaxation time properties, and electron density, which is linked to photon attenuation properties of biological tissues...
May 14, 2018: Medical Physics
Waqar Haque, Vivek Verma, E Brian Butler, Bin S Teh
Background: Randomized esophageal cancer (EC) trials have utilized two- or three-dimensional conformal radiotherapy (3DCRT). Advanced radiotherapy (RT) techniques [(ARTs): intensity-modulated radiotherapy (IMRT) and proton beam therapy (PBT)] may have benefits, but are relatively unproven. This is the first study to date evaluating utilization of ARTs versus 3DCRT in the trimodality setting in the United States. Methods: The National Cancer Data Base (NCDB) was queried (2004-2013) for newly-diagnosed cT1b-T4bN0/N+M0 EC receiving neoadjuvant CRT followed by esophagectomy...
April 2018: Journal of Gastrointestinal Oncology
Amy C Schefler, Ryan S Kim
Retinoblastoma and uveal melanoma are the most common intraocular malignancies observed in pediatric and adult populations, respectively. For retinoblastoma, intra-arterial chemotherapy has dramatically improved treatment outcomes and eye salvage rates compared with traditional salvage rates of systemic chemotherapy and external beam radiation therapy. Intravitreal injections of chemotherapy have also demonstrated excellent efficacy for vitreous seeds. Uveal melanoma, on the other hand, is treated predominantly with iodine-125 plaque brachytherapy or with proton beam therapy...
2018: F1000Research
Alejandra Daruich, Alexandre Matet, Ann Schalenbourg, Leonidas Zografos
PURPOSE: To evaluate, in eyes with radiation maculopathy, the effect of 2-month-interval anti-vascular endothelial growth factor therapy on best-corrected visual acuity and foveal avascular zone (FAZ) enlargement using optical coherence tomography angiography. METHODS: Consecutive treatment-naive patients with radiation maculopathy after proton beam irradiation for choroidal melanoma were retrospectively included. Clinical and optical coherence tomography angiography data at baseline and the 6-month visit were recorded...
May 3, 2018: Retina
Joseph K Kim, Jonathan E Leeman, Nadeem Riaz, Sean McBride, Chiaojung Jillian Tsai, Nancy Y Lee
The application of proton beam radiation therapy in the treatment of head and neck cancer has grown tremendously in the past few years. Globally, widespread interest in proton beam therapy has led to multiple research efforts regarding its therapeutic value and cost-effectiveness. The current standard of care using modern photon radiation technology has demonstrated excellent treatment outcomes, yet there are some situations where disease control remains suboptimal with the potential for detrimental acute and chronic toxicities...
May 9, 2018: Current Treatment Options in Oncology
Do Hoon Lim
Radiation therapy is highly effective for the management of pediatric malignant central nervous system (CNS) tumors including embryonal tumors. With the increment of long-term survivors from malignant CNS tumors, the radiation-related toxicities have become a major concern and we need to improve the treatment strategies to reduce the late complications without compromising the treatment outcomes. One of such strategies is to reduce the radiation dose to craniospinal axis or radiation volume and to avoid or defer radiation therapy until after the age of three...
May 2018: Journal of Korean Neurosurgical Society
Rami A El Shafie, Maja Czech, Kerstin A Kessel, Daniel Habermehl, Dorothea Weber, Stefan Rieken, Nina Bougatf, Oliver Jäkel, Jürgen Debus, Stephanie E Combs
BACKGROUND: With 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...
May 8, 2018: Radiation Oncology
Safia K Ahmed, Paul D Brown, Robert L Foote
The physical characteristics of proton therapy result in steeper dose gradients and superior dose conformality compared to photon therapy. These properties render proton therapy ideal for skull base tumors requiring dose escalation for optimal tumor control, and may also be beneficial for brain tumors as a means of mitigating radiation-related adverse effects. This review summarizes the literature regarding the role of proton therapy compared to photon therapy in the treatment of adult brain and skull base tumors...
April 2018: Seminars in Radiation Oncology
Jan Unkelbach, Harald Paganetti
Accurate prediction of tumor control and toxicities in radiation therapy faces many uncertainties. Besides interpatient variability in the response to radiation, there are also dosimetric uncertainties, that is, differences between the dose displayed in a treatment planning system and the dose actually delivered to the patient. These uncertainties originate from several sources including imperfect knowledge of the patient geometry, approximation in the physics of radiation interaction with tissues, and uncertainties in the biological effectiveness of radiation...
April 2018: Seminars in Radiation Oncology
Johannes A Langendijk, Liesbeth J Boersma, Coen R N Rasch, Marco van Vulpen, Johannes B Reitsma, Arjen van der Schaaf, Ewoud Schuit
The favorable beam properties of protons can be translated into clinical benefits by target dose escalation to improve local control without enhancing unacceptable radiation toxicity or to spare normal tissues to prevent radiation-induced side effects without jeopardizing local tumor control. For the clinical validation of the added value of protons to improve local control, randomized controlled trials are required. For the clinical validation of the added value of protons to prevent side effects, both model-based validation or randomized controlled trials can be used...
April 2018: Seminars in Radiation Oncology
Jacobus Maarten Schippers, Anthony Lomax, Adriano Garonna, Katia Parodi
In recent years there has been increasing interest in the more extensive application of proton therapy in a clinical and preferably hospital-based environment. However, broader adoption of proton therapy has been hindered by the costs of treatment, which are still much higher than those in advanced photon therapy. This article presents an overview of on-going technical developments, which have a reduction of the capital investment or operational costs either as a major goal or as a potential outcome. Developments in instrumentation for proton therapy, such as gantries and accelerators, as well as facility layout and efficiency in treatment logistics will be discussed in this context...
April 2018: Seminars in Radiation Oncology
Lior Z Braunstein, Oren Cahlon
Proton radiotherapy confers significant dosimetric advantages in the treatment of malignancies that arise adjacent to critical radiosensitive structures. To date, these advantages have been most prominent in the treatment of pediatric and central nervous system malignancies, although emerging data support the use of protons among other anatomical sites in which radiotherapy plays an important role. With advances in the overall treatment paradigm for breast cancer, most patients with localized disease now exhibit long-term disease control and, consequently, may manifest the late toxicities of aggressive treatment...
April 2018: Seminars in Radiation Oncology
Ann C Raldow, Theodore S Hong
Gastrointestinal malignancies inherently arise amidst visceral organs that are very radiation sensitive. While radiation therapy is an integral part of cancer treatment, its use has historically been limited by normal tissue toxicity. Proton therapy is a form of external-beam radiation associated with several dosimetric advantages as compared to photon therapy. Proton radiation may allow for the delivery of tumoricidal doses while minimizing side effects by decreasing the dose to adjacent organs at risk. We discuss the rationale for and challenges of using protons in the treatment of gastrointestinal cancers...
April 2018: Seminars in Radiation Oncology
Zhongxing Liao, Saumil J Gandhi, Steven H Lin, Jeffrey Bradley
The finite range of proton beams in tissues offers unique dosimetric advantages that theoretically allow dose to the target to be escalated while minimizing exposure of surrounding tissues and thus minimizing radiation-induced toxicity. This theoretical advantage has led to widespread adoption of proton therapy around the world for a wide variety of tumors at different anatomical sites. Many treatment-planning comparisons have shown that proton therapy has substantial dosimetric advantages over conventional radiotherapy...
April 2018: Seminars in Radiation Oncology
Matthew D Hall, Julie A Bradley, Ronny L Rotondo, Ricardo Hanel, Chetan Shah, Christopher G Morris, Philipp R Aldana, Daniel J Indelicato
PURPOSE: To estimate the rate of and identify risk factors for vasculopathy after proton therapy in pediatric patients with central nervous system and skull base tumors. METHODS AND MATERIALS: Between 2006 and 2015, 644 pediatric patients with central nervous system and skull base tumors were treated with proton therapy at a single institution. The 3 most common histologies were craniopharyngioma (n = 135), ependymoma (n = 135), and low-grade glioma (n = 131)...
March 29, 2018: International Journal of Radiation Oncology, Biology, Physics
Tereza Hanušová, Kamila Johnová, Matěj Navrátil, Jiří Valenta, Lutz Müller
Activation of detectors and phantoms used for commissioning and quality assurance of clinical proton beams may lead to radiation protection issues. Good understanding of the activation nuclide vectors involved is necessary to assess radiation risk for the personnel working with these devices on a daily basis or to fulfill legal requirements regarding transport of radioactive material and its release to the public. Eleven devices and material samples were irradiated with a 220 MeV proton pencil beam (PBS, Proton Therapy Center, Prague)...
May 4, 2018: Physics in Medicine and Biology
T Depuydt
The use of proton therapy as a treatment modality is becoming more widespread in conventional radiation therapy practice. Commercialisation and introduction of compact systems has led to embedding of proton therapy facilities in existing hospital environments. In addition, technologically, proton therapy is currently undergoing an important evolution, moving from passive scattering delivery techniques to active pencil beam scanning, adopting image guidance techniques from conventional radiotherapy and introducing various range verification techniques in the clinic...
January 1, 2018: Annals of the ICRP
Kylie H Kang, Emily Schapira, Andrzej Niemierko, Maria Martinez-Lage, Marc R Bussière, Torunn I Yock, Jay S Loeffler, William E Butler, Bob S Carter, Helen A Shih
PURPOSE: Central neurocytomas (CNs) are rare World Health Organization grade II tumors managed with surgery and radiation therapy. We report our experience in managing CN with proton beam therapy (PBT) when radiation therapy was used. METHODS AND MATERIALS: We identified 61 patients with pathologically diagnosed CN treated at our institution between 1996 and 2016, of which 24 met inclusion criteria. Patient, tumor, and treatment characteristics are reported in context of progression-free survival and treatment-related adverse events...
February 16, 2018: Practical Radiation Oncology
Manjit Dosanjh, Bleddyn Jones, Jörg Pawelke, Martin Pruschy, Brita Singers Sørensen
Particle therapy (PT) as cancer treatment, using protons or heavier ions, can provide a more favorable dose distribution compared to X-rays. While the physical characteristics of particle radiation have been the aim of intense research, less focus has been placed on the actual biological responses arising from particle irradiation. One of the biggest challenges for proton radiobiology is the RBE, with an increasing concern that the clinically-applied generic RBE-value of 1.1 is an approximation, as RBE is a complex quantity, depending on both biological and physical parameters, such as dose, LET, cellular and tissue radiobiological characteristics, as well as the endpoints being studied...
April 24, 2018: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
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