Pub Date : 2021-07-29DOI: 10.22541/au.162756383.31786605/v1
S. Baliga, J. Matsui, B. Klamer, A. Cetnar, A. Ewing, C. Cadieux, Ajay Gupta, B. Setty, Ryan D. Roberts, R. Olshefski, T. Cripe, T. Scharschmidt, J. Aldrink, E. Mardis, N. Yeager, J. Palmer
OBJECTIVES The objective of this study is to report disease outcomes and toxicity with the use of SBRT in the treatment of pediatric metastatic disease. METHODS All pediatric and adolescent young adult (AYA) patients' who received SBRT were included between the years 2000-2020. Study endpoints included local control (LC), progression free survival (PFS), overall survival (OS), cumulative incidence (CI) of death or local failure and toxicity. The endpoints with respect to survival and LC were calculated using the Kaplan-Meier estimate. The cumulative incidence of local failure was calculated using death as a competing risk. RESULTS 16 patients with 36 lesions irradiated met inclusion criteria and formed the study cohort. The median OS and PFS for the entire cohort were 17 months and 15.7 months, respectively. The 1 year OS for the entire cohort was 75%. The 6- and 12 month local control was 85 and 78%, respectively. There were no local failures in irradiated lesions for patients who received a BED10 ≥100 Gy. Patients who were treated with SBRT who had ≤5 metastatic lesions at first recurrence had a superior 1 year OS of 100versus 50% for those with >5 lesions. One patient (6.3%) experienced a Grade 3 CNS toxicity. CONCLUSIONS Local control was excellent with SBRT delivered to metastatic disease, particularly for lesions receiving a BED10 ≥100 Gy. High-grade toxicity was rare in our patient population. Patients with five or fewer metastatic sites have a significantly better OS compared to >5 sites. ADVANCES IN KNOWLEDGE: This study demonstrates that SBRT is safe and efficacious in the treatment of pediatric oligometastatic disease.
{"title":"Clinical outcomes and efficacy of stereotactic body radiation therapy in children, Adolescents, and Young Adults with Metastatic Solid Tumors.","authors":"S. Baliga, J. Matsui, B. Klamer, A. Cetnar, A. Ewing, C. Cadieux, Ajay Gupta, B. Setty, Ryan D. Roberts, R. Olshefski, T. Cripe, T. Scharschmidt, J. Aldrink, E. Mardis, N. Yeager, J. Palmer","doi":"10.22541/au.162756383.31786605/v1","DOIUrl":"https://doi.org/10.22541/au.162756383.31786605/v1","url":null,"abstract":"OBJECTIVES\u0000The objective of this study is to report disease outcomes and toxicity with the use of SBRT in the treatment of pediatric metastatic disease.\u0000\u0000\u0000METHODS\u0000All pediatric and adolescent young adult (AYA) patients' who received SBRT were included between the years 2000-2020. Study endpoints included local control (LC), progression free survival (PFS), overall survival (OS), cumulative incidence (CI) of death or local failure and toxicity. The endpoints with respect to survival and LC were calculated using the Kaplan-Meier estimate. The cumulative incidence of local failure was calculated using death as a competing risk.\u0000\u0000\u0000RESULTS\u000016 patients with 36 lesions irradiated met inclusion criteria and formed the study cohort. The median OS and PFS for the entire cohort were 17 months and 15.7 months, respectively. The 1 year OS for the entire cohort was 75%. The 6- and 12 month local control was 85 and 78%, respectively. There were no local failures in irradiated lesions for patients who received a BED10 ≥100 Gy. Patients who were treated with SBRT who had ≤5 metastatic lesions at first recurrence had a superior 1 year OS of 100versus 50% for those with >5 lesions. One patient (6.3%) experienced a Grade 3 CNS toxicity.\u0000\u0000\u0000CONCLUSIONS\u0000Local control was excellent with SBRT delivered to metastatic disease, particularly for lesions receiving a BED10 ≥100 Gy. High-grade toxicity was rare in our patient population. Patients with five or fewer metastatic sites have a significantly better OS compared to >5 sites.\u0000\u0000\u0000ADVANCES IN KNOWLEDGE:\u0000This study demonstrates that SBRT is safe and efficacious in the treatment of pediatric oligometastatic disease.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132923057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-18DOI: 10.1101/2020.11.16.20231514
D. Sharma, R. Guleria, N. Wig, A. Mohan, G. Rath, V. Subramani, S. Bhatnagar, S. Mallick, Aman Sharma, P. Patil, K. Madan, M. Soneja, S. Thulkar, A. Singh, Sheetal Singh
Background: The World Health Organization (WHO) has declared coronavirus disease 2019 (COVID-19) as pandemic in March 2020. Currently there is no vaccine or specific effective treatment for COVID-19. The major cause of death in COVID-19 is severe pneumonia leading to respiratory failure. Radiation in low doses (<100 cGy) has been known for its anti-inflammatory effect and therefore, low dose radiation therapy (LDRT) to lungs can potentially mitigate the severity of pneumonia and reduce mortality. We conducted a pilot trial to study the feasibility and clinical efficacy of LDRT to lungs in the management of patients with COVID-19. Methods: From June to Aug 2020, we enrolled 10 patients with COVID-19 having moderate to severe risk disease [National Early Warning Score (NEWS) of [≥]5]. Patients were treated as per the standard COVID-19 management guidelines along with LDRT to both lungs with a dose of 70cGy in single fraction. Response assessment was done based on the clinical parameters using the NEWS. Results: All patients completed the prescribed treatment. Nine patients had complete clinical recovery mostly within a period ranging from 3-7 days. One patient, who was a known hypertensive, showed clinical deterioration and died 24 days after LDRT. No patients showed the signs of acute radiation toxicity. Conclusion: Results of our study (90% response rate) suggest the feasibility and clinical effectiveness of LDRT in COVID-19 patients having moderate to severe risk disease. This mandates a randomized controlled trial to establish the clinical efficacy of LDRT in COVID-19 pneumonia.
{"title":"Low-dose radiation therapy for COVID-19 pneumonia: a pilot study","authors":"D. Sharma, R. Guleria, N. Wig, A. Mohan, G. Rath, V. Subramani, S. Bhatnagar, S. Mallick, Aman Sharma, P. Patil, K. Madan, M. Soneja, S. Thulkar, A. Singh, Sheetal Singh","doi":"10.1101/2020.11.16.20231514","DOIUrl":"https://doi.org/10.1101/2020.11.16.20231514","url":null,"abstract":"Background: The World Health Organization (WHO) has declared coronavirus disease 2019 (COVID-19) as pandemic in March 2020. Currently there is no vaccine or specific effective treatment for COVID-19. The major cause of death in COVID-19 is severe pneumonia leading to respiratory failure. Radiation in low doses (<100 cGy) has been known for its anti-inflammatory effect and therefore, low dose radiation therapy (LDRT) to lungs can potentially mitigate the severity of pneumonia and reduce mortality. We conducted a pilot trial to study the feasibility and clinical efficacy of LDRT to lungs in the management of patients with COVID-19. Methods: From June to Aug 2020, we enrolled 10 patients with COVID-19 having moderate to severe risk disease [National Early Warning Score (NEWS) of [≥]5]. Patients were treated as per the standard COVID-19 management guidelines along with LDRT to both lungs with a dose of 70cGy in single fraction. Response assessment was done based on the clinical parameters using the NEWS. Results: All patients completed the prescribed treatment. Nine patients had complete clinical recovery mostly within a period ranging from 3-7 days. One patient, who was a known hypertensive, showed clinical deterioration and died 24 days after LDRT. No patients showed the signs of acute radiation toxicity. Conclusion: Results of our study (90% response rate) suggest the feasibility and clinical effectiveness of LDRT in COVID-19 patients having moderate to severe risk disease. This mandates a randomized controlled trial to establish the clinical efficacy of LDRT in COVID-19 pneumonia.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"47 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124934231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The International Commission on Radiological Protection (ICRP) has considered for over sixty years that the lens of the eye is among the most radiosensitive tissues, and has recommended dose limits for the lens to prevent occurrence of vision impairing cataracts (VICs). Epidemiological evidence that doses much lower than previously thought produce cataracts led ICRP to recommend reducing dose threshold for VICs and reducing an occupational equivalent dose limit for the lens in 2011, when only a single threshold of 0.5 Gy was recommended. On the basis of epidemiological evidence, ICRP assumed progression of minor opacities into VICs and no dose rate effect. This contrasts with previously recommended separate thresholds for minor opacities and VICs, and for different exposure scenarios. Progression was assumed based on similar risks of cataracts and cataract surgery in Japanese atomic bomb survivors. The absence of dose rate effect derived from the observed similar thresholds for protracted exposures in Chernobyl cleanup workers and in atomic bomb survivors. Since 2011, there has been an increasing body of epidemiological evidence relating to cataracts and other ocular diseases (i.e., glaucoma and macular degeneration), particularly at low doses and low dose rates. This review paper gives an overview of the scientific basis of the 2011 ICRP recommendation, discusses the plausibility of these two assumptions in the light of emerging scientific evidence, and considers the radiosensitivity of the lens among ocular structures.
{"title":"An update on effects of ionizing radiation exposure on the eye.","authors":"Nobuyuki Hamada, Tamara Azizova, Mark Little","doi":"10.1259/bjr.20190829","DOIUrl":"https://doi.org/10.1259/bjr.20190829","url":null,"abstract":"The International Commission on Radiological Protection (ICRP) has considered for over sixty years that the lens of the eye is among the most radiosensitive tissues, and has recommended dose limits for the lens to prevent occurrence of vision impairing cataracts (VICs). Epidemiological evidence that doses much lower than previously thought produce cataracts led ICRP to recommend reducing dose threshold for VICs and reducing an occupational equivalent dose limit for the lens in 2011, when only a single threshold of 0.5 Gy was recommended. On the basis of epidemiological evidence, ICRP assumed progression of minor opacities into VICs and no dose rate effect. This contrasts with previously recommended separate thresholds for minor opacities and VICs, and for different exposure scenarios. Progression was assumed based on similar risks of cataracts and cataract surgery in Japanese atomic bomb survivors. The absence of dose rate effect derived from the observed similar thresholds for protracted exposures in Chernobyl cleanup workers and in atomic bomb survivors. Since 2011, there has been an increasing body of epidemiological evidence relating to cataracts and other ocular diseases (i.e., glaucoma and macular degeneration), particularly at low doses and low dose rates. This review paper gives an overview of the scientific basis of the 2011 ICRP recommendation, discusses the plausibility of these two assumptions in the light of emerging scientific evidence, and considers the radiosensitivity of the lens among ocular structures.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130796288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-28DOI: 10.21203/rs.3.rs-31053/v1
Chen-yi Zhan, Qian Chen, Mingyue Zhang, Y. Xiang, Jie Chen, Dongqin Zhu, Chao Chen, Tianyi Xia, Yunjun Yang
OBJECTIVES We hypothesized that not all small hematomas are benign and that radiomics could predict hematoma expansion (HE) and short-term outcomes in small hematomas. METHODS We analyzed 313 patients with small (<10 ml) intracerebral hemorrhage (ICH) who underwent baseline non-contrast CT within 6 h of symptom onset between September 2013 and February 2019. Poor outcome was defined as a Glasgow Outcome Scale score ≤3. A radiomic model and a clinical model were built using least absolute shrinkageand selection operator algorithm or multivariate analysis. A combined model that incorporated the developed radiomic score and clinical factors was then constructed. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of these models. RESULTS The addition of radiomics to clinical factors significantly improved the prediction performance of HE compared with the clinical model alone in both the training {AUC, 0.762 [95% CI (0.665-0.859)] versus AUC, 0.651 [95% CI (0.556-0.745)], p = 0.007} and test {AUC, 0.776 [95% CI (0.655-0.897) versus AUC, 0.631 [95% CI (0.451-0.810)], p = 0.001} cohorts. Moreover, the radiomic-based model achieved good discrimination ability of poor outcomes in the 3-10 ml group (AUCs 0.720 and 0.701). CONCLUSION Compared with clinical information alone, combined model had greater potential for discriminating between benign and malignant course in patients with small ICH, particularly 3-10 ml hematomas. ADVANCES IN KNOWLEDGE Radiomics can be used as a supplement to conventional medical imaging, improving clinical decision-making and facilitating personalized treatment in small ICH.
目的:我们假设并非所有的小血肿都是良性的，放射组学可以预测小血肿的血肿扩张(HE)和短期预后。方法:我们分析了2013年9月至2019年2月期间313例小脑出血(<10 ml)患者，这些患者在症状出现后6小时内接受了基线非对比CT检查。不良预后定义为格拉斯哥预后量表评分≤3分。采用最小绝对收缩和选择算子算法或多变量分析建立放射学模型和临床模型。然后建立一个结合放射学评分和临床因素的联合模型。采用受者工作特征曲线下面积(AUC)来评价模型的性能。结果在训练队列(AUC, 0.762 [95% CI(0.665-0.859)]与AUC, 0.651 [95% CI (0.556-0.745)]， p = 0.007)和检验队列(AUC, 0.776 [95% CI(0.655-0.897)]与AUC, 0.631 [95% CI (0.451-0.810)]， p = 0.001)中，与单独的临床模型相比，放射组学与临床因素的结合显著提高了HE的预测性能。此外，基于放射组学的模型对3-10 ml组不良预后的鉴别能力较好(auc分别为0.720和0.701)。结论与单纯临床资料相比，联合模型对小脑出血患者，尤其是3-10 ml血肿患者的良恶性鉴别具有更大的潜力。放射组学可以作为传统医学成像的补充，改善临床决策，促进小型脑出血的个性化治疗。
{"title":"Radiomics for intracerebral hemorrhage: are all small hematomas benign?","authors":"Chen-yi Zhan, Qian Chen, Mingyue Zhang, Y. Xiang, Jie Chen, Dongqin Zhu, Chao Chen, Tianyi Xia, Yunjun Yang","doi":"10.21203/rs.3.rs-31053/v1","DOIUrl":"https://doi.org/10.21203/rs.3.rs-31053/v1","url":null,"abstract":"OBJECTIVES\u0000We hypothesized that not all small hematomas are benign and that radiomics could predict hematoma expansion (HE) and short-term outcomes in small hematomas.\u0000\u0000\u0000METHODS\u0000We analyzed 313 patients with small (<10 ml) intracerebral hemorrhage (ICH) who underwent baseline non-contrast CT within 6 h of symptom onset between September 2013 and February 2019. Poor outcome was defined as a Glasgow Outcome Scale score ≤3. A radiomic model and a clinical model were built using least absolute shrinkageand selection operator algorithm or multivariate analysis. A combined model that incorporated the developed radiomic score and clinical factors was then constructed. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of these models.\u0000\u0000\u0000RESULTS\u0000The addition of radiomics to clinical factors significantly improved the prediction performance of HE compared with the clinical model alone in both the training {AUC, 0.762 [95% CI (0.665-0.859)] versus AUC, 0.651 [95% CI (0.556-0.745)], p = 0.007} and test {AUC, 0.776 [95% CI (0.655-0.897) versus AUC, 0.631 [95% CI (0.451-0.810)], p = 0.001} cohorts. Moreover, the radiomic-based model achieved good discrimination ability of poor outcomes in the 3-10 ml group (AUCs 0.720 and 0.701).\u0000\u0000\u0000CONCLUSION\u0000Compared with clinical information alone, combined model had greater potential for discriminating between benign and malignant course in patients with small ICH, particularly 3-10 ml hematomas.\u0000\u0000\u0000ADVANCES IN KNOWLEDGE\u0000Radiomics can be used as a supplement to conventional medical imaging, improving clinical decision-making and facilitating personalized treatment in small ICH.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"11 suppl_1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116597016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Coronary artery fistulas (CAFs) are abnormal connections of the coronary arteries that bypass the myocardial capillary bed and terminate into chambers of the heart or major blood vessels. CAFs are rare, and most of them are congenital. Because CAFs can be asymptomatic and detected incidentally, the true incidence is difficult to evaluate. CAFs usually have various and complicated image features, and the clinical symptoms mainly depend on the size, origin and drainage site of the fistulas. Thus, accurate imaging assessment of these characteristics is crucial for therapeutic planning and post-operative evaluation. Due to the high temporal and spatial resolution, coronary CT angiography has recently become more widely used in cardiovascular disease diagnosis, and more asymptomatic CAFs are accidentally found. Furthermore, with multiplanar reconstruction images, some complicated and subtle structures can be displayed more accurately. In this article, we reviewed the imaging features of CAFs on coronary CT angiography, mainly focusing on the pre- and post-operative anatomy displaying of these abnormalities.
{"title":"Coronary artery fistulas detected with coronary CT angiography: a pictorial review of 73 cases.","authors":"Ning Li, P. Zhao, Da-wei Wu, Changhu Liang","doi":"10.1259/bjr.20190523","DOIUrl":"https://doi.org/10.1259/bjr.20190523","url":null,"abstract":"Coronary artery fistulas (CAFs) are abnormal connections of the coronary arteries that bypass the myocardial capillary bed and terminate into chambers of the heart or major blood vessels. CAFs are rare, and most of them are congenital. Because CAFs can be asymptomatic and detected incidentally, the true incidence is difficult to evaluate. CAFs usually have various and complicated image features, and the clinical symptoms mainly depend on the size, origin and drainage site of the fistulas. Thus, accurate imaging assessment of these characteristics is crucial for therapeutic planning and post-operative evaluation. Due to the high temporal and spatial resolution, coronary CT angiography has recently become more widely used in cardiovascular disease diagnosis, and more asymptomatic CAFs are accidentally found. Furthermore, with multiplanar reconstruction images, some complicated and subtle structures can be displayed more accurately. In this article, we reviewed the imaging features of CAFs on coronary CT angiography, mainly focusing on the pre- and post-operative anatomy displaying of these abnormalities.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"82 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131204492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Simon Deycmar, Erica Faccin, Tamara Kazimova, P. Knobel, I. Telarovic, F. Tschanz, V. Waller, Rona Winkler, C. Yong, Dario Zingariello, M. Pruschy
Clinical parameters and empirical evidence are the primary determinants for current treatment planning in radiation oncology. Personalized medicine in radiation oncology is only at the very beginning to take the genetic background of a tumor entity into consideration to define an individual treatment regimen, the total dose or the combination with a specific anticancer agent. Likewise, stratification of patients towards proton radiotherapy is linked to its physical advantageous energy deposition at the tumor site with minimal healthy tissue being co-irradiated distal to the target volume. Hence, the fact that photon and proton irradiation also induce different qualities of DNA damages, which require differential DNA damage repair mechanisms has been completely neglected so far. These subtle differences could be efficiently exploited in a personalized treatment approach and could be integrated into personalized treatment planning. A differential requirement of the two major DNA double strand break repair pathways, homologous recombination and non-homologous end joining, was recently identified in response to proton and photon irradiation, respectively, and subsequently influence the mode of ionizing radiation-induced cell death and susceptibility of tumor cells with defects in DNA repair machineries to either quality of ionizing radiation.This review focuses on the differential DNA-damage responses and subsequent biological processes induced by photon and proton irradiation in dependence of the genetic background and discusses their impact on the unicellular level and in the tumor microenvironment and their implications for combined treatment modalities.
{"title":"The relative biological effectiveness of proton irradiation in dependence of DNA damage repair.","authors":"Simon Deycmar, Erica Faccin, Tamara Kazimova, P. Knobel, I. Telarovic, F. Tschanz, V. Waller, Rona Winkler, C. Yong, Dario Zingariello, M. Pruschy","doi":"10.1259/bjr.20190494","DOIUrl":"https://doi.org/10.1259/bjr.20190494","url":null,"abstract":"Clinical parameters and empirical evidence are the primary determinants for current treatment planning in radiation oncology. Personalized medicine in radiation oncology is only at the very beginning to take the genetic background of a tumor entity into consideration to define an individual treatment regimen, the total dose or the combination with a specific anticancer agent. Likewise, stratification of patients towards proton radiotherapy is linked to its physical advantageous energy deposition at the tumor site with minimal healthy tissue being co-irradiated distal to the target volume. Hence, the fact that photon and proton irradiation also induce different qualities of DNA damages, which require differential DNA damage repair mechanisms has been completely neglected so far. These subtle differences could be efficiently exploited in a personalized treatment approach and could be integrated into personalized treatment planning. A differential requirement of the two major DNA double strand break repair pathways, homologous recombination and non-homologous end joining, was recently identified in response to proton and photon irradiation, respectively, and subsequently influence the mode of ionizing radiation-induced cell death and susceptibility of tumor cells with defects in DNA repair machineries to either quality of ionizing radiation.This review focuses on the differential DNA-damage responses and subsequent biological processes induced by photon and proton irradiation in dependence of the genetic background and discusses their impact on the unicellular level and in the tumor microenvironment and their implications for combined treatment modalities.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130889852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Seidensaal, S. Harrabi, Matthias Uhl, Juergen Debus
Re-irradiation can offer a potentially curative solution in case of progression after initial therapy, however a second course of radiotherapy can be associated with an increased risk of severe side-effects. Particle therapy with protons and especially carbon ions spares surrounding tissue better than most photon techniques, thus it is of high potential for re-irradiation. Irradiation of tumors of the brain, head and neck and skull bases involves several delicate risk organs, e.g. optic system, brainstem, salivary gland or swallowing muscles. Adequate local control rates with tolerable side-effects have been described for several tumors of these locations as meningioma, adenoid cyctic carcinoma, chordoma or chondrosarcoma and head and neck tumors. High life time doses nonetheless lead to a different scope of side-effects, e.g. an enhanced rate of carotid blow outs has been reported. This review summarizes the current data on particle irradiation of the aforementioned locations and malignancies.
{"title":"Re-irradiation with protons or heavy ions with focus on head and neck, skull base and brain malignancies.","authors":"K. Seidensaal, S. Harrabi, Matthias Uhl, Juergen Debus","doi":"10.1259/bjr.20190516","DOIUrl":"https://doi.org/10.1259/bjr.20190516","url":null,"abstract":"Re-irradiation can offer a potentially curative solution in case of progression after initial therapy, however a second course of radiotherapy can be associated with an increased risk of severe side-effects. Particle therapy with protons and especially carbon ions spares surrounding tissue better than most photon techniques, thus it is of high potential for re-irradiation. Irradiation of tumors of the brain, head and neck and skull bases involves several delicate risk organs, e.g. optic system, brainstem, salivary gland or swallowing muscles. Adequate local control rates with tolerable side-effects have been described for several tumors of these locations as meningioma, adenoid cyctic carcinoma, chordoma or chondrosarcoma and head and neck tumors. High life time doses nonetheless lead to a different scope of side-effects, e.g. an enhanced rate of carotid blow outs has been reported. This review summarizes the current data on particle irradiation of the aforementioned locations and malignancies.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"7 15","pages":"20190516"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141226143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The combination of radiotherapy and immunotherapy is one of the most promising strategies for cancer treatment. Recent clinical results support the pre-clinical experiments pointing to a benefit for the combined treatment in metastatic patients. Charged particle therapy (using protons or heavier ions) is considered one of the most advanced radiotherapy techniques, but its cost remains higher than conventional X-ray therapy. The most important question to be addressed to justify a more widespread use of particle therapy is whether they can be more effective than X-rays in combination with immunotherapy. Protons and heavy ions have physical advantages compared to X-rays that lead to a reduced damage to the immune cells, that are required for an effective immune response. Moreover, densely ionizing radiation may have biological advantages, due to different cell death pathways and release of cytokine mediators of inflammation. We will discuss results in esophageal cancer patients showing that charged particles can reduce the damage to blood lymphocytes compared to X-rays, and preliminary in vitro studies pointing to an increased release of immune-stimulating cytokines after heavy ion exposure. Pre-clinical and clinical studies are ongoing to test these hypotheses.
放疗与免疫疗法相结合是最有前途的癌症治疗策略之一。最近的临床结果支持了临床前的实验，指出联合治疗对转移性患者有好处。带电粒子疗法（使用质子或较重的离子）被认为是最先进的放射治疗技术之一，但其成本仍然高于传统的 X 射线疗法。要想更广泛地使用粒子疗法，最重要的问题是粒子疗法与免疫疗法相结合是否比 X 射线更有效。质子和重离子与 X 射线相比具有物理优势，可减少对免疫细胞的损伤，而免疫细胞是有效免疫反应所必需的。此外，高密度电离辐射可能具有生物学优势，因为细胞死亡途径和炎症细胞因子介质的释放不同。我们将讨论食道癌患者的研究结果，与 X 射线相比，带电粒子可减少对血液淋巴细胞的损伤，初步体外研究表明，重离子照射后免疫刺激细胞因子的释放增加。目前正在进行临床前和临床研究，以验证这些假设。
{"title":"Harnessing radiation to improve immunotherapy: better with particles?","authors":"M. Durante, Silvia C. Formenti","doi":"10.1259/bjr.20190224","DOIUrl":"https://doi.org/10.1259/bjr.20190224","url":null,"abstract":"The combination of radiotherapy and immunotherapy is one of the most promising strategies for cancer treatment. Recent clinical results support the pre-clinical experiments pointing to a benefit for the combined treatment in metastatic patients. Charged particle therapy (using protons or heavier ions) is considered one of the most advanced radiotherapy techniques, but its cost remains higher than conventional X-ray therapy. The most important question to be addressed to justify a more widespread use of particle therapy is whether they can be more effective than X-rays in combination with immunotherapy. Protons and heavy ions have physical advantages compared to X-rays that lead to a reduced damage to the immune cells, that are required for an effective immune response. Moreover, densely ionizing radiation may have biological advantages, due to different cell death pathways and release of cytokine mediators of inflammation. We will discuss results in esophageal cancer patients showing that charged particles can reduce the damage to blood lymphocytes compared to X-rays, and preliminary in vitro studies pointing to an increased release of immune-stimulating cytokines after heavy ion exposure. Pre-clinical and clinical studies are ongoing to test these hypotheses.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"6 20","pages":"20190224"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141226153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Albertini, M. Matter, L. Nenoff, Ye Zhang, A. Lomax
It is recognised that the use of a single plan calculated on an image acquired some time before the treatment is generally insufficient to accurately represent the daily dose to the target and to the organs at risk. This is particularly true for protons, due to the physical finite range. Although this characteristic enables the generation of steep dose gradients, which is essential for highly conformal radiotherapy, it also tightens the dependency of the delivered dose to the range accuracy. In particular, the use of an out-dated patient anatomy is one of the most significant sources of range inaccuracy, thus affecting the quality of the planned dose distribution. A plan should be ideally adapted as soon as anatomical variations occur, ideally online. In this review, we describe in detail the different steps of the adaptive workflow and discuss the challenges and corresponding state-of-the art developments in particular for an online adaptive strategy.
{"title":"Online daily adaptive proton therapy.","authors":"F. Albertini, M. Matter, L. Nenoff, Ye Zhang, A. Lomax","doi":"10.1259/bjr.20190594","DOIUrl":"https://doi.org/10.1259/bjr.20190594","url":null,"abstract":"It is recognised that the use of a single plan calculated on an image acquired some time before the treatment is generally insufficient to accurately represent the daily dose to the target and to the organs at risk. This is particularly true for protons, due to the physical finite range. Although this characteristic enables the generation of steep dose gradients, which is essential for highly conformal radiotherapy, it also tightens the dependency of the delivered dose to the range accuracy. In particular, the use of an out-dated patient anatomy is one of the most significant sources of range inaccuracy, thus affecting the quality of the planned dose distribution. A plan should be ideally adapted as soon as anatomical variations occur, ideally online. In this review, we describe in detail the different steps of the adaptive workflow and discuss the challenges and corresponding state-of-the art developments in particular for an online adaptive strategy.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128184893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Proton beam therapy is a highly conformal form of radiation therapy, which currently represents an important therapeutic component in multidisciplinary management in paediatric oncology. The precise adjustability of protons results in a reduction of radiation-related long-term side-effects and secondary malignancy induction, which is of particular importance for the quality of life. Proton irradiation has been shown to offer significant advantages over conventional photon-based radiotherapy, although the biological effectiveness of both irradiation modalities is comparable. This review evaluates current data from clinical and dosimetric studies on the treatment of tumours of the central nervous system, soft tissue and bone sarcomas of the head and neck region, paraspinal or pelvic region, and retinoblastoma. To date, the clinical results of irradiating childhood tumours with high-precision proton therapy are promising both with regard to tumour cure and the reduction of adverse events. Modern proton therapy techniques such as pencil beam scanning and intensity modulation are increasingly established modern facilities. However, further investigations with larger patient cohorts and longer follow-up periods are required, in order to be able to have clear evidence on clinical benefits.
{"title":"Paediatric proton therapy.","authors":"H. Thomas, B. Timmermann","doi":"10.1259/bjr.20190601","DOIUrl":"https://doi.org/10.1259/bjr.20190601","url":null,"abstract":"Proton beam therapy is a highly conformal form of radiation therapy, which currently represents an important therapeutic component in multidisciplinary management in paediatric oncology. The precise adjustability of protons results in a reduction of radiation-related long-term side-effects and secondary malignancy induction, which is of particular importance for the quality of life. Proton irradiation has been shown to offer significant advantages over conventional photon-based radiotherapy, although the biological effectiveness of both irradiation modalities is comparable. This review evaluates current data from clinical and dosimetric studies on the treatment of tumours of the central nervous system, soft tissue and bone sarcomas of the head and neck region, paraspinal or pelvic region, and retinoblastoma. To date, the clinical results of irradiating childhood tumours with high-precision proton therapy are promising both with regard to tumour cure and the reduction of adverse events. Modern proton therapy techniques such as pencil beam scanning and intensity modulation are increasingly established modern facilities. However, further investigations with larger patient cohorts and longer follow-up periods are required, in order to be able to have clear evidence on clinical benefits.","PeriodicalId":226783,"journal":{"name":"The British journal of radiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128834382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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