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Reducing Radiation Dermatitis for PBS Proton Therapy Breast Cancer Patients Using SpotDelete. 使用 SpotDelete 减少 PBS 质子治疗乳腺癌患者的放射性皮炎。
IF 2.1 Q3 ONCOLOGY Pub Date : 2024-08-28 eCollection Date: 2024-09-01 DOI: 10.1016/j.ijpt.2024.100628
Samantha G Hedrick, Laura Buchanan, Stephen Mahan, Chester Ramsey

Purpose: The purpose of this work was to reduce the severity of radiation dermatitis for breast cancer patients receiving pencil beam scanning proton therapy. The hypothesis was that eliminating proton spots (SpotDelete) in the 0.5 cm skin rind would reduce the potentially higher relative biological effectiveness (RBE) known to occur at the Bragg Peak.

Patients and methods: Our center has been using an in-house developed Python script in RayStation since 2021 to remove spots from the skin rind of breast patients. In this work, we retrospectively reviewed the on-treatment visit data from a cohort of breast patients treated with hypofractionation (16 fractions) before this technique (MinDepth) and after (SpotDelete) to acquire the physician-reported radiation dermatitis scores. We evaluated the delivered treatment plans, calculating the linear energy transfer (LET) and applying 3 variable RBE models, Carabe-Fernandez, Wedenberg, and McNamara. An α/β of 10 was assumed for the skin.

Results: In the MinDepth cohort (n = 28), grade 1, 2, and 3 dermatitis accounted for 57%, 36%, and 7% of the cases, respectively. For SpotDelete (n = 27), the incidence rate of grade 1 and 2 acute radiation dermatitis was 67% and 37%, respectively. There were 0 instances of grade 3 dermatitis observed in the SpotDelete cohort. The onset of radiation dermatitis in the SpotDelete cohort was delayed compared to MinDepth, occurring 1 week later in the course of treatment. There was no significant difference in LET or in any of the variable RBE models when analyzing the 0.5 cm skin rind between the cohorts.

Conclusion: Despite the lack of correlation in LET or RBE, SpotDelete has been shown to reduce the severity and onset of radiation dermatitis. Possibly, more research into the α/β for skin and RBE models based on skin cell lines could provide insight into the efficacy of the SpotDelete technique.

目的:这项研究的目的是减轻接受铅笔束扫描质子治疗的乳腺癌患者放射性皮炎的严重程度。假设消除 0.5 厘米皮肤边缘的质子点(SpotDelete)将降低已知在布拉格峰发生的潜在较高相对生物效应(RBE):自 2021 年以来,我们中心一直在使用 RayStation 中自行开发的 Python 脚本来清除乳腺患者皮肤边缘的斑点。在这项工作中,我们回顾性地查看了一组乳腺癌患者在使用该技术(MinDepth)前和使用该技术(SpotDelete)后接受低分量治疗(16 次分次)的治疗访视数据,以获取医生报告的放射性皮炎评分。我们通过计算线性能量传递(LET)和应用 Carabe-Fernandez、Wedenberg 和 McNamara 三种可变 RBE 模型,对放射治疗计划进行了评估。假设皮肤的α/β为10:在 MinDepth 组群(28 人)中,1 级、2 级和 3 级皮炎分别占 57%、36% 和 7%。在 SpotDelete 组(n = 27)中,1 级和 2 级急性放射性皮炎的发病率分别为 67% 和 37%。在 SpotDelete 群体中观察到的 3 级皮炎为 0 例。与 MinDepth 相比,SpotDelete 组群中放射性皮炎的发病时间有所推迟,在治疗过程中推迟了 1 周。在分析队列之间的 0.5 厘米皮缘时,LET 或任何可变 RBE 模型均无明显差异:结论:尽管 LET 或 RBE 缺乏相关性,但 SpotDelete 已被证明能减轻放射性皮炎的严重程度并减少其发生。对皮肤的α/β和基于皮肤细胞系的 RBE 模型进行更多研究,可能会有助于深入了解 SpotDelete 技术的功效。
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引用次数: 0
Secondary Cancer in Prostate Cancer Patients Treated With Advanced External Beam Radiation Therapy. 接受先进体外放射治疗的前列腺癌患者的继发性癌症
IF 2.1 Q3 ONCOLOGY Pub Date : 2024-08-23 eCollection Date: 2024-09-01 DOI: 10.1016/j.ijpt.2024.100627
Sarah E Kulkarni, Sagar A Patel, Yuxian Sun, Ashesh B Jani, Theresa W Gillespie, Mark W McDonald, Yuan Liu

Purpose: Previous studies have shown that external beam radiation therapy is associated with an increased risk of second primary cancer (SPC) among prostate cancer (PCa) patients, but the relative risks associated with newer and advanced radiation modalities such as proton beam therapy (PBT) and stereotactic body radiation therapy (SBRT) are unclear. This study aimed to assess the relative probability of SPC among patients treated with these newer modalities compared to intensity-modulated radiation therapy (IMRT).

Patients and methods: Using the National Cancer Database (NCDB), N0M0 PCa cases diagnosed between 2004 and 2018 were identified. Second primary cancer probabilities were compared among those treated with curative-intent PBT, SBRT, and IMRT. Multivariable logistic regression and inverse probability of treatment weighting were used to generate adjusted odds ratios (aORs) and 95% confidence intervals (CIs).

Results: In total, 133 898 patients were included, with a median age of 69 years and median follow-up of 6.4 years. As their first course of treatment, 3420 (2.6%) received PBT, 121 211 (90.5%) received IMRT, and 9267 (6.9%) received SBRT. Compared with IMRT, PBT and SBRT were associated with lower SPC risk (aORs and 95% CIs, PBT: 0.49 [0.40-0.60], SBRT: 0.57 (0.51-0.63), P < .001). Inverse probability of treatment weighting analyses corroborated these results.

Conclusion: In this large national cohort, PBT and SBRT performed similarly and were associated with reduced SPC risk compared to IMRT when used as the first course of treatment.

目的:以往的研究表明,体外放射治疗与前列腺癌(PCa)患者罹患第二原发癌(SPC)的风险增加有关,但质子束治疗(PBT)和立体定向体放射治疗(SBRT)等更新、更先进的放射模式的相关风险尚不清楚。本研究旨在评估与调强放射治疗(IMRT)相比,接受这些较新模式治疗的患者发生SPC的相对概率:通过国家癌症数据库(NCDB),确定了2004年至2018年间诊断的N0M0 PCa病例。比较了接受治愈性PBT、SBRT和IMRT治疗的患者的二次原发癌概率。采用多变量逻辑回归和逆治疗概率加权生成调整后的几率比(aORs)和95%置信区间(CIs):共纳入 133 898 例患者,中位年龄为 69 岁,中位随访时间为 6.4 年。3420名患者(2.6%)接受了PBT治疗,121211名患者(90.5%)接受了IMRT治疗,9267名患者(6.9%)接受了SBRT治疗。与 IMRT 相比,PBT 和 SBRT 与较低的 SPC 风险相关(aORs 和 95% CIs,PBT:0.49 [0.40-0.60],SBRT:0.57 (0.51-0.63),P 结论:在这一大型全国队列中,PBT 和 SBRT 的疗效相似,与 IMRT 相比,PBT 和 SBRT 在作为第一疗程时可降低 SPC 风险。
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引用次数: 0
Particle Beam Radiobiology Status and Challenges: A PTCOG Radiobiology Subcommittee Report. 粒子束放射生物学的现状与挑战:PTCOG 放射生物学小组委员会报告。
IF 2.1 Q3 ONCOLOGY Pub Date : 2024-08-08 eCollection Date: 2024-09-01 DOI: 10.1016/j.ijpt.2024.100626
Reem Ahmad, Amelia Barcellini, Kilian Baumann, Malte Benje, Tamara Bender, Paloma Bragado, Alexandra Charalampopoulou, Reema Chowdhury, Anthony J Davis, Daniel K Ebner, John Eley, Jake A Kloeber, Robert W Mutter, Thomas Friedrich, Alvaro Gutierrez-Uzquiza, Alexander Helm, Marta Ibáñez-Moragues, Lorea Iturri, Jeannette Jansen, Miguel Ángel Morcillo, Daniel Puerta, Anggraeini Puspitasari Kokko, Daniel Sánchez-Parcerisa, Emanuele Scifoni, Takashi Shimokawa, Olga Sokol, Michael D Story, Juliette Thariat, Walter Tinganelli, Francesco Tommasino, Charlot Vandevoorde, Cläre von Neubeck

Particle therapy (PT) represents a significant advancement in cancer treatment, precisely targeting tumor cells while sparing surrounding healthy tissues thanks to the unique depth-dose profiles of the charged particles. Furthermore, their linear energy transfer and relative biological effectiveness enhance their capability to treat radioresistant tumors, including hypoxic ones. Over the years, extensive research has paved the way for PT's clinical application, and current efforts aim to refine its efficacy and precision, minimizing the toxicities. In this regard, radiobiology research is evolving toward integrating biotechnology to advance drug discovery and radiation therapy optimization. This shift from basic radiobiology to understanding the molecular mechanisms of PT aims to expand the therapeutic window through innovative dose delivery regimens and combined therapy approaches. This review, written by over 30 contributors from various countries, provides a comprehensive look at key research areas and new developments in PT radiobiology, emphasizing the innovations and techniques transforming the field, ranging from the radiobiology of new irradiation modalities to multimodal radiation therapy and modeling efforts. We highlight both advancements and knowledge gaps, with the aim of improving the understanding and application of PT in oncology.

粒子疗法(PT)是癌症治疗领域的一大进步,由于带电粒子独特的深度-剂量分布,它可以精确地靶向肿瘤细胞,同时保护周围的健康组织。此外,粒子的线性能量转移和相对生物效应增强了其治疗抗放射肿瘤(包括缺氧性肿瘤)的能力。多年来,广泛的研究为 PT 的临床应用铺平了道路,目前的目标是提高其疗效和精确度,最大限度地减少毒性。在这方面,放射生物学研究正朝着整合生物技术的方向发展,以推进药物发现和放射治疗优化。这种从基础放射生物学到了解 PT 分子机制的转变,旨在通过创新的剂量给药方案和联合治疗方法来扩大治疗窗口。本综述由来自不同国家的 30 多位撰稿人撰写,全面介绍了 PT 放射生物学的关键研究领域和新进展,强调了改变该领域的创新和技术,从新辐照模式的放射生物学到多模式放射治疗和建模工作。我们强调了研究进展和知识差距,旨在提高人们对肿瘤学中 PT 的理解和应用。
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引用次数: 0
Clinical Translation of a Deep Learning Model of Radiation-Induced Lymphopenia for Esophageal Cancer. 食管癌放射诱导淋巴细胞减少症深度学习模型的临床转化。
IF 2.1 Q3 ONCOLOGY Pub Date : 2024-08-05 eCollection Date: 2024-09-01 DOI: 10.1016/j.ijpt.2024.100624
Zongsheng Hu, Radhe Mohan, Yan Chu, Xiaochun Wang, Peter S N van Rossum, Yiqing Chen, Madison E Grayson, Angela G Gearhardt, Clemens Grassberger, Degui Zhi, Brian P Hobbs, Steven H Lin, Wenhua Cao

Purpose: Radiation-induced lymphopenia is a common immune toxicity that adversely impacts treatment outcomes. We report here our approach to translate a deep-learning (DL) model developed to predict severe lymphopenia risk among esophageal cancer into a strategy for incorporating the immune system as an organ-at-risk (iOAR) to mitigate the risk.

Materials and methods: We conducted "virtual clinical trials" utilizing retrospective data for 10 intensity-modulated radiation therapy (IMRT) and 10 passively-scattered proton therapy (PSPT) esophageal cancer patients. For each patient, additional treatment plans of the modality other than the original were created employing standard-of-care (SOC) dose constraints. Predicted values of absolute lymphocyte count (ALC) nadir for all plans were estimated using a previously-developed DL model. The model also yielded the relative magnitudes of contributions of iOARs dosimetric factors to ALC nadir, which were used to compute iOARs dose-volume constraints, which were incorporated into optimization criteria to produce "IMRT-enhanced" and "intensity-modulated proton therapy (IMPT)-enhanced" plans.

Results: Model-predicted ALC nadir for the original IMRT (IMRT-SOC) and PSPT plans agreed well with actual values. IMPT-SOC showed greater immune sparing vs IMRT and PSPT. The average mean body doses were 13.10 Gy vs 7.62 Gy for IMRT-SOC vs IMPT-SOC for patients treated with IMRT-SOC; and 8.08 Gy vs 6.68 Gy for PSPT vs IMPT-SOC for patients treated with PSPT. For IMRT patients, the average predicted ALC nadir of IMRT-SOC, IMRT-enhanced, IMPT-SOC, and IMPT-enhanced was 281, 327, 351, and 392 cells/µL, respectively. For PSPT patients, the average predicted ALC nadir of PSPT, IMPT-SOC, and IMPT-enhanced was 258, 316, and 350 cells/µL, respectively. Enhanced plans achieved higher predicted ALC nadir, with an average improvement of 40.8 cells/µL (20.6%).

Conclusion: The proposed DL model-guided strategy to incorporate the immune system as iOAR in IMRT and IMPT optimization has the potential for radiation-induced lymphopenia mitigation. A prospective clinical trial is planned.

目的:放射诱导的淋巴细胞减少症是一种常见的免疫毒性,会对治疗效果产生不利影响。我们在此报告了我们将为预测食管癌严重淋巴细胞减少症风险而开发的深度学习(DL)模型转化为将免疫系统作为风险器官(iOAR)以降低风险的策略的方法:我们利用 10 例调强放射治疗(IMRT)和 10 例被动散射质子治疗(PSPT)食管癌患者的回顾性数据进行了 "虚拟临床试验"。根据标准治疗(SOC)剂量限制,为每位患者制定了除原始治疗方案之外的其他治疗方案。所有计划的绝对淋巴细胞计数 (ALC) 最低点预测值都是通过之前开发的 DL 模型估算出来的。该模型还得出了 iOARs 剂量测定因子对 ALC nadir 的相对贡献大小,并将其用于计算 iOARs 剂量-容积约束,将其纳入优化标准,以生成 "IMRT 增强 "和 "强度调制质子疗法 (IMPT) 增强 "计划:原始 IMRT(IMRT-SOC)和 PSPT 方案的模型预测 ALC nadir 与实际值非常吻合。与 IMRT 和 PSPT 相比,IMPT-SOC 显示出更大的免疫疏通作用。对于接受 IMRT-SOC 治疗的患者,IMRT-SOC 与 IMPT-SOC 的平均体内剂量分别为 13.10 Gy 与 7.62 Gy;对于接受 PSPT 治疗的患者,PSPT 与 IMPT-SOC 的平均体内剂量分别为 8.08 Gy 与 6.68 Gy。对于 IMRT 患者,IMRT-SOC、IMRT-增强、IMPT-SOC 和 IMPT-增强的平均预测 ALC nadir 分别为 281、327、351 和 392 cells/µL。对于 PSPT 患者,PSPT、IMPT-SOC 和 IMPT 增强型的平均预测 ALC 最低值分别为 258、316 和 350 cells/µL。增强型计划实现了更高的预测 ALC 最低值,平均提高了 40.8 个细胞/微升(20.6%):结论:将免疫系统作为iOAR纳入IMRT和IMPT优化的DL模型指导策略具有缓解放射诱导的淋巴细胞减少症的潜力。计划进行前瞻性临床试验。
{"title":"Clinical Translation of a Deep Learning Model of Radiation-Induced Lymphopenia for Esophageal Cancer.","authors":"Zongsheng Hu, Radhe Mohan, Yan Chu, Xiaochun Wang, Peter S N van Rossum, Yiqing Chen, Madison E Grayson, Angela G Gearhardt, Clemens Grassberger, Degui Zhi, Brian P Hobbs, Steven H Lin, Wenhua Cao","doi":"10.1016/j.ijpt.2024.100624","DOIUrl":"10.1016/j.ijpt.2024.100624","url":null,"abstract":"<p><strong>Purpose: </strong>Radiation-induced lymphopenia is a common immune toxicity that adversely impacts treatment outcomes. We report here our approach to translate a deep-learning (DL) model developed to predict severe lymphopenia risk among esophageal cancer into a strategy for incorporating the immune system as an organ-at-risk (iOAR) to mitigate the risk.</p><p><strong>Materials and methods: </strong>We conducted \"virtual clinical trials\" utilizing retrospective data for 10 intensity-modulated radiation therapy (IMRT) and 10 passively-scattered proton therapy (PSPT) esophageal cancer patients. For each patient, additional treatment plans of the modality other than the original were created employing standard-of-care (SOC) dose constraints. Predicted values of absolute lymphocyte count (ALC) nadir for all plans were estimated using a previously-developed DL model. The model also yielded the relative magnitudes of contributions of iOARs dosimetric factors to ALC nadir, which were used to compute iOARs dose-volume constraints, which were incorporated into optimization criteria to produce \"IMRT-enhanced\" and \"intensity-modulated proton therapy (IMPT)-enhanced\" plans.</p><p><strong>Results: </strong>Model-predicted ALC nadir for the original IMRT (IMRT-SOC) and PSPT plans agreed well with actual values. IMPT-SOC showed greater immune sparing vs IMRT and PSPT. The average mean body doses were 13.10 Gy vs 7.62 Gy for IMRT-SOC vs IMPT-SOC for patients treated with IMRT-SOC; and 8.08 Gy vs 6.68 Gy for PSPT vs IMPT-SOC for patients treated with PSPT. For IMRT patients, the average predicted ALC nadir of IMRT-SOC, IMRT-enhanced, IMPT-SOC, and IMPT-enhanced was 281, 327, 351, and 392 cells/µL, respectively. For PSPT patients, the average predicted ALC nadir of PSPT, IMPT-SOC, and IMPT-enhanced was 258, 316, and 350 cells/µL, respectively. Enhanced plans achieved higher predicted ALC nadir, with an average improvement of 40.8 cells/µL (20.6%).</p><p><strong>Conclusion: </strong>The proposed DL model-guided strategy to incorporate the immune system as iOAR in IMRT and IMPT optimization has the potential for radiation-induced lymphopenia mitigation. A prospective clinical trial is planned.</p>","PeriodicalId":36923,"journal":{"name":"International Journal of Particle Therapy","volume":"13 ","pages":"100624"},"PeriodicalIF":2.1,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11369390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142126792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cone-Beam CT Images as an Indicator of QACT During Adaptive Proton Therapy of Extremity Sarcomas. 锥形束 CT 图像作为四肢肉瘤自适应质子治疗过程中 QACT 的指标。
IF 2.1 Q3 ONCOLOGY Pub Date : 2024-04-26 eCollection Date: 2024-06-01 DOI: 10.1016/j.ijpt.2024.100017
Nrusingh C Biswal, Baoshe Zhang, Elizabeth Nichols, Matthew E Witek, William F Regine, ByongYong Yi

Purpose: Periodic quality assurance CTs (QACTs) are routine in proton beam therapy. In this study, we tested whether the necessity for a QACT could be determined by evaluating the change in beam path length (BPL) on daily cone-beam CT (CBCT).

Patients and methods: In this Institutional Review Board-approved study, we retrospectively analyzed 959 CBCT images from 78 patients with sarcomas treated with proton pencil-beam scanning. Plans on 17 QACTs out of a total of 243 were clinically determined to be replanned for various reasons. Daily CBCTs were retrospectively analyzed by automatic ray-tracing of each beam from the isocenter to the skin surface along the central axis. A script was developed for this purpose. Patterns of change in BPL on CBCT images were compared to those from adaptive planning using weekly QACTs.

Results: Sixteen of the 17 adaptive replans showed BPL changes ≥4 mm for at least 1 of the beams on 3 consecutive CBCT sessions. Similarly, 43 of 63 nonadaptively planned patients had BPL changes <4 mm for all of the beams. A new QACT criterium of a BPL change of any beam ≥4 mm on 3 consecutive CBCT sessions resulted in a sensitivity of 94.1% and a specificity of 68.3%. Had the BPL change been used as the QACT predictor, a total of 37 QACTs would have been performed rather than 243 QACTs in clinical practice.

Conclusion: The use of BPL changes on CBCT images represented a significant reduction (85%) in total QACT burden while maintaining treatment quality and accuracy. QACT can be performed only when it is needed, but not in a periodic manner. The benefits of reducing QACT frequency include reducing imaging dose and optimizing patient time and staff resources.

目的:定期质量保证 CT(QACT)是质子束治疗的常规方法。在这项研究中,我们测试了是否有必要通过评估每日锥束 CT(CBCT)上束路径长度(BPL)的变化来确定是否需要进行 QACT:在这项经机构审查委员会批准的研究中,我们回顾性分析了 78 名接受质子铅笔束扫描治疗的肉瘤患者的 959 张 CBCT 图像。在总共 243 个 QACT 中,有 17 个 QACT 的计划因各种原因被临床确定为需要重新计划。通过对每束射线从等中心到皮肤表面沿中心轴进行自动射线追踪,对每天的 CBCT 进行回顾性分析。为此开发了一个脚本。将 CBCT 图像上 BPL 的变化模式与使用每周 QACTs 进行自适应规划的模式进行比较:结果:在 17 个自适应重扫描中,有 16 个在连续 3 次 CBCT 扫描中至少有 1 个光束的 BPL 变化≥4 mm。同样,63 名非适应性计划患者中有 43 人的 BPL 发生了变化:使用 CBCT 图像上的 BPL 变化可显著减少(85%)QACT 的总负担,同时保持治疗质量和准确性。只有在需要时才能进行 QACT,而不是定期进行。减少 QACT 频率的好处包括降低成像剂量、优化患者时间和人力资源。
{"title":"Cone-Beam CT Images as an Indicator of QACT During Adaptive Proton Therapy of Extremity Sarcomas.","authors":"Nrusingh C Biswal, Baoshe Zhang, Elizabeth Nichols, Matthew E Witek, William F Regine, ByongYong Yi","doi":"10.1016/j.ijpt.2024.100017","DOIUrl":"10.1016/j.ijpt.2024.100017","url":null,"abstract":"<p><strong>Purpose: </strong>Periodic quality assurance CTs (QACTs) are routine in proton beam therapy. In this study, we tested whether the necessity for a QACT could be determined by evaluating the change in beam path length (BPL) on daily cone-beam CT (CBCT).</p><p><strong>Patients and methods: </strong>In this Institutional Review Board-approved study, we retrospectively analyzed 959 CBCT images from 78 patients with sarcomas treated with proton pencil-beam scanning. Plans on 17 QACTs out of a total of 243 were clinically determined to be replanned for various reasons. Daily CBCTs were retrospectively analyzed by automatic ray-tracing of each beam from the isocenter to the skin surface along the central axis. A script was developed for this purpose. Patterns of change in BPL on CBCT images were compared to those from adaptive planning using weekly QACTs.</p><p><strong>Results: </strong>Sixteen of the 17 adaptive replans showed BPL changes ≥4 mm for at least 1 of the beams on 3 consecutive CBCT sessions. Similarly, 43 of 63 nonadaptively planned patients had BPL changes <4 mm for all of the beams. A new QACT criterium of a BPL change of any beam ≥4 mm on 3 consecutive CBCT sessions resulted in a sensitivity of 94.1% and a specificity of 68.3%. Had the BPL change been used as the QACT predictor, a total of 37 QACTs would have been performed rather than 243 QACTs in clinical practice.</p><p><strong>Conclusion: </strong>The use of BPL changes on CBCT images represented a significant reduction (85%) in total QACT burden while maintaining treatment quality and accuracy. QACT can be performed only when it is needed, but not in a periodic manner. The benefits of reducing QACT frequency include reducing imaging dose and optimizing patient time and staff resources.</p>","PeriodicalId":36923,"journal":{"name":"International Journal of Particle Therapy","volume":"12 ","pages":"100017"},"PeriodicalIF":2.1,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11252065/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141634855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
PTCOG Gastrointestinal Subcommittee Lower Gastrointestinal Tract Malignancies Consensus Statement. PTCOG 胃肠道小组委员会下消化道恶性肿瘤共识声明。
IF 1.7 Q3 ONCOLOGY Pub Date : 2024-04-26 eCollection Date: 2024-03-01 DOI: 10.1016/j.ijpt.2024.100019
J Isabelle Choi, Andrzej Wojcieszynski, Richard A Amos, Huan Giap, Smith Apisarnthanarax, Jonathan B Ashman, Aman Anand, Luis A Perles, Tyler Williamson, Shanmugasundaram Ramkumar, Jason Molitoris, Charles B Simone, Michael D Chuong

Purpose: Radiotherapy delivery in the definitive management of lower gastrointestinal (LGI) tract malignancies is associated with substantial risk of acute and late gastrointestinal (GI), genitourinary, dermatologic, and hematologic toxicities. Advanced radiation therapy techniques such as proton beam therapy (PBT) offer optimal dosimetric sparing of critical organs at risk, achieving a more favorable therapeutic ratio compared with photon therapy.

Materials and methods: The international Particle Therapy Cooperative Group GI Subcommittee conducted a systematic literature review, from which consensus recommendations were developed on the application of PBT for LGI malignancies.

Results: Eleven recommendations on clinical indications for which PBT should be considered are presented with supporting literature, and each recommendation was assessed for level of evidence and strength of recommendation. Detailed technical guidelines pertaining to simulation, treatment planning and delivery, and image guidance are also provided.

Conclusion: PBT may be of significant value in select patients with LGI malignancies. Additional clinical data are needed to further elucidate the potential benefits of PBT for patients with anal cancer and rectal cancer.

目的:在下消化道(LGI)恶性肿瘤的最终治疗中,放疗与急性和晚期胃肠道(GI)、泌尿生殖系统、皮肤和血液毒性的巨大风险相关。质子束疗法(PBT)等先进的放射治疗技术能最大限度地保留有风险的关键器官的剂量,与光子疗法相比,能获得更有利的治疗比:国际粒子治疗合作组消化道小组委员会进行了一次系统的文献综述,并在此基础上就PBT在LGI恶性肿瘤中的应用提出了共识性建议:结果:共提出了 11 项关于应考虑使用 PBT 的临床适应症的建议,并附有支持性文献,对每项建议都进行了证据级别和推荐强度评估。此外,还提供了有关模拟、治疗计划和实施以及图像引导的详细技术指南:结论:PBT 可能对某些 LGI 恶性肿瘤患者有重要价值。需要更多临床数据来进一步阐明 PBT 对肛门癌和直肠癌患者的潜在益处。
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引用次数: 0
The Status and Challenges for Prostate Stereotactic Body Radiation Therapy Treatments in United States Proton Therapy Centers: An NRG Oncology Practice Survey. 美国质子治疗中心前列腺立体定向体放射治疗的现状与挑战:NRG 肿瘤学实践调查。
IF 2.1 Q3 ONCOLOGY Pub Date : 2024-04-24 eCollection Date: 2024-03-01 DOI: 10.1016/j.ijpt.2024.100020
Jiajian Shen, Paige A Taylor, Carlos E Vargas, Minglei Kang, Jatinder Saini, Jun Zhou, Peilong Wang, Wei Liu, Charles B Simone, Ying Xiao, Liyong Lin

Purpose: To report the current practice pattern of the proton stereotactic body radiation therapy (SBRT) for prostate treatments.

Materials and methods: A survey was designed to inquire about the practice of proton SBRT treatment for prostate cancer. The survey was distributed to all 30 proton therapy centers in the United States that participate in the National Clinical Trial Network in February, 2023. The survey focused on usage, patient selection criteria, prescriptions, target contours, dose constraints, treatment plan optimization and evaluation methods, patient-specific QA, and image-guided radiation therapy (IGRT) methods.

Results: We received responses from 25 centers (83% participation). Only 8 respondent proton centers (32%) reported performing SBRT of the prostate. The remaining 17 centers cited 3 primary reasons for not offering this treatment: no clinical need, lack of volumetric imaging, and/or lack of clinical evidence. Only 1 center cited the reduction in overall reimbursement as a concern for not offering prostate SBRT. Several common practices among the 8 centers offering SBRT for the prostate were noted, such as using Hydrogel spacers, fiducial markers, and magnetic resonance imaging (MRI) for target delineation. Most proton centers (87.5%) utilized pencil beam scanning (PBS) delivery and completed Imaging and Radiation Oncology Core (IROC) phantom credentialing. Treatment planning typically used parallel opposed lateral beams, and consistent parameters for setup and range uncertainties were used for plan optimization and robustness evaluation. Measurements-based patient-specific QA, beam delivery every other day, fiducial contours for IGRT, and total doses of 35 to 40 GyRBE were consistent across all centers. However, there was no consensus on the risk levels for patient selection.

Conclusion: Prostate SBRT is used in about 1/3 of proton centers in the US. There was a significant consistency in practices among proton centers treating with proton SBRT. It is possible that the adoption of proton SBRT may become more common if proton SBRT is more commonly offered in clinical trials.

目的:报告目前质子立体定向体放射治疗(SBRT)治疗前列腺癌的实践模式:设计了一项调查,以了解质子 SBRT 治疗前列腺癌的实践情况。调查表于 2023 年 2 月分发给美国参加国家临床试验网络的所有 30 个质子治疗中心。调查的重点包括使用情况、患者选择标准、处方、靶轮廓、剂量限制、治疗方案优化和评估方法、患者特异性质量保证以及图像引导放射治疗(IGRT)方法:我们收到了来自 25 个中心(83% 参与)的回复。只有 8 家质子中心(32%)报告对前列腺进行了 SBRT 治疗。其余 17 个中心列举了不提供这种治疗的 3 个主要原因:无临床需求、缺乏容积成像和/或缺乏临床证据。只有 1 家中心认为,不提供前列腺 SBRT 治疗的原因是总体报销额度减少。在提供前列腺 SBRT 治疗的 8 家中心中,有几种常见的做法,如使用水凝胶垫片、靶标和磁共振成像(MRI)进行靶区划分。大多数质子中心(87.5%)使用铅笔束扫描(PBS)传输,并完成了成像与放射肿瘤学核心(IROC)的人体模型认证。治疗计划通常使用平行对侧射束,并将一致的设置参数和范围不确定性用于计划优化和稳健性评估。以测量为基础的患者特异性质量保证、隔天一次的射束传输、IGRT 的靶点轮廓以及 35 至 40 GyRBE 的总剂量在所有中心都是一致的。但是,对于选择患者的风险水平,各中心并没有达成共识:结论:美国约有 1/3 的质子中心使用前列腺 SBRT。采用质子 SBRT 治疗的质子中心在做法上有很大的一致性。如果质子 SBRT 在临床试验中得到更广泛的应用,质子 SBRT 的应用可能会变得更加普遍。
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引用次数: 0
Long-Term Outcomes Following Definitive or Adjuvant Proton Radiotherapy for Adenoid Cystic Carcinoma. 腺样囊性癌确诊或辅助质子放疗后的长期疗效
IF 1.7 Q3 ONCOLOGY Pub Date : 2024-04-24 eCollection Date: 2024-03-01 DOI: 10.1016/j.ijpt.2024.100008
Etzer Augustin, Adam L Holtzman, Roi Dagan, Curtis M Bryant, Daniel J Indelicato, Christopher G Morris, Rohan L Deraniyagala, Rui P Fernandes, Anthony M Bunnell, Stacey M Nedrud, William M Mendenhall

Purpose: Adenoid cystic carcinoma (ACC) is a rare malignancy accounting for 1% of all head and neck cancers. Treatment for ACC has its challenges and risks, yet few outcomes studies exist. We present long-term outcomes of patients with ACC of the head and neck treated with proton therapy (PT).

Materials and methods: Under an institutional review board-approved, single-institutional prospective outcomes registry, we reviewed the records of 56 patients with de novo, nonmetastatic ACC of the head and neck treated with PT with definitive (n = 9) or adjuvant PT (n = 47) from June 2007 to December 2021. The median dose to the primary site was 72.6 gray relative biological equivalent (range, 64-74.4) delivered as either once (n = 19) or twice (n = 37) daily treatments. Thirty patients received concurrent chemotherapy. Thirty-one patients received nodal radiation, 30 electively and 1 for nodal involvement.

Results: With a median follow-up of 6.2 years (range, 0.9-14.7), the 5-year local-regional control (LRC), disease-free survival, cause-specific survival, and overall survival rates were 88%, 85%, 89%, and 89%, respectively. Intracranial extension (P = .003) and gross residual tumor (P = .0388) were factors associated with LRC rates. While the LRC rate for those with a gross total resection was 96%, those with subtotal resection or biopsy alone were 81% and 76%, respectively. The 5-year cumulative incidence of clinically significant grade ≥3 toxicity was 15%, and the crude incidence at the most recent follow-up was 23% (n = 13).

Conclusion: This is the largest sample size with the longest median follow-up to date of patients with ACC treated with PT. PT can provide excellent disease control for ACC of the head and neck with acceptable toxicity. T4 disease, intracranial involvement, and gross residual disease at the time of PT following either biopsy or subtotal resection were significant prognostic features for worse outcomes.

目的:腺样囊性癌(ACC)是一种罕见的恶性肿瘤,占所有头颈部癌症的 1%。ACC的治疗具有挑战性和风险性,但很少有疗效研究。我们介绍了采用质子疗法(PT)治疗头颈部ACC患者的长期疗效:根据机构审查委员会批准的单一机构前瞻性结果登记,我们回顾了自2007年6月至2021年12月接受质子治疗的56例头颈部新发、非转移性ACC患者的记录,这些患者接受了明确的质子治疗(9例)或辅助质子治疗(47例)。原发部位的中位剂量为72.6灰相对生物当量(范围为64-74.4),每天治疗一次(19例)或两次(37例)。30 名患者同时接受了化疗。31例患者接受了结节放射治疗,其中30例为选择性治疗,1例为结节受累治疗:中位随访时间为 6.2 年(0.9-14.7 年),5 年局部区域控制率(LRC)、无病生存率、病因特异性生存率和总生存率分别为 88%、85%、89% 和 89%。颅内扩展(P = .003)和肿瘤大体残留(P = .0388)是影响LRC率的相关因素。大体全切除者的左侧淋巴结转移率为96%,而次全切除或单纯活检者的左侧淋巴结转移率分别为81%和76%。临床显著性≥3级毒性的5年累积发生率为15%,最近一次随访的粗略发生率为23%(n = 13):这是迄今为止样本量最大、中位随访时间最长的PT治疗ACC患者。PT能很好地控制头颈部ACC的病情,且毒性可接受。T4病变、颅内受累以及活检或次全切除术后PT时的大体残留病变是预后较差的重要特征。
{"title":"Long-Term Outcomes Following Definitive or Adjuvant Proton Radiotherapy for Adenoid Cystic Carcinoma.","authors":"Etzer Augustin, Adam L Holtzman, Roi Dagan, Curtis M Bryant, Daniel J Indelicato, Christopher G Morris, Rohan L Deraniyagala, Rui P Fernandes, Anthony M Bunnell, Stacey M Nedrud, William M Mendenhall","doi":"10.1016/j.ijpt.2024.100008","DOIUrl":"https://doi.org/10.1016/j.ijpt.2024.100008","url":null,"abstract":"<p><strong>Purpose: </strong>Adenoid cystic carcinoma (ACC) is a rare malignancy accounting for 1% of all head and neck cancers. Treatment for ACC has its challenges and risks, yet few outcomes studies exist. We present long-term outcomes of patients with ACC of the head and neck treated with proton therapy (PT).</p><p><strong>Materials and methods: </strong>Under an institutional review board-approved, single-institutional prospective outcomes registry, we reviewed the records of 56 patients with de novo, nonmetastatic ACC of the head and neck treated with PT with definitive (<i>n</i> = 9) or adjuvant PT (<i>n</i> = 47) from June 2007 to December 2021. The median dose to the primary site was 72.6 gray relative biological equivalent (range, 64-74.4) delivered as either once (<i>n</i> = 19) or twice (<i>n</i> = 37) daily treatments. Thirty patients received concurrent chemotherapy. Thirty-one patients received nodal radiation, 30 electively and 1 for nodal involvement.</p><p><strong>Results: </strong>With a median follow-up of 6.2 years (range, 0.9-14.7), the 5-year local-regional control (LRC), disease-free survival, cause-specific survival, and overall survival rates were 88%, 85%, 89%, and 89%, respectively. Intracranial extension (<i>P</i> = .003) and gross residual tumor (<i>P</i> = .0388) were factors associated with LRC rates. While the LRC rate for those with a gross total resection was 96%, those with subtotal resection or biopsy alone were 81% and 76%, respectively. The 5-year cumulative incidence of clinically significant grade ≥3 toxicity was 15%, and the crude incidence at the most recent follow-up was 23% (<i>n</i> = 13).</p><p><strong>Conclusion: </strong>This is the largest sample size with the longest median follow-up to date of patients with ACC treated with PT. PT can provide excellent disease control for ACC of the head and neck with acceptable toxicity. T4 disease, intracranial involvement, and gross residual disease at the time of PT following either biopsy or subtotal resection were significant prognostic features for worse outcomes.</p>","PeriodicalId":36923,"journal":{"name":"International Journal of Particle Therapy","volume":"11 ","pages":"100008"},"PeriodicalIF":1.7,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11096740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140959886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Strategic Operational Redesign Improves Prior Authorization Access: A Validation Study. 战略操作重新设计改进了先前授权访问:一项验证研究
IF 1.7 Q3 ONCOLOGY Pub Date : 2023-11-24 eCollection Date: 2023-01-01 DOI: 10.14338/IJPT-23-00009.1
Eric D Brooks, Fantine Giap, Vincent Cassidy, Matthew S Ning, Bradlee Robbert, Polly Redding, Matthew Palmer, L Montreal Turner, William M Mendenhall, Stuart Klein, Nancy P Mendenhall

Purpose: Obtaining prior authorization (PA) before treatment is becoming increasingly burdensome in oncology, especially in radiation oncology. Here, we describe the impact of a strategic novel operational PA redesign to shorten authorization time and to improve patient access to cancer care at a large United States academic proton therapy center. We ask whether such a redesign may be replicable and adoptable across oncology centers.

Materials and methods: Our PA redesign strategy was based on a 3-tiered approach. Specifically, we (1) held payors accountable to legally backed timelines, (2) leveraged expertise on insurance policies and practices, and (3) updated the submission, appeal writing, and planning procedures for PA. Metrics were compared at the following 3 time points: 6 months before, at phase-in, and at 6 months after intervention.

Results: In analyzing the impact of improving PA access to care, the percentage of approvals for commercial proton beam therapy improved by an absolute 30.6% postintervention (P < .001). The proportion of commercially insured patients treated with proton beam therapy also increased by 6.2%, and the number of new starts rose by 11.7 patients/mo. Overall patient census increased by 13 patients/d. Median authorization time was 1 week, and 90% of surveyed providers reported reduced PA burden and improved patient care.

Conclusion: This is the first validated, comprehensive operational strategy to improve access to cancer therapy while reducing the burden of PA. This novel approach may be helpful for addressing barriers to PA in medical and surgical oncology because the redesign is predicated on laws that regulate PA across disciplines.

在肿瘤学领域,尤其是放射肿瘤学领域,在治疗前获得事先授权(PA)正变得越来越困难。在这里,我们描述了战略性的新型操作PA重新设计的影响,该重新设计缩短了授权时间,并改善了美国大型学术质子治疗中心患者获得癌症治疗的机会。我们想知道这样的重新设计是否可以在肿瘤中心复制和采用。我们的PA重新设计策略基于三层方法。具体而言,我们(1)要求付款人对法律支持的时间表负责,(2)利用保险政策和实践方面的专业知识,以及(3)更新PA的提交、上诉写作和规划程序。在以下3个时间点对指标进行比较:干预前6个月、逐步干预时和干预后6个月。在分析改善PA获得护理的影响时,商业质子束治疗的批准百分比在干预后绝对提高了30.6% (P < 0.001)。商业保险患者接受质子束治疗的比例也增加了6.2%,新开始治疗的人数增加了11.7例/月。患者总数增加了13例/d。中位授权时间为1周,90%的受访提供者报告减轻了PA负担并改善了患者护理。这是第一个经过验证的全面业务战略,旨在改善癌症治疗的可及性,同时减轻PA的负担。这种新颖的方法可能有助于解决医学和外科肿瘤学中PA的障碍,因为重新设计是基于规范跨学科PA的法律。
{"title":"Strategic Operational Redesign Improves Prior Authorization Access: A Validation Study.","authors":"Eric D Brooks, Fantine Giap, Vincent Cassidy, Matthew S Ning, Bradlee Robbert, Polly Redding, Matthew Palmer, L Montreal Turner, William M Mendenhall, Stuart Klein, Nancy P Mendenhall","doi":"10.14338/IJPT-23-00009.1","DOIUrl":"10.14338/IJPT-23-00009.1","url":null,"abstract":"<p><strong>Purpose: </strong>Obtaining prior authorization (PA) before treatment is becoming increasingly burdensome in oncology, especially in radiation oncology. Here, we describe the impact of a strategic novel operational PA redesign to shorten authorization time and to improve patient access to cancer care at a large United States academic proton therapy center. We ask whether such a redesign may be replicable and adoptable across oncology centers.</p><p><strong>Materials and methods: </strong>Our PA redesign strategy was based on a 3-tiered approach. Specifically, we (1) held payors accountable to legally backed timelines, (2) leveraged expertise on insurance policies and practices, and (3) updated the submission, appeal writing, and planning procedures for PA. Metrics were compared at the following 3 time points: 6 months before, at phase-in, and at 6 months after intervention.</p><p><strong>Results: </strong>In analyzing the impact of improving PA access to care, the percentage of approvals for commercial proton beam therapy improved by an absolute 30.6% postintervention (<i>P</i> < .001). The proportion of commercially insured patients treated with proton beam therapy also increased by 6.2%, and the number of new starts rose by 11.7 patients/mo. Overall patient census increased by 13 patients/d. Median authorization time was 1 week, and 90% of surveyed providers reported reduced PA burden and improved patient care.</p><p><strong>Conclusion: </strong>This is the first validated, comprehensive operational strategy to improve access to cancer therapy while reducing the burden of PA. This novel approach may be helpful for addressing barriers to PA in medical and surgical oncology because the redesign is predicated on laws that regulate PA across disciplines.</p>","PeriodicalId":36923,"journal":{"name":"International Journal of Particle Therapy","volume":"1 1","pages":"65-72"},"PeriodicalIF":1.7,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10698628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44242671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Patient-Specific Quality Assurance in Pencil Beam Scanning by 2-Dimensional Array 二维阵列铅笔束扫描患者特异性质量保证
Q3 ONCOLOGY Pub Date : 2023-11-08 DOI: 10.14338/ijpt-23-00016.1
Nuttida Rawiwan, Nichakan Chatchumnan, Mananchaya Vimolnoch, Sakda Kingkaew, Sornjarod Oonsiri
Purpose: This study aimed to determine the characteristics of 2D ionization chamber array and the confidence limits of the gamma passing rate in pencil beam scanning proton therapy. Materials and Methods: The Varian ProBeam Compact spot-scanning system and the PTW OCTAVIUS 1500XDR array were used as a proton therapy system and detector, respectively. Our methods consisted of 2 parts: (1) the characteristics of the detector were tested and (2) patient-specific quality assurance was performed and evaluated by gamma analysis using dose-difference and distance-to-agreement criteria of 3% and 2 mm, respectively, with 123 treatment plans in head and neck, breast, chest, abdomen, and pelvic regions. Results: The PTW OCTAVIUS 1500XDR array had good reproducibility, uniformity, linearity, repetition rate, and monitor unit per spot within 0.1%, with accuracy, energy dependence, and measurement depth within 0.5%. The overall uncertainty of the PTW OCTAVIUS 1500XDR array was 2.49%. For field size and range shifter, using gamma analysis, the passing rate was 100%. The overall results of patient-specific quality assurance with the gamma evaluation were 98.9% ± 1.6% in 123 plans and confidence limit was 95.7%. Conclusion: The PTW OTAVIUS 1500XDR offered effective performance in pencil beam scanning proton therapy.
摘要:目的:研究二维电离室阵列的特性及其在铅笔束扫描质子治疗中伽马通过率的置信限。材料和方法:分别使用Varian ProBeam Compact点扫描系统和PTW OCTAVIUS 1500XDR阵列作为质子治疗系统和探测器。我们的方法由两部分组成:(1)对检测器的特性进行测试;(2)通过伽马分析,分别使用3%和2mm的剂量差和距离一致性标准,对头颈部、乳房、胸部、腹部和骨盆区域的123个治疗方案进行患者特异性质量保证和评估。结果:PTW OCTAVIUS 1500XDR阵列重现性、均匀性、线性、重复率好,监测单位/点在0.1%以内,准确度、能量依赖性、测量深度在0.5%以内。PTW OCTAVIUS 1500XDR阵列的总体不确定度为2.49%。对于场大小和范围移位器,使用伽马分析,通过率为100%。在123个方案中,患者特异性质量保证的gamma评价总体结果为98.9%±1.6%,置信限为95.7%。结论:PTW OTAVIUS 1500XDR在铅笔束扫描质子治疗中表现良好。
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引用次数: 0
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International Journal of Particle Therapy
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