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Operational Performance of a Compact Proton Therapy System: A 5-Year Experience. 紧凑型质子治疗系统的操作性能:5年经验。
IF 1.7 Q3 ONCOLOGY Pub Date : 2022-07-01 eCollection Date: 2022-01-01 DOI: 10.14338/IJPT-21-00033.1
Omar A Zeidan, Ethan Pepmiller, Twyla Willoughby, Zhiqiu Li, James Burkavage, Brian Harper, Michael Fraser, Katie Moffatt, Sanford L Meeks, Naren Ramakrishna

Purpose: We present an analysis of various operational metrics for a novel compact proton therapy system, including clinical case mix, subsystems utilization, and quality assurance trends in beam delivery parameters over a period of 5 years.

Materials and methods: Patient-specific data from a total of 850 patients (25,567 fractions) have been collected and analyzed. The patient mix include a variety of simple, intermediate, and complex cases. Beam-specific delivery parameters for a total of 3585 beams were analyzed. In-room imaging system usage for off-line adaptive purpose is reported. We also report key machine performances metrics based on routine quality assurance in addition to uptime.

Results: Our analysis shows that system subcomponents including gantry and patient positioning system have maintained a tight mechanical tolerance over the 5-year period. Various beam parameters were all within acceptable tolerances with no clear trends. Utilization frequency histograms of gantry and patient positioning system show that only a small fraction of all available angles was used for patient deliveries with cardinal angels as the most usable. Similarly, beam-specific metrics, such as range, modulation, and air gaps, were clustered unevenly over the available range indicating that this compact system was more than capable to treat the complex variety of tumors of our patient mix.

Conclusion: Our data show that this compact system is versatile, robust, and capable of delivering complex treatments like a large full-gantry system. Utilization data show that a fraction of all subcomponents range of angular motion has been used. Compilation of beam-specific metrics, such as range and modulation, show uneven distributions with specific clustering over the entire usable range. Our findings could be used to further optimize the performance and cost-effectiveness of future compact proton systems.

目的:我们对一种新型紧凑型质子治疗系统的各种操作指标进行了分析,包括临床病例组合、子系统利用率和5年来束流输送参数的质量保证趋势。材料和方法:共收集和分析了850例患者(25,567份)的患者特异性数据。患者组合包括各种简单、中级和复杂病例。分析了共3585束的光束特定传输参数。报告了用于离线自适应目的的室内成像系统的使用。除了正常运行时间外,我们还报告基于常规质量保证的关键机器性能指标。结果:我们的分析表明,在5年的时间里,包括龙门和患者定位系统在内的系统子组件保持了严格的机械耐受性。各种光束参数均在可接受的公差范围内,没有明显的趋势。龙门和病人定位系统的使用频率直方图显示,只有一小部分可用的角度被用于病人分娩,其中基数角是最可用的。同样,波束特定指标,如范围、调制和气隙,在可用范围内不均匀地聚集在一起,表明这种紧凑的系统比我们的患者组合更有能力治疗复杂的肿瘤。结论:我们的数据表明,这个紧凑的系统是多功能的,坚固的,能够像一个大型的全龙门架系统一样提供复杂的治疗。利用数据表明,只使用了角运动所有子分量范围的一小部分。波束特定度量的汇编,如范围和调制,显示出在整个可用范围内具有特定聚类的不均匀分布。我们的发现可以用于进一步优化未来紧凑型质子系统的性能和成本效益。
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引用次数: 3
Proton Arc Therapy vs Interstitial HDR Brachytherapy in Gynecologic Cancer with Parametrial/pelvic Side Wall Extension. 质子弧治疗与间质性HDR近距离治疗伴骨盆侧壁伸展的妇科癌症。
IF 1.7 Q3 ONCOLOGY Pub Date : 2022-06-28 eCollection Date: 2022-01-01 DOI: 10.14338/IJPT-22-00013.1
ByongYong Yi, Sina Mossahebi, Arezoo Modiri, Elizabeth M Nichols, Mariana Guerrero, Narottam Lamichhane, Pranshu Mohindra

Purpose: To investigate whether volumetric-modulated proton arc therapy (VPAT) plans generate comparable doses to organs at risk (OARs) compared with interstitial high-dose-rate (iHDR) brachytherapy for patients with gynecologic cancer with disease extension to parametrial/pelvic side wall, who are not eligible for the aggressive procedure.

Materials and methods: VPAT delivers proton arc beams by modulated energies at the beam nozzle while maintaining the same incident energy to the gantry during the arc rotation. Plans of 10 patients previously treated with iHDR brachytherapy for high-risk clinical treatment volumes (HRCTV; 31.8-110.6 cm3; lateral dimensions, 4.2-5.6 cm) were selected and compared with VPAT plans. VPAT plans for each patient were designed using a 152- to 245-MeV range of energy-modulated proton beams.

Results: HRCTV coverage of the VPAT plans was comparable to that of the iHDR plans, with V150% showing no statistical differences. On average, the V100% and V90% of VPAT plans were higher than those of the iHDR plans, 95.0% vs 91.9% (P = .02) and 98.6% vs 97.5% (P = .02), respectively. D100 was also 17% higher for the VPAT plans (P = .03). On average, the D2cm3 of bladder, rectum, and small bowels in the VPAT plans were considerably lower than those in iHDR plans (by 17.4%, 35.2%, and 65.6%, respectively; P < .05 for all OARs).

Conclusion: VPAT-generated plans were dosimetrically superior to those with HDR brachytherapy with interstitial needles for locally advanced gynecologic cancer with parametrial/pelvic side wall disease extension. Dosimetrically, VPAT provides a noninvasive alternative to iHDR brachytherapy with a superior dosimetric profile.

目的:研究体积调节质子弧治疗(VPAT)计划是否与间质性高剂量率(iHDR)近距离放射治疗相比,对疾病扩展到参数/骨盆侧壁的妇科癌症患者产生相当的危险器官(OARs)剂量,这些患者不符合侵略性手术的条件。材料和方法:VPAT在光束喷嘴处通过调制能量输送质子电弧光束,同时在电弧旋转过程中保持相同的入射能量。10例既往iHDR近距离放疗患者高危临床治疗量计划(HRCTV;31.8 - -110.6立方厘米;选择外侧尺寸(4.2-5.6 cm)与VPAT平面图进行比较。每个病人的VPAT计划都是用152- 245兆电子伏的能量调制质子束设计的。结果:VPAT方案的HRCTV覆盖率与iHDR方案相当,V150%无统计学差异。VPAT计划的V100%和V90%平均高于iHDR计划,分别为95.0%比91.9% (P = 0.02)和98.6%比97.5% (P = 0.02)。VPAT计划的D100也高出17% (P = .03)。平均而言,VPAT组膀胱、直肠和小肠的D2cm3明显低于iHDR组(分别低17.4%、35.2%和65.6%;所有桨均为0.05)。结论:vpat生成的计划在剂量学上优于HDR间质针近距离治疗局部晚期妇科癌伴参数性/盆腔侧壁疾病扩展。在剂量学上,VPAT为iHDR近距离治疗提供了一种无创替代方案,具有优越的剂量学特征。
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引用次数: 1
Analysis of the Rate of Re-planning in Spot-Scanning Proton Therapy. 点扫描质子治疗中重新计划率的分析。
IF 1.7 Q3 ONCOLOGY Pub Date : 2022-06-28 eCollection Date: 2022-01-01 DOI: 10.14338/IJPT-21-00043.1
Yue-Houng Hu, Riley H Harper, Noelle C Deiter, Jaden D Evans, Anita Mahajan, Jon J Kruse, Daniel W Mundy

Purpose: Finite proton range affords improved dose conformality of radiation therapy when patient regions-of-interest geometries are well characterized. Substantial changes in patient anatomy necessitate re-planning (RP) to maintain effective, safe treatment. Regularly planned verification scanning (VS) is performed to ensure consistent treatment quality. Substantial resources, however, are required to conduct an effective proton plan verification program, which includes but is not limited to, additional computed tomography (CT) scanner time and dedicated personnel: radiation therapists, medical physicists, physicians, and medical dosimetrists.

Materials and methods: Verification scans (VSs) and re-plans (RPs) of 711 patients treated with proton therapy between June 2015 and June 2018 were studied. All treatment RP was performed with the intent to maintain original plan integrity and coverage. The treatments were classified by anatomic site: brain, craniospinal, bone, spine, head and neck (H&N), lung or chest, breast, prostate, rectum, anus, pelvis, esophagus, liver, abdomen, and extremity. Within each group, the dates of initial simulation scan, number of VSs, number of fractions completed at the time of VS, and the frequency of RP were collected. Data were analyzed in terms of rate of RP and individual likelihood of RP.

Results: A total of 2196 VSs and 201 RPs were performed across all treatment sites. H&N and lung or chest disease sites represented the largest proportion of plan modifications in terms of rate of re-plan (RoR: 54% and 58%, respectively) and individual likelihood of RP on a per patient basis (likelihood of RP [RP%]: 46% and 39%, respectively). These sites required RP beyond 4 weeks of treatment, suggesting continued benefit for frequent, periodic VS. Disease sites in the lower pelvis demonstrated a low yield for RP per VS (0.01-0.02), suggesting that decreasing VS frequency, particularly late in treatment, may be reasonable.

Conclusions: A large degree of variation in RoR and individual RP% was observed between anatomic treatment sites. The present retrospective analysis provides data to help develop anatomic site-based VS protocols.

目的:当患者感兴趣区域的几何形状得到很好的表征时,有限的质子范围可以提高放射治疗的剂量一致性。患者解剖结构的实质性变化需要重新规划(RP)以维持有效、安全的治疗。定期计划验证扫描(VS),以确保一致的处理质量。然而,进行有效的质子计划验证程序需要大量的资源,包括但不限于额外的计算机断层扫描(CT)扫描时间和专门的人员:放射治疗师、医学物理学家、医生和医学剂量测定师。材料和方法:研究了2015年6月至2018年6月期间711例质子治疗患者的验证扫描(VSs)和重新计划(rp)。所有RP治疗都是为了保持原始计划的完整性和覆盖率而进行的。按解剖部位分类:脑、颅脊、骨、脊柱、头颈、肺或胸、乳腺、前列腺、直肠、肛门、骨盆、食道、肝脏、腹部、四肢。在每组中,收集初始模拟扫描的日期、VS的数量、VS时完成的分数数量和RP的频率。根据RP的发生率和个体RP的可能性来分析数据。结果:在所有治疗部位共进行了2196例VSs和201例RPs。在重新计划率(RoR分别为54%和58%)和每位患者RP的个体可能性(RP的可能性[RP%]分别为46%和39%)方面,H&N和肺或胸部疾病部位代表了计划修改的最大比例。这些部位在治疗4周后需要RP,这表明对于频繁、周期性VS的持续获益,骨盆下部的疾病部位显示每VS的RP发生率较低(0.01-0.02),这表明减少VS的频率,特别是在治疗后期,可能是合理的。结论:不同解剖治疗部位的RoR和个体RP%存在很大程度的差异。目前的回顾性分析提供了数据,以帮助制定基于解剖部位的VS协议。
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引用次数: 1
Health Care Resource Utilization for Esophageal Cancer Using Proton versus Photon Radiation Therapy. 食管癌质子与光子放射治疗的保健资源利用。
IF 1.7 Q3 ONCOLOGY Pub Date : 2022-06-23 eCollection Date: 2022-01-01 DOI: 10.14338/IJPT-22-00001.1
Steven H Lin, Kaiping Liao, Xiudong Lei, Vivek Verma, Sherif Shaaban, Percy Lee, Aileen B Chen, Albert C Koong, Wayne L Hoftstetter, Steven J Frank, Zhongxing Liao, Ya-Chen Tina Shih, Sharon H Giordano, Grace L Smith

Purpose: In patients treated with chemoradiation for esophageal cancer (EC), randomized trial data demonstrate that proton beam therapy (PBT) reduces toxicities and postoperative complications (POCs) compared with intensity-modulated radiation therapy (IMRT). However, whether radiation therapy modality affects postoperative health care resource utilization remains unknown.

Materials and methods: We examined 287 patients with EC who received chemoradiation (prescribed 50.4 Gy/GyE) followed by esophagectomy, including a real-world observational cohort of 237 consecutive patients treated from 2007 to 2013 with PBT (n = 81) versus IMRT (n = 156); and an independent, contemporary comparison cohort of 50 patients from a randomized trial treated from 2012 to 2019 with PBT (n = 21) versus IMRT (n = 29). Postoperative complications were abstracted from medical records. Health care charges were obtained from institutional claims and adjusted for inflation (2021 dollars). Charge differences (Δ = $PBT - $IMRT) were compared by treatment using adjusted generalized linear models with the gamma distribution.

Results: Baseline PBT versus IMRT characteristics were not significantly different. In the observational cohort, during the neoadjuvant chemoradiation phase, health care charges were higher for PBT versus IMRT (Δ = +$71,959; 95% confidence interval [CI], $62,274-$82,138; P < .001). There was no difference in surgical charges (Δ = -$2234; 95% CI, -$6003 to $1695; P = .26). However, during postoperative hospitalization following esophagectomy, health care charges were lower for PBT versus IMRT (Δ = -$25,115; 95% CI, -$37,625 to -$9776; P = .003). In the comparison cohort, findings were analogous: Charges were higher for PBT versus IMRT during chemoradiation (Δ = +$61,818; 95% CI, $49,435-$75,069; P < .001), not different for surgery (Δ = -$4784; 95% CI, -$6439 to $3487; P = .25), and lower for PBT postoperatively (Δ = -$27,048; 95% CI, -$41,974 to -$5300; P = .02). Lower postoperative charges for PBT were especially seen among patients with any POCs in the contemporary comparison (Δ = -$176,448; 95% CI, -$209,782 to -$78,813; P = .02).

Conclusion: Higher up-front chemoradiation resource utilization for PBT in patients with EC was partially offset postoperatively, moderated by reduction in POC risks. Results extend existing clinical evidence of toxicity reduction with PBT.

目的:在接受放化疗的食管癌(EC)患者中,随机试验数据表明,与调强放疗(IMRT)相比,质子束治疗(PBT)可减少毒性和术后并发症(POCs)。然而,放射治疗方式是否影响术后医疗资源的利用仍然未知。材料和方法:我们研究了287例接受放化疗(处方50.4 Gy/GyE)后食管切除术的EC患者,包括一个现实世界的观察队列,从2007年到2013年,连续237例患者接受PBT (n = 81)和IMRT (n = 156)治疗;以及一项独立的当代比较队列,来自2012年至2019年接受PBT (n = 21)和IMRT (n = 29)治疗的随机试验的50名患者。从病历中提取术后并发症。保健费用来自机构索赔,并根据通货膨胀进行调整(2021美元)。电荷差异(Δ = $PBT - $IMRT)采用调整后的广义线性模型与伽马分布进行比较。结果:基线PBT与IMRT特征无显著差异。在观察队列中,在新辅助放化疗阶段,PBT的医疗费用高于IMRT (Δ = +$71,959;95%置信区间[CI]为62,274- 82,138美元;P < 0.001)。手术费用没有差别(Δ = - 2234美元;95%置信区间为- 6003美元至1695美元;P = .26)。然而,在食管切除术后住院期间,PBT的医疗费用低于IMRT (Δ = -$25,115;95% CI, - 37,625至- 9776美元;P = .003)。在比较队列中,结果是类似的:放化疗期间PBT的费用高于IMRT (Δ = + 61,818美元;95% ci, 49,435- 75,069美元;P < .001),手术无差异(Δ = -$4784;95% CI, - 6439至3487美元;P = .25),而术后PBT的比例更低(Δ = - 27,048美元;95% CI, - 41974至- 5300美元;P = .02)。在当代比较中,PBT的术后费用较低,特别是在任何POCs患者中(Δ = - 176,448美元;95% CI, - 209,782至- 78,813美元;P = .02)。结论:EC患者术前PBT放化疗资源利用率的提高在术后被部分抵消,并因POC风险的降低而得到缓和。结果扩展了PBT降低毒性的现有临床证据。
{"title":"Health Care Resource Utilization for Esophageal Cancer Using Proton versus Photon Radiation Therapy.","authors":"Steven H Lin,&nbsp;Kaiping Liao,&nbsp;Xiudong Lei,&nbsp;Vivek Verma,&nbsp;Sherif Shaaban,&nbsp;Percy Lee,&nbsp;Aileen B Chen,&nbsp;Albert C Koong,&nbsp;Wayne L Hoftstetter,&nbsp;Steven J Frank,&nbsp;Zhongxing Liao,&nbsp;Ya-Chen Tina Shih,&nbsp;Sharon H Giordano,&nbsp;Grace L Smith","doi":"10.14338/IJPT-22-00001.1","DOIUrl":"https://doi.org/10.14338/IJPT-22-00001.1","url":null,"abstract":"<p><strong>Purpose: </strong>In patients treated with chemoradiation for esophageal cancer (EC), randomized trial data demonstrate that proton beam therapy (PBT) reduces toxicities and postoperative complications (POCs) compared with intensity-modulated radiation therapy (IMRT). However, whether radiation therapy modality affects postoperative health care resource utilization remains unknown.</p><p><strong>Materials and methods: </strong>We examined 287 patients with EC who received chemoradiation (prescribed 50.4 Gy/GyE) followed by esophagectomy, including a real-world observational cohort of 237 consecutive patients treated from 2007 to 2013 with PBT (n = 81) versus IMRT (n = 156); and an independent, contemporary comparison cohort of 50 patients from a randomized trial treated from 2012 to 2019 with PBT (n = 21) versus IMRT (n = 29). Postoperative complications were abstracted from medical records. Health care charges were obtained from institutional claims and adjusted for inflation (2021 dollars). Charge differences (Δ = $PBT - $IMRT) were compared by treatment using adjusted generalized linear models with the gamma distribution.</p><p><strong>Results: </strong>Baseline PBT versus IMRT characteristics were not significantly different. In the observational cohort, during the neoadjuvant chemoradiation phase, health care charges were higher for PBT versus IMRT (Δ = +$71,959; 95% confidence interval [CI], $62,274-$82,138; <i>P</i> < .001). There was no difference in surgical charges (Δ = -$2234; 95% CI, -$6003 to $1695; <i>P</i> = .26). However, during postoperative hospitalization following esophagectomy, health care charges were lower for PBT versus IMRT (Δ = -$25,115; 95% CI, -$37,625 to -$9776; <i>P</i> = .003). In the comparison cohort, findings were analogous: Charges were higher for PBT versus IMRT during chemoradiation (Δ = +$61,818; 95% CI, $49,435-$75,069; <i>P</i> < .001), not different for surgery (Δ = -$4784; 95% CI, -$6439 to $3487; <i>P</i> = .25), and lower for PBT postoperatively (Δ = -$27,048; 95% CI, -$41,974 to -$5300; <i>P</i> = .02). Lower postoperative charges for PBT were especially seen among patients with any POCs in the contemporary comparison (Δ = -$176,448; 95% CI, -$209,782 to -$78,813; <i>P</i> = .02).</p><p><strong>Conclusion: </strong>Higher up-front chemoradiation resource utilization for PBT in patients with EC was partially offset postoperatively, moderated by reduction in POC risks. Results extend existing clinical evidence of toxicity reduction with PBT.</p>","PeriodicalId":36923,"journal":{"name":"International Journal of Particle Therapy","volume":"9 1","pages":"18-27"},"PeriodicalIF":1.7,"publicationDate":"2022-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9238132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40462221","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: 2
Comparison of Estimated Late Toxicities between IMPT and IMRT Based on Multivariable NTCP Models for High-Risk Prostate Cancers Treated with Pelvic Nodal Radiation. 基于多变量NTCP模型的盆腔淋巴结放射治疗高危前列腺癌IMPT和IMRT的估计晚期毒性比较
IF 1.7 Q3 ONCOLOGY Pub Date : 2022-06-13 eCollection Date: 2022-01-01 DOI: 10.14338/IJPT-21-00042.1
Srinivas Chilukuri, Sham Sundar, Kartikeswar Patro, Mayur Sawant, Rangasamy Sivaraman, Manikandan Arjunan, Pankaj Kumar Panda, Dayananda Sharma, Rakesh Jalali

Purpose: To compare the late gastrointestinal (GI) and genitourinary toxicities (GU) estimated using multivariable normal tissue complication probability (NTCP) models, between pencil-beam scanning proton beam therapy (PBT) and helical tomotherapy (HT) in patients of high-risk prostate cancers requiring pelvic nodal irradiation (PNI) using moderately hypofractionated regimen.

Materials and methods: Twelve consecutive patients treated with PBT at our center were replanned with HT using the same planning goals. Six late GI and GU toxicity domains (stool frequency, rectal bleeding, fecal incontinence, dysuria, urinary incontinence, and hematuria) were estimated based on the published multivariable NTCP models. The ΔNTCP (difference in absolute NTCP between HT and PBT plans) for each of the toxicity domains was calculated. A one-sample Kolmogorov-Smirnov test was used to analyze distribution of data, and either a paired t test or a Wilcoxon matched-pair signed rank test was used to test statistical significance.

Results: Proton beam therapy and HT plans achieved adequate target coverage. Proton beam therapy plans led to significantly better sparing of bladder, rectum, and bowel bag especially in the intermediate range of 15 to 40 Gy, whereas doses to penile bulb and femoral heads were higher with PBT plans. The average ΔNTCP for grade (G)2 rectal bleeding, fecal incontinence, stool frequency, dysuria, urinary incontinence, and G1 hematuria was 12.17%, 1.67%, 2%, 5.83%, 2.42%, and 3.91%, respectively, favoring PBT plans. The average cumulative ΔNTCP for GI and GU toxicities (ΣΔNTCP) was 16.58% and 11.41%, respectively, favoring PBT. Using a model-based selection threshold of any G2 ΔNTCP >10%, 67% (8 patients) would be eligible for PBT.

Conclusion: Proton beam therapy plans led to superior sparing of organs at risk compared with HT, which translated to lower NTCP for late moderate GI and GU toxicities in patients of prostate cancer treated with PNI. For two-thirds of our patients, the difference in estimated absolute NTCP values between PBT and HT crossed the accepted threshold for minimal clinically important difference.

目的:比较使用多变量正常组织并发症概率(NTCP)模型估计的晚期胃肠道(GI)和泌尿生殖系统毒性(GU),铅笔束扫描质子束治疗(PBT)和螺旋断层治疗(HT)对需要盆腔淋巴结放射治疗(PNI)的高危前列腺癌患者采用中度低分割方案。材料和方法:12例连续在本中心接受PBT治疗的患者使用相同的计划目标重新计划HT。根据已发表的多变量NTCP模型估计了6个晚期GI和GU毒性域(大便频率、直肠出血、大便失禁、排尿困难、尿失禁和血尿)。计算每个毒性区域的ΔNTCP (HT和PBT方案之间的绝对NTCP差异)。采用单样本Kolmogorov-Smirnov检验分析数据分布,采用配对t检验或Wilcoxon配对对符号秩检验检验统计显著性。结果:质子束治疗和高温疗法计划达到了足够的目标覆盖率。质子束治疗方案能更好地保护膀胱、直肠和肠袋,特别是在15 - 40 Gy的中间范围内,而PBT方案对阴茎球和股骨头的剂量更高。(G)2级直肠出血、大便失禁、大便频率、排尿困难、尿失禁和G1级血尿的平均ΔNTCP分别为12.17%、1.67%、2%、5.83%、2.42%和3.91%,支持PBT方案。GI和GU毒性(ΣΔNTCP)的平均累积ΔNTCP分别为16.58%和11.41%,有利于PBT。使用基于模型的选择阈值,任何G2 ΔNTCP >10%, 67%(8名患者)将符合PBT。结论:与HT相比,质子束治疗方案能更好地保留有危险的器官,这意味着PNI治疗前列腺癌患者中晚期GI和GU毒性的NTCP降低。对于三分之二的患者,PBT和HT之间估计的绝对NTCP值的差异超过了最小临床重要差异的可接受阈值。
{"title":"Comparison of Estimated Late Toxicities between IMPT and IMRT Based on Multivariable NTCP Models for High-Risk Prostate Cancers Treated with Pelvic Nodal Radiation.","authors":"Srinivas Chilukuri,&nbsp;Sham Sundar,&nbsp;Kartikeswar Patro,&nbsp;Mayur Sawant,&nbsp;Rangasamy Sivaraman,&nbsp;Manikandan Arjunan,&nbsp;Pankaj Kumar Panda,&nbsp;Dayananda Sharma,&nbsp;Rakesh Jalali","doi":"10.14338/IJPT-21-00042.1","DOIUrl":"https://doi.org/10.14338/IJPT-21-00042.1","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the late gastrointestinal (GI) and genitourinary toxicities (GU) estimated using multivariable normal tissue complication probability (NTCP) models, between pencil-beam scanning proton beam therapy (PBT) and helical tomotherapy (HT) in patients of high-risk prostate cancers requiring pelvic nodal irradiation (PNI) using moderately hypofractionated regimen.</p><p><strong>Materials and methods: </strong>Twelve consecutive patients treated with PBT at our center were replanned with HT using the same planning goals. Six late GI and GU toxicity domains (stool frequency, rectal bleeding, fecal incontinence, dysuria, urinary incontinence, and hematuria) were estimated based on the published multivariable NTCP models. The ΔNTCP (difference in absolute NTCP between HT and PBT plans) for each of the toxicity domains was calculated. A one-sample Kolmogorov-Smirnov test was used to analyze distribution of data, and either a paired <i>t</i> test or a Wilcoxon matched-pair signed rank test was used to test statistical significance.</p><p><strong>Results: </strong>Proton beam therapy and HT plans achieved adequate target coverage. Proton beam therapy plans led to significantly better sparing of bladder, rectum, and bowel bag especially in the intermediate range of 15 to 40 Gy, whereas doses to penile bulb and femoral heads were higher with PBT plans. The average ΔNTCP for grade (G)2 rectal bleeding, fecal incontinence, stool frequency, dysuria, urinary incontinence, and G1 hematuria was 12.17%, 1.67%, 2%, 5.83%, 2.42%, and 3.91%, respectively, favoring PBT plans. The average cumulative ΔNTCP for GI and GU toxicities (ΣΔNTCP) was 16.58% and 11.41%, respectively, favoring PBT. Using a model-based selection threshold of any G2 ΔNTCP >10%, 67% (8 patients) would be eligible for PBT.</p><p><strong>Conclusion: </strong>Proton beam therapy plans led to superior sparing of organs at risk compared with HT, which translated to lower NTCP for late moderate GI and GU toxicities in patients of prostate cancer treated with PNI. For two-thirds of our patients, the difference in estimated absolute NTCP values between PBT and HT crossed the accepted threshold for minimal clinically important difference.</p>","PeriodicalId":36923,"journal":{"name":"International Journal of Particle Therapy","volume":"9 1","pages":"42-53"},"PeriodicalIF":1.7,"publicationDate":"2022-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9238124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40462219","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
A Review of Boron Neutron Capture Therapy: Its History and Current Challenges. 硼中子俘获疗法的历史与挑战
IF 1.7 Q3 ONCOLOGY Pub Date : 2022-06-09 eCollection Date: 2022-01-01 DOI: 10.14338/IJPT-22-00002.1
Will H Jin, Crystal Seldon, Michael Butkus, Wolfgang Sauerwein, Huan B Giap

Mechanism of action: External beam, whether with photons or particles, remains as the most common type of radiation therapy. The main drawback is that radiation deposits dose in healthy tissue before reaching its target. Boron neutron capture therapy (BNCT) is based on the nuclear capture and fission reactions that occur when 10B is irradiated with low-energy (0.0025 eV) thermal neutrons. The resulting 10B(n,α)7Li capture reaction produces high linear energy transfer (LET) α particles, helium nuclei (4He), and recoiling lithium-7 (7Li) atoms. The short range (5-9 μm) of the α particles limits the destructive effects within the boron-containing cells. In theory, BNCT can selectively destroy malignant cells while sparing adjacent normal tissue at the cellular levels by delivering a single fraction of radiation with high LET particles.

History: BNCT has been around for many decades. Early studies were promising for patients with malignant brain tumors, recurrent tumors of the head and neck, and cutaneous melanomas; however, there were certain limitations to its widespread adoption and use.

Current limitations and prospects: Recently, BNCT re-emerged owing to several developments: (1) small footprint accelerator-based neutron sources; (2) high specificity third-generation boron carriers based on monoclonal antibodies, nanoparticles, among others; and (3) treatment planning software and patient positioning devices that optimize treatment delivery and consistency.

作用机制:无论是光子还是粒子外束,仍然是最常见的放射治疗类型。主要的缺点是辐射在到达目标之前会在健康组织中沉积剂量。硼中子俘获疗法(BNCT)是基于低能量(0.0025 eV)热中子照射10B时发生的核俘获和裂变反应。由此产生的10B(n,α)7Li捕获反应产生高线性能量转移(LET) α粒子、氦核(4He)和反冲锂-7 (7Li)原子。α粒子的短范围(5 ~ 9 μm)限制了其在含硼细胞内的破坏作用。理论上,BNCT可以选择性地摧毁恶性细胞,同时在细胞水平上保留邻近的正常组织,通过提供高LET粒子的单一部分辐射。历史:BNCT已经存在了几十年。早期研究对恶性脑瘤、头颈部复发性肿瘤和皮肤黑色素瘤患者有希望;然而,它的广泛采用和使用有一定的限制。目前的局限性和前景:近年来,由于以下几个方面的发展,BNCT重新出现:(1)基于小足迹加速器的中子源;(2)基于单克隆抗体、纳米颗粒等的高特异性第三代硼载体;(3)优化治疗交付和一致性的治疗计划软件和患者定位装置。
{"title":"A Review of Boron Neutron Capture Therapy: Its History and Current Challenges.","authors":"Will H Jin,&nbsp;Crystal Seldon,&nbsp;Michael Butkus,&nbsp;Wolfgang Sauerwein,&nbsp;Huan B Giap","doi":"10.14338/IJPT-22-00002.1","DOIUrl":"https://doi.org/10.14338/IJPT-22-00002.1","url":null,"abstract":"<p><strong>Mechanism of action: </strong>External beam, whether with photons or particles, remains as the most common type of radiation therapy. The main drawback is that radiation deposits dose in healthy tissue before reaching its target. Boron neutron capture therapy (BNCT) is based on the nuclear capture and fission reactions that occur when <sup>10</sup>B is irradiated with low-energy (0.0025 eV) thermal neutrons. The resulting <sup>10</sup>B(n,α)<sup>7</sup>Li capture reaction produces high linear energy transfer (LET) α particles, helium nuclei (<sup>4</sup>He), and recoiling lithium-7 (<sup>7</sup>Li) atoms. The short range (5-9 μm) of the α particles limits the destructive effects within the boron-containing cells. In theory, BNCT can selectively destroy malignant cells while sparing adjacent normal tissue at the cellular levels by delivering a single fraction of radiation with high LET particles.</p><p><strong>History: </strong>BNCT has been around for many decades. Early studies were promising for patients with malignant brain tumors, recurrent tumors of the head and neck, and cutaneous melanomas; however, there were certain limitations to its widespread adoption and use.</p><p><strong>Current limitations and prospects: </strong>Recently, BNCT re-emerged owing to several developments: (1) small footprint accelerator-based neutron sources; (2) high specificity third-generation boron carriers based on monoclonal antibodies, nanoparticles, among others; and (3) treatment planning software and patient positioning devices that optimize treatment delivery and consistency.</p>","PeriodicalId":36923,"journal":{"name":"International Journal of Particle Therapy","volume":"9 1","pages":"71-82"},"PeriodicalIF":1.7,"publicationDate":"2022-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9238127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40462128","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: 12
Determination of Integral Depth Dose in Proton Pencil Beam Using Plane-parallel Ionization Chambers. 用平面平行电离室测定质子束的积分深度剂量。
IF 1.7 Q3 ONCOLOGY Pub Date : 2022-06-03 eCollection Date: 2022-01-01 DOI: 10.14338/IJPT-22-00006.1
Phatthraporn Thasasi, Sirinya Ruangchan, Puntiwa Oonsiri, Sornjarod Oonsiri

Purpose: This study aimed to determine the integral depth-dose curves and assess the geometric collection efficiency of different detector diameters in proton pencil beam scanning.

Materials and methods: The Varian ProBeam Compact spot scanning system was used for this study. The integral depth-dose curves with a proton energy range of 130 to 220 MeV were acquired with 2 types of Bragg peak chambers: 34070 with 8-cm diameter and 34089 with 15-cm diameter (PTW), multi-layer ionization chamber with 12-cm diameter (Giraffe, IBA Dosimetry), and PeakFinder with 8-cm diameter (PTW). To assess geometric collection efficiency, the integral depth-dose curves of 8- and 12-cm chamber diameters were compared to a 15-cm chamber diameter as the largest detector.

Results: At intermediate depths of 130, 150, 190, and 220 MeV, PTW Bragg peak chamber type 34089 provided the highest integral depth-dose curves followed by IBA Giraffe, PTW Bragg peak chamber type 34070, and PTW PeakFinder. Moreover, PTW Bragg peak chamber type 34089 had increased geometric collection efficiency up to 3.8%, 6.1%, and 3.1% when compared to PTW Bragg peak chamber type 34070, PTW PeakFinder, and IBA Giraffe, respectively.

Conclusion: A larger plane-parallel ionization chamber could increase the geometric collection efficiency of the detector, especially at intermediate depths and high-energy proton beams.

目的:确定质子铅笔束扫描中不同直径探测器的整体深度-剂量曲线,并评估其几何收集效率。材料和方法:本研究使用瓦里安ProBeam Compact点扫描系统。采用直径为8cm的34070和直径为15cm的34089 (PTW)、直径为12cm的多层电离室(Giraffe, IBA dose - metry)和直径为8cm的PeakFinder (PTW)两种类型的Bragg峰室,获得了质子能量范围为130 ~ 220mev的积分深度-剂量曲线。为了评估几何收集效率,将直径为8 cm和12 cm的腔室与直径为15 cm的腔室作为最大检测器进行了积分深度-剂量曲线的比较。结果:在中等深度130、150、190和220 MeV处,PTW Bragg峰腔34089型的整体深度-剂量曲线最高,其次是IBA Giraffe、PTW Bragg峰腔34070和PTW PeakFinder。与PTW Bragg峰室34070、PTW PeakFinder和IBA Giraffe相比,PTW Bragg峰室34089的几何收集效率分别提高3.8%、6.1%和3.1%。结论:更大的平面平行电离室可以提高探测器的几何收集效率,特别是在中深度和高能质子束中。
{"title":"Determination of Integral Depth Dose in Proton Pencil Beam Using Plane-parallel Ionization Chambers.","authors":"Phatthraporn Thasasi,&nbsp;Sirinya Ruangchan,&nbsp;Puntiwa Oonsiri,&nbsp;Sornjarod Oonsiri","doi":"10.14338/IJPT-22-00006.1","DOIUrl":"https://doi.org/10.14338/IJPT-22-00006.1","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to determine the integral depth-dose curves and assess the geometric collection efficiency of different detector diameters in proton pencil beam scanning.</p><p><strong>Materials and methods: </strong>The Varian ProBeam Compact spot scanning system was used for this study. The integral depth-dose curves with a proton energy range of 130 to 220 MeV were acquired with 2 types of Bragg peak chambers: 34070 with 8-cm diameter and 34089 with 15-cm diameter (PTW), multi-layer ionization chamber with 12-cm diameter (Giraffe, IBA Dosimetry), and PeakFinder with 8-cm diameter (PTW). To assess geometric collection efficiency, the integral depth-dose curves of 8- and 12-cm chamber diameters were compared to a 15-cm chamber diameter as the largest detector.</p><p><strong>Results: </strong>At intermediate depths of 130, 150, 190, and 220 MeV, PTW Bragg peak chamber type 34089 provided the highest integral depth-dose curves followed by IBA Giraffe, PTW Bragg peak chamber type 34070, and PTW PeakFinder. Moreover, PTW Bragg peak chamber type 34089 had increased geometric collection efficiency up to 3.8%, 6.1%, and 3.1% when compared to PTW Bragg peak chamber type 34070, PTW PeakFinder, and IBA Giraffe, respectively.</p><p><strong>Conclusion: </strong>A larger plane-parallel ionization chamber could increase the geometric collection efficiency of the detector, especially at intermediate depths and high-energy proton beams.</p>","PeriodicalId":36923,"journal":{"name":"International Journal of Particle Therapy","volume":"9 2","pages":"1-9"},"PeriodicalIF":1.7,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9415752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40349608","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
Brainstem Toxicity in Pediatric Patients Treated with Protons Using a Single-vault Synchrocyclotron System. 使用单拱顶同步回旋加速器系统质子治疗儿科患者脑干毒性。
IF 1.7 Q3 ONCOLOGY Pub Date : 2022-06-03 eCollection Date: 2022-01-01 DOI: 10.14338/IJPT-22-00008.1
Inema Orukari, Stephanie Perkins, Tianyu Zhao, Jiayi Huang, Douglas F Caruthers, Sai Duriseti

Purpose: Cranial radiation therapy remains an integral component of curative treatment for pediatric patients with brain tumors. Proton beam radiation therapy (PBT) can limit collateral radiation dose to surrounding normal tissue, thus reducing off-target exposure while maintaining appropriate tumor coverage. While PBT offers significant advantages over photon therapy for pediatric patients with intracranial malignancies, cases of brainstem necrosis after PBT have raised concerns that PBT may pose an increased risk of necrosis over photon therapy. We investigated the incidence of brainstem necrosis at our institution in children treated with PBT for intracranial malignancies.

Patients and methods: Patients with pediatric brain tumor treated with passively scattered PBT, using a gantry-mounted, synchrocyclotron single-vault system between 2013 and 2018, were retrospectively reviewed. Inclusion criteria included patients 21 years of age or younger who received a minimum 0.1 cm3 maximum brainstem dose of 50 Gray relative biological effectiveness (GyRBE). Patients were assessed for "central nervous system necrosis" in the brainstem per the Common Terminology Criteria for Adverse Events (CTCAE), version 5.0 (US National Cancer Institute, Bethesda, Maryland) criteria.

Results: Fifty-eight patients were included for analysis. The median age was 10.3 years. Twenty-one (36.2%) patients received craniospinal irradiation. Thirty-four (58.6%) patients received chemotherapy. The median prescription radiation dose was 54 GyRBE. Regarding published dosimetric constraints used at 3 separate proton centers, the goal brainstem D50% <52 GyRBE was exceeded in 23 (40%) patients, but the brainstem Dmax <58 GyRBE was not exceeded in any patients. No patient experienced grade ≥2 brainstem injury. One patient demonstrated radiographic changes consistent with grade 1 toxicity. This patient had myeloablative chemotherapy with tandem stem cell rescue before PBT.

Conclusion: Our data demonstrates a low risk of any brainstem injury in children treated with passively scattered PBT using a single-vault synchrocyclotron.

目的:颅放射治疗仍然是根治性治疗儿科脑肿瘤患者的一个组成部分。质子束放射治疗(PBT)可以限制对周围正常组织的附带辐射剂量,从而减少脱靶照射,同时保持适当的肿瘤覆盖。虽然PBT治疗颅内恶性肿瘤的儿科患者比光子治疗有明显的优势,但PBT后脑干坏死的病例引起了人们的关注,PBT可能会比光子治疗增加坏死的风险。我们调查了我院接受PBT治疗颅内恶性肿瘤患儿脑干坏死的发生率。患者和方法:回顾性分析了2013年至2018年使用龙门式同步回旋加速器单拱顶系统进行被动分散PBT治疗的儿童脑肿瘤患者。纳入标准包括21岁或以下的患者,接受最小0.1 cm3的最大脑干剂量为50 Gray相对生物有效性(GyRBE)。根据不良事件通用术语标准(CTCAE) 5.0版(美国国家癌症研究所,Bethesda, Maryland)标准对患者进行脑干“中枢神经系统坏死”评估。结果:58例患者纳入分析。中位年龄为10.3岁。21例(36.2%)患者接受了颅脊髓照射。34例(58.6%)患者接受化疗。处方放射剂量中位数为54 GyRBE。结论:我们的数据表明,使用单拱顶同步回旋加速器被动分散PBT治疗儿童脑干损伤的风险较低。
{"title":"Brainstem Toxicity in Pediatric Patients Treated with Protons Using a Single-vault Synchrocyclotron System.","authors":"Inema Orukari,&nbsp;Stephanie Perkins,&nbsp;Tianyu Zhao,&nbsp;Jiayi Huang,&nbsp;Douglas F Caruthers,&nbsp;Sai Duriseti","doi":"10.14338/IJPT-22-00008.1","DOIUrl":"https://doi.org/10.14338/IJPT-22-00008.1","url":null,"abstract":"<p><strong>Purpose: </strong>Cranial radiation therapy remains an integral component of curative treatment for pediatric patients with brain tumors. Proton beam radiation therapy (PBT) can limit collateral radiation dose to surrounding normal tissue, thus reducing off-target exposure while maintaining appropriate tumor coverage. While PBT offers significant advantages over photon therapy for pediatric patients with intracranial malignancies, cases of brainstem necrosis after PBT have raised concerns that PBT may pose an increased risk of necrosis over photon therapy. We investigated the incidence of brainstem necrosis at our institution in children treated with PBT for intracranial malignancies.</p><p><strong>Patients and methods: </strong>Patients with pediatric brain tumor treated with passively scattered PBT, using a gantry-mounted, synchrocyclotron single-vault system between 2013 and 2018, were retrospectively reviewed. Inclusion criteria included patients 21 years of age or younger who received a minimum 0.1 cm<sup>3</sup> maximum brainstem dose of 50 Gray relative biological effectiveness (GyRBE). Patients were assessed for \"central nervous system necrosis\" in the brainstem per the Common Terminology Criteria for Adverse Events (CTCAE), version 5.0 (US National Cancer Institute, Bethesda, Maryland) criteria.</p><p><strong>Results: </strong>Fifty-eight patients were included for analysis. The median age was 10.3 years. Twenty-one (36.2%) patients received craniospinal irradiation. Thirty-four (58.6%) patients received chemotherapy. The median prescription radiation dose was 54 GyRBE. Regarding published dosimetric constraints used at 3 separate proton centers, the goal brainstem D50% <52 GyRBE was exceeded in 23 (40%) patients, but the brainstem Dmax <58 GyRBE was not exceeded in any patients. No patient experienced grade ≥2 brainstem injury. One patient demonstrated radiographic changes consistent with grade 1 toxicity. This patient had myeloablative chemotherapy with tandem stem cell rescue before PBT.</p><p><strong>Conclusion: </strong>Our data demonstrates a low risk of any brainstem injury in children treated with passively scattered PBT using a single-vault synchrocyclotron.</p>","PeriodicalId":36923,"journal":{"name":"International Journal of Particle Therapy","volume":"9 1","pages":"12-17"},"PeriodicalIF":1.7,"publicationDate":"2022-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9238130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40462129","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: 2
Early Experience Using Proton Beam Therapy for Extremity Soft Tissue Sarcoma: A Multicenter Study. 质子束治疗四肢软组织肉瘤的早期经验:一项多中心研究。
IF 1.7 Q3 ONCOLOGY Pub Date : 2022-05-06 eCollection Date: 2022-01-01 DOI: 10.14338/IJPT-21-00037.1
Brady S Laughlin, Michael A Golafshar, Safia Ahmed, Matthew Prince, Justin D Anderson, Tamara Vern-Gross, Mahesh Seetharam, Krista Goulding, Ivy Petersen, Todd DeWees, Jonathan B Ashman

Purpose: Proton beam therapy (PBT) may provide an advantage when planning well-selected patients with extremity soft tissue sarcoma (eSTS), specifically for large, anatomically challenging cases. We analyzed our early experience with PBT on toxicity and outcomes.

Materials and methods: A retrospective study was performed for eSTS treated between June 2016 and October 2020 with pencil beam scanning PBT at 2 institutions. Diagnostic, treatment, and toxicity characteristics were gathered from baseline to last follow-up or death. Wound complications were defined as secondary operations for wound repair (debridement, drainage, skin graft, and muscle flap) or nonoperative management requiring hospitalization. Statistical analysis was performed with R software.

Results: Twenty consecutive patients with a median age 51.5 years (range, 19-78 years) were included. Median follow-up was 13.7 months (range, 1.7-48.1 months). Tumor presentation was primary (n = 17) or recurrent after prior combined modality therapy (n = 3). Tumor location was either lower extremity (n = 16) or upper extremity (n = 4). Radiation was delivered preoperatively in most patients (n = 18). Median pretreatment tumor size was 7.9 cm (range, 1.3 -30.0 cm). The 1-year locoregional control was 100%. Four patients (20%) had developed metastatic disease by end of follow-up. Maximum toxicity for acute dermatitis was grade 2 in 8 patients (40%) and grade 3 in 3 patients (15%). After preoperative radiation and surgical resection, acute wound complications occurred in 6 patients (35%). Tumor size was larger in patients with acute wound complications compared with those without (medians 16 cm, range [12-30.0 cm] vs 6.3 cm, [1.3-14.4 cm], P = .003).

Conclusion: PBT for well selected eSTS cases demonstrated excellent local control and similar acute wound complication rate comparable to historic controls. Long-term follow-up and further dosimetric analyses will provide further insight into potential advantages of PBT in this patient population.

目的:质子束治疗(PBT)可能提供一个优势,当计划精心选择的患者肢体软组织肉瘤(eSTS),特别是大的,解剖上具有挑战性的情况下。我们分析了早期使用PBT的毒性和结果。材料和方法:回顾性研究2016年6月至2020年10月在2家机构使用铅笔束扫描PBT治疗的est。从基线到最后一次随访或死亡收集诊断、治疗和毒性特征。创面并发症定义为创面修复的二次手术(清创、引流、皮肤移植和肌肉瓣)或需要住院治疗的非手术处理。采用R软件进行统计分析。结果:共纳入20例患者,中位年龄51.5岁(范围19-78岁)。中位随访时间为13.7个月(范围1.7-48.1个月)。肿瘤表现为原发(n = 17)或先前联合治疗后复发(n = 3)。肿瘤位置为下肢(n = 16)或上肢(n = 4)。大多数患者(n = 18)术前给予放疗。中位预处理肿瘤大小为7.9 cm(范围1.3 -30.0 cm)。1年局部区域控制率为100%。4名患者(20%)在随访结束时发生转移性疾病。急性皮炎的最大毒性为8例(40%)2级,3例(15%)3级。术前放疗及手术切除后出现急性伤口并发症6例(35%)。有急性伤口并发症的患者肿瘤大小大于无急性伤口并发症的患者(中位数为16 cm,范围[12-30.0 cm] vs 6.3 cm, [1.3-14.4 cm], P = 0.003)。结论:PBT对选择良好的est病例具有良好的局部控制和相似的急性伤口并发症发生率,与历史对照组相当。长期随访和进一步的剂量学分析将进一步了解PBT在该患者群体中的潜在优势。
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引用次数: 3
Dosimetric Advantages of Silicone-Filled Vaginal Spacers in Pediatric Proton Therapy. 硅胶阴道垫片在小儿质子治疗中的剂量学优势。
IF 1.7 Q3 ONCOLOGY Pub Date : 2022-05-06 eCollection Date: 2022-01-01 DOI: 10.14338/IJPT-21-00044.1
Ozgur Ates, Li Zhao, David Sobczak, Chia-Ho Hua, Matthew J Krasin

We introduce a custom-made silicone-filled vaginal spacer for use during treatment of female patients receiving pelvic proton radiation therapy. Commercially available vaginal dilators can be purchased as hollow objects; when filled with a media, they can act as a beam stopper and/or tissue spacer while pushing uninvolved vaginal wall away from a high-dose region. Dosimetric advantages of these specifically constructed silicone-filled vaginal spacers were investigated when compared to the unaltered commercially available product or no vaginal spacer in pediatric proton therapy.

我们介绍了一种定制的硅胶填充阴道垫片,用于接受骨盆质子放射治疗的女性患者。市面上可买到的阴道扩张器是中空的;当充满介质时,它们可以作为光束阻挡器和/或组织间隔器,同时将未受影响的阴道壁推离高剂量区域。在儿科质子治疗中,与未改变的市售产品或无阴道间隔剂相比,研究了这些专门构建的硅胶填充阴道间隔剂的剂量学优势。
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引用次数: 0
期刊
International Journal of Particle Therapy
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