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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 Q2 Medicine 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 Q2 Medicine 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。
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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 Q2 Medicine 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。
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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 Q2 Medicine 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":null,"pages":null},"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 Q2 Medicine 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。
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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 Q2 Medicine 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。
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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 Q2 Medicine 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。
{"title":"Early Experience Using Proton Beam Therapy for Extremity Soft Tissue Sarcoma: A Multicenter Study.","authors":"Brady S Laughlin,&nbsp;Michael A Golafshar,&nbsp;Safia Ahmed,&nbsp;Matthew Prince,&nbsp;Justin D Anderson,&nbsp;Tamara Vern-Gross,&nbsp;Mahesh Seetharam,&nbsp;Krista Goulding,&nbsp;Ivy Petersen,&nbsp;Todd DeWees,&nbsp;Jonathan B Ashman","doi":"10.14338/IJPT-21-00037.1","DOIUrl":"https://doi.org/10.14338/IJPT-21-00037.1","url":null,"abstract":"<p><strong>Purpose: </strong>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.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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], <i>P</i> = .003).</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":36923,"journal":{"name":"International Journal of Particle Therapy","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2022-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9238125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40462130","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: 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 Q2 Medicine 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
Vaginal Sparing Radiotherapy Using IMPT and Daily Dilator Placement for Women with Anal Cancer. 阴道保留放疗使用IMPT和每日扩张器放置肛门癌妇女。
IF 1.7 Q2 Medicine Pub Date : 2022-04-26 eCollection Date: 2022-01-01 DOI: 10.14338/IJPT-21-00025
Scott C Lester, Laura A McGrath, Rachael M Guenzel, Jenae C Quinn, Carolyn J Schultz, T Baron Bradley, Bret D Kazemba, Shima Ito, Christopher L Hallemeier

Sexual dysfunction is a common toxicity and detrimental for the quality of life of women treated with chemoradiotherapy for anal cancer. Sexual dysfunction occurs because the vagina is closely approximated to the anal canal and typically receives substantial doses of radiation. Strategies for mitigation have largely been focused on posttreatment therapy and symptom management. The use of daily vaginal dilator placement during radiotherapy to mitigate dose to the vagina has been previously explored with modest gains, while proton therapy is under active investigation for the treatment of anal cancer. Use of proton therapy for anal cancer reduces dose to some organs at risk but may inadvertently increase vaginal toxicity if the proton beam terminates in the vaginal tissue. Herein, we present the case histories of 2 women treated for squamous cell carcinoma of the anal canal with the novel combination of intensity-modulated proton therapy and daily vaginal dilator placement to maximally reduce dose to the vagina and protect it from areas of increased energy deposition at the end of the proton range.

性功能障碍是肛门癌患者接受放化疗后常见的毒性,对患者的生活质量不利。性功能障碍的发生是因为阴道与肛管非常接近,通常会受到大剂量的辐射。缓解策略主要侧重于治疗后治疗和症状管理。在放疗期间每日放置阴道扩张器以减轻对阴道的剂量,先前已进行了探索,并取得了一定的进展,而质子治疗正在积极研究中,用于治疗肛门癌。使用质子治疗肛门癌可以减少对某些危险器官的剂量,但如果质子束终止于阴道组织,则可能无意中增加阴道毒性。在此,我们报告了2名女性肛管鳞状细胞癌患者的病例史,她们采用了强度调节质子治疗和每日阴道扩张器放置的新组合,以最大限度地减少阴道剂量,并保护阴道免受质子范围结束时能量沉积增加的区域的影响。
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引用次数: 0
Feasibility Study of Using XRV-124 Scintillation Detector for Collinearity Measurement in Uniform Scanning Proton Therapy. XRV-124闪烁探测器用于均匀扫描质子治疗共线性测量的可行性研究。
IF 1.7 Q2 Medicine Pub Date : 2022-04-22 eCollection Date: 2022-01-01 DOI: 10.14338/IJPT-21-00040.1
Biniam Tesfamicael, Colton Eckert, Suresh Rana

Purpose: The purpose of this work is to study the feasibility of using an XRV-124 scintillation detector in measuring the collinearity of the x-ray system and uniform scanning proton beam.

Methods: A brass aperture for Snout 10 was manufactured. The center of the aperture had an opening of 1 cm in diameter (4 cm for the film measurements). The 2D kV x-ray images of the XRV-124 were acquired such that the marker inside the detector is aligned to the imaging isocenter. After obtaining the optimal camera settings, a uniform scanning proton beam was delivered for various ranges (12 g/cm2 to 28 g/cm2 in step size of 2 g/cm2). For each range, 10 monitor units (MU) of the first layer were delivered to the XRV-124 detector. Collinearity tests were repeated by using EDR2 and EBT3 films following our current quality assurance protocol in practice. The results from the XRV-124 measurements were compared against the collinearity results from EDR2 and EBT3 films.

Results and discussion: The collinearity results were evaluated in the horizontal (x) and vertical (y) directions. The average deviation in collinearity in the x-direction was -0.24 ± 0.30 mm, 0.57 ± 0.39 mm, and -0.27 ± 0.14 mm for EDR2, EBT3, and XRV-124, respectively. In the y-direction, the average deviation was 0.39 ± 0.07 mm, 0.29 ± 0.14 mm, and 0.39 ± 0.03 mm for EDR2, EBT3, and XRV-124, respectively.

Conclusion: The measurement results from the XRV-124 and films are in good agreement. Compared to film, the use of the XRV-124 detector for collinearity measurements in uniform scanning protons is more efficient and provides results in real time.

目的:研究用XRV-124闪烁探测器测量x射线系统和均匀扫描质子束共线性的可行性。方法:制作10号口鼻的黄铜孔。光圈中心的开口直径为1厘米(薄膜测量为4厘米)。获得了XRV-124的二维kV x射线图像,使得探测器内部的标记与成像等中心对齐。在获得最佳相机设置后,在不同范围内(12 g/cm2至28 g/cm2,步长为2 g/cm2)均匀扫描质子束。对于每个量程,将第一层的10个监视器(MU)交付给XRV-124探测器。使用EDR2和EBT3薄膜,按照我们目前的质量保证方案重复共线性测试。XRV-124的测量结果与EDR2和EBT3薄膜的共线性结果进行了比较。结果与讨论:在水平(x)和垂直(y)方向上评价共线性结果。EDR2、EBT3和XRV-124的x方向共线性平均偏差分别为-0.24±0.30 mm、0.57±0.39 mm和-0.27±0.14 mm。在y方向上,EDR2、EBT3和XRV-124的平均偏差分别为0.39±0.07 mm、0.29±0.14 mm和0.39±0.03 mm。结论:XRV-124的测量结果与薄膜的测量结果吻合较好。与胶片相比,使用XRV-124探测器在均匀扫描质子中进行共线性测量更有效,并提供实时结果。
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引用次数: 1
期刊
International Journal of Particle Therapy
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