Pub Date : 2024-09-11DOI: 10.1016/j.adro.2024.101611
Thomas Tessonnier PhD , Domenico Ivan Filosa MS , Celine Karle MS , Filipa Baltazar MS , Lorenzo Manti PhD , Lars Glimelius MS , Thomas Haberer PhD , Amir Abdollahi PhD, MD , Juergen Debus PhD, MD , Stewart Mein PhD , Ivana Dokic PhD , Andrea Mairani PhD
Purpose
Spot-scanning hadron arc radiation therapy (SHArc) is a novel delivery technique for ion beams with potentially improved dose conformity and dose-averaged linear energy transfer (LETd) redistribution. The first dosimetric validation and in vitro verification of carbon ion arc delivery is presented.
Methods and Materials
Intensity-modulated particle therapy (IMPT) and SHArc plans were designed to deliver homogeneous physical dose or biological dose in a cylindrical polymethyl methacrylate (PMMA) phantom. Additional IMPT carbon plans were optimized for testing different LETd-boosting strategies. Verifications of planned doses were performed with an ionization chamber, and a clonogenic survival assay was conducted using A549 cancer lung cell line. Radiation-induced nuclear 53BP1 foci were assessed to evaluate the cellular response in both normoxic and hypoxic conditions.
Results
Dosimetric measurements and clonogenic assay results showed a good agreement with planned dose and survival distributions. Measured survival fractions and foci confirmed carbon ions SHArc as a potential modality to overcome hypoxia-induced radioresistance. LETd-boosted IMPT plans reached similar LETd in the target as in SHArc plans, promising similar features against hypoxia but at the cost of an increased entrance dose. SHArc resulted, however, in a lower dose bath but in a larger volume around the target.
Conclusions
The first proof-of-principle of carbon ions SHArc delivery was performed, and experimental evidence suggests this novel modality as an attractive approach for treating hypoxic tumors.
{"title":"First Dosimetric and Biological Verification for Spot-Scanning Hadron Arc Radiation Therapy With Carbon Ions","authors":"Thomas Tessonnier PhD , Domenico Ivan Filosa MS , Celine Karle MS , Filipa Baltazar MS , Lorenzo Manti PhD , Lars Glimelius MS , Thomas Haberer PhD , Amir Abdollahi PhD, MD , Juergen Debus PhD, MD , Stewart Mein PhD , Ivana Dokic PhD , Andrea Mairani PhD","doi":"10.1016/j.adro.2024.101611","DOIUrl":"10.1016/j.adro.2024.101611","url":null,"abstract":"<div><h3>Purpose</h3><div>Spot-scanning hadron arc radiation therapy (SHArc) is a novel delivery technique for ion beams with potentially improved dose conformity and dose-averaged linear energy transfer (LET<sub>d</sub>) redistribution. The first dosimetric validation and in vitro verification of carbon ion arc delivery is presented.</div></div><div><h3>Methods and Materials</h3><div>Intensity-modulated particle therapy (IMPT) and SHArc plans were designed to deliver homogeneous physical dose or biological dose in a cylindrical polymethyl methacrylate (PMMA) phantom. Additional IMPT carbon plans were optimized for testing different LET<sub>d</sub>-boosting strategies. Verifications of planned doses were performed with an ionization chamber, and a clonogenic survival assay was conducted using A549 cancer lung cell line. Radiation-induced nuclear 53BP1 foci were assessed to evaluate the cellular response in both normoxic and hypoxic conditions.</div></div><div><h3>Results</h3><div>Dosimetric measurements and clonogenic assay results showed a good agreement with planned dose and survival distributions. Measured survival fractions and foci confirmed carbon ions SHArc as a potential modality to overcome hypoxia-induced radioresistance. LET<sub>d</sub>-boosted IMPT plans reached similar LET<sub>d</sub> in the target as in SHArc plans, promising similar features against hypoxia but at the cost of an increased entrance dose. SHArc resulted, however, in a lower dose bath but in a larger volume around the target.</div></div><div><h3>Conclusions</h3><div>The first proof-of-principle of carbon ions SHArc delivery was performed, and experimental evidence suggests this novel modality as an attractive approach for treating hypoxic tumors.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 12","pages":"Article 101611"},"PeriodicalIF":2.2,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554169","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}
Pub Date : 2024-09-11DOI: 10.1016/j.adro.2024.101624
Craig E. Grossman MD, PhD, MSCE , Oguz Akin MD , Antonio L. Damato PhD , David A. Nunez PhD , Michael J. Zelefsky MD
Purpose
Rectal spacers have gained popularity as a dose-sparing material for prostate cancer radiation therapy (RT). However, the procedure can be associated with unintended rectal wall infiltration (RWI) of the spacer gel. We therefore classified RWI severity as a function of depth and explored its association with rectal toxicity using a data set from prostate cancer patients treated with RT on a prospective randomized clinical trial (RCT).
Methods and Materials
Postimplant T2-weighted magnetic resonance images of 149 subjects randomized to the hydrogel spacer arm of a published multicenter RCT were assessed for the presence and depth of RWI. All implants were assigned a score of 0 (no rectal wall signal changes), 1 (rectal wall edema/signal change), 2 (partial RWI), or 3 (full-thickness RWI); RWI was defined as a score of 2 or 3. Correlations were made between RWI score and physician-reported procedure, acute, and late rectal toxicity.
Results
Although 62.4% of implants had no rectal wall signal abnormalities, 24% [scores of 2 (20.1%) and 3 (4.0%)] of procedures exhibited radiographic evidence of RWI. Full-thickness RWI was associated with both a longer length (22.8 ± 7.0 mm, P = .008) and a larger circumferential percentage (35.8% ± 9.2%, P = .045) of rectal infiltration. Although 7 subjects (5%) experienced transient procedure-related rectal toxicities (most commonly perineal/rectal pain), only one had RWI (score of 2, National Cancer Institute's Common Terminology Criteria for Adverse Events grade 1). Consequently, no correlation was observed between procedural rectal toxicity and the presence/extent of RWI (P = .64). Similarly, no difference in acute (P = .64) or late (P = .85) rectal toxicity incidence or grade was detected between RWI categories; none of the 6 men with a RWI score of 3 developed late rectal toxicity by 15 months.
Conclusions
Based on data from an RCT, RWI did not contribute to increased rectal toxicity prior and up to 15 months after conventional prostate cancer RT.
{"title":"Depth of Hydrogel Spacer Rectal Wall Infiltration Was Not Associated With Rectal Toxicity: Results From a Randomized Prospective Trial","authors":"Craig E. Grossman MD, PhD, MSCE , Oguz Akin MD , Antonio L. Damato PhD , David A. Nunez PhD , Michael J. Zelefsky MD","doi":"10.1016/j.adro.2024.101624","DOIUrl":"10.1016/j.adro.2024.101624","url":null,"abstract":"<div><h3>Purpose</h3><div>Rectal spacers have gained popularity as a dose-sparing material for prostate cancer radiation therapy (RT). However, the procedure can be associated with unintended rectal wall infiltration (RWI) of the spacer gel. We therefore classified RWI severity as a function of depth and explored its association with rectal toxicity using a data set from prostate cancer patients treated with RT on a prospective randomized clinical trial (RCT).</div></div><div><h3>Methods and Materials</h3><div>Postimplant T2-weighted magnetic resonance images of 149 subjects randomized to the hydrogel spacer arm of a published multicenter RCT were assessed for the presence and depth of RWI. All implants were assigned a score of 0 (no rectal wall signal changes), 1 (rectal wall edema/signal change), 2 (partial RWI), or 3 (full-thickness RWI); RWI was defined as a score of 2 or 3. Correlations were made between RWI score and physician-reported procedure, acute, and late rectal toxicity.</div></div><div><h3>Results</h3><div>Although 62.4% of implants had no rectal wall signal abnormalities, 24% [scores of 2 (20.1%) and 3 (4.0%)] of procedures exhibited radiographic evidence of RWI. Full-thickness RWI was associated with both a longer length (22.8 ± 7.0 mm, <em>P</em> = .008) and a larger circumferential percentage (35.8% ± 9.2%, <em>P</em> = .045) of rectal infiltration. Although 7 subjects (5%) experienced transient procedure-related rectal toxicities (most commonly perineal/rectal pain), only one had RWI (score of 2, National Cancer Institute's Common Terminology Criteria for Adverse Events grade 1). Consequently, no correlation was observed between procedural rectal toxicity and the presence/extent of RWI (<em>P</em> = .64). Similarly, no difference in acute (<em>P</em> = .64) or late (<em>P</em> = .85) rectal toxicity incidence or grade was detected between RWI categories; none of the 6 men with a RWI score of 3 developed late rectal toxicity by 15 months.</div></div><div><h3>Conclusions</h3><div>Based on data from an RCT, RWI did not contribute to increased rectal toxicity prior and up to 15 months after conventional prostate cancer RT.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 12","pages":"Article 101624"},"PeriodicalIF":2.2,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142653487","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}
Pub Date : 2024-09-08DOI: 10.1016/j.adro.2024.101626
Crosby Rock MD , Katelyn Kane MD , Sumit Sood MD , Ying Cao MS , Ronald C. Chen MD, MPH , Fen Wang MD
Purpose
There is very little information detailing outcomes and toxicity following reirradiation for ultracentrally located thoracic tumors, and detailed dosimetric data are nonexistent. These data are critical for the safe management of these extremely difficult cases.
Methods and Materials
The records of 15 individuals undergoing 10-fraction hypofractionated stereotactic body radiation therapy for the management of ultracentrally located thoracic tumors between 2009 and 2020 at a single institution were retrospectively reviewed. Treatment outcomes and toxicity were analyzed. A detailed dosimetric analysis of treatment plans and centrally located organs at risk (OARs) from the initial reirradiation and cumulative radiation therapy courses were presented.
Results
At a median follow up of 10 months, the 1- and 3-year overall survival, progression-free survival, and local control were 52% and 28%, 33% and 28%, and 76% and 61%, respectively. Treatment-related adverse events were low, with 5 individuals (33%) developing ≥grade 2 pneumonitis (grade 2 = 4, grade 3 = 1). Dosimetric parameters were not associated with the development of clinically relevant pneumonitis. No adverse events involving central OARs (esophagus, great vessels, and primary bronchial tree) were identified. The median cumulative mean lung dose was 24 Gy equivalent total doses in 2 Gy fractions (EQD2) (range, 10-33 Gy), with a volume receiving 20 G (V20) of 33% (range, 11%-51%). The median esophageal, primary bronchial tree, and great vessel maximum doses (Dmax) were 93.2 Gy (EQD2) (range, 50-148 Gy), 163 Gy (range, 77-204 Gy), and 191 Gy (range, 129-262 Gy), respectively.
Conclusions
The current investigation is the first to provide detailed cumulative dosimetric data from a cohort of patients comprised entirely of ultracentrally located thoracic tumors. Despite unfavorable anatomic tumor location, given an intimate association with critical OARs, delivering an ablative dose with a 10-fraction hypofractionated stereotactic body radiation therapy course can serve as a feasible option for these challenging cases.
{"title":"Reirradiation of Utracentrally Located Thoracic Tumors Using a 10-Fraction Hypofractionated Stereotactic Body Radiation Therapy Course: A Detailed Dosimetric Analysis","authors":"Crosby Rock MD , Katelyn Kane MD , Sumit Sood MD , Ying Cao MS , Ronald C. Chen MD, MPH , Fen Wang MD","doi":"10.1016/j.adro.2024.101626","DOIUrl":"10.1016/j.adro.2024.101626","url":null,"abstract":"<div><h3>Purpose</h3><div>There is very little information detailing outcomes and toxicity following reirradiation for ultracentrally located thoracic tumors, and detailed dosimetric data are nonexistent. These data are critical for the safe management of these extremely difficult cases.</div></div><div><h3>Methods and Materials</h3><div>The records of 15 individuals undergoing 10-fraction hypofractionated stereotactic body radiation therapy for the management of ultracentrally located thoracic tumors between 2009 and 2020 at a single institution were retrospectively reviewed. Treatment outcomes and toxicity were analyzed. A detailed dosimetric analysis of treatment plans and centrally located organs at risk (OARs) from the initial reirradiation and cumulative radiation therapy courses were presented.</div></div><div><h3>Results</h3><div>At a median follow up of 10 months, the 1- and 3-year overall survival, progression-free survival, and local control were 52% and 28%, 33% and 28%, and 76% and 61%, respectively. Treatment-related adverse events were low, with 5 individuals (33%) developing ≥grade 2 pneumonitis (grade 2 = 4, grade 3 = 1). Dosimetric parameters were not associated with the development of clinically relevant pneumonitis. No adverse events involving central OARs (esophagus, great vessels, and primary bronchial tree) were identified. The median cumulative mean lung dose was 24 Gy equivalent total doses in 2 Gy fractions (EQD2) (range, 10-33 Gy), with a volume receiving 20 G (V20) of 33% (range, 11%-51%). The median esophageal, primary bronchial tree, and great vessel maximum doses (Dmax) were 93.2 Gy (EQD2) (range, 50-148 Gy), 163 Gy (range, 77-204 Gy), and 191 Gy (range, 129-262 Gy), respectively.</div></div><div><h3>Conclusions</h3><div>The current investigation is the first to provide detailed cumulative dosimetric data from a cohort of patients comprised entirely of ultracentrally located thoracic tumors. Despite unfavorable anatomic tumor location, given an intimate association with critical OARs, delivering an ablative dose with a 10-fraction hypofractionated stereotactic body radiation therapy course can serve as a feasible option for these challenging cases.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 12","pages":"Article 101626"},"PeriodicalIF":2.2,"publicationDate":"2024-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142445237","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}
Pub Date : 2024-09-06DOI: 10.1016/j.adro.2024.101625
Yue Lin MD , Muhammad M. Qureshi MBBS, MPH , Sonny Batra MD , Minh-Tam Truong MD , Kimberley S. Mak MD, MPH
Purpose
The optimal delivery schedule for stereotactic body radiation therapy (SBRT) in treating stage I non-small cell lung cancer (NSCLC) is unknown. This study used the National Cancer Database to examine daily versus every other day (QOD) SBRT scheduling, including trends over time and association with survival.
Methods and Materials
The National Cancer Database was used to retrospectively identify patients with stage I NSCLC treated with 3-, 4-, or 5-fraction of SBRT between 2004 and 2016. Survival analysis was performed using the Kaplan-Meier method and Cox regression modeling.
Results
Of 15,269 patients, 3927 (25.7%) received SBRT daily, and 11,342 (74.3%) received treatment QOD. The use of QOD treatment increased from 63.2% in 2007 to 78.3% in 2016, and 5-fraction SBRT increased from 3.7% in 2004 to 51.4% in 2016 (both P < .0001). QOD 5-fraction became the most prevalent scheduling from 2012 to 2016 (28.5% in 2012 to 41.6% in 2016). Factors significantly associated with daily SBRT scheduling included number of fractions, race, lower income, lower comorbidities, and treatment at academic/research programs (all P ≤ .01).
Median survival for daily SBRT was 37.9 months versus 38.4 months for QOD (P = .4). On multivariable analysis, no difference was found in overall survival between daily versus QOD scheduling (adjusted hazard ratio [aHR], 0.99; 95% confidence interval [CI], 0.94-1.04; P = .55). Five-fraction SBRT was associated with worse survival versus 3 fractions (aHR, 1.09; 95% CI, 1.03-1.15; P = .002). With 3-fraction SBRT, QOD treatment was associated with improved survival versus daily treatment (aHR, 0.91; 95% CI, 0.84-0.98; P = .02). With 5-fraction SBRT, QOD treatment was associated with worse survival versus daily treatment (aHR, 1.11; 95% CI, 1.02-1.22; P = .02).
Conclusions
QOD SBRT schedules were more frequently used to treat stage I NSCLC than daily regimens by a factor of 3:1, and QOD 5-fraction SBRT became the most common dose schedule after 2012. Three-fraction QOD SBRT was associated with improved survival versus daily, whereas 5-fraction QOD SBRT was associated with worse survival versus daily.
{"title":"Consecutive Daily Versus Every Other Day Stereotactic Body Radiation Therapy Scheduling for Stage I Non-small Cell Lung Cancer","authors":"Yue Lin MD , Muhammad M. Qureshi MBBS, MPH , Sonny Batra MD , Minh-Tam Truong MD , Kimberley S. Mak MD, MPH","doi":"10.1016/j.adro.2024.101625","DOIUrl":"10.1016/j.adro.2024.101625","url":null,"abstract":"<div><h3>Purpose</h3><div>The optimal delivery schedule for stereotactic body radiation therapy (SBRT) in treating stage I non-small cell lung cancer (NSCLC) is unknown. This study used the National Cancer Database to examine daily versus every other day (QOD) SBRT scheduling, including trends over time and association with survival.</div></div><div><h3>Methods and Materials</h3><div>The National Cancer Database was used to retrospectively identify patients with stage I NSCLC treated with 3-, 4-, or 5-fraction of SBRT between 2004 and 2016. Survival analysis was performed using the Kaplan-Meier method and Cox regression modeling.</div></div><div><h3>Results</h3><div>Of 15,269 patients, 3927 (25.7%) received SBRT daily, and 11,342 (74.3%) received treatment QOD. The use of QOD treatment increased from 63.2% in 2007 to 78.3% in 2016, and 5-fraction SBRT increased from 3.7% in 2004 to 51.4% in 2016 (both <em>P <</em> .0001). QOD 5-fraction became the most prevalent scheduling from 2012 to 2016 (28.5% in 2012 to 41.6% in 2016). Factors significantly associated with daily SBRT scheduling included number of fractions, race, lower income, lower comorbidities, and treatment at academic/research programs (all <em>P</em> ≤ .01).</div><div>Median survival for daily SBRT was 37.9 months versus 38.4 months for QOD (<em>P =</em> .4). On multivariable analysis, no difference was found in overall survival between daily versus QOD scheduling (adjusted hazard ratio [aHR], 0.99; 95% confidence interval [CI], 0.94-1.04; <em>P =</em> .55). Five-fraction SBRT was associated with worse survival versus 3 fractions (aHR, 1.09; 95% CI, 1.03-1.15; <em>P =</em> .002). With 3-fraction SBRT, QOD treatment was associated with improved survival versus daily treatment (aHR, 0.91; 95% CI, 0.84-0.98; <em>P =</em> .02). With 5-fraction SBRT, QOD treatment was associated with worse survival versus daily treatment (aHR, 1.11; 95% CI, 1.02-1.22; <em>P =</em> .02).</div></div><div><h3>Conclusions</h3><div>QOD SBRT schedules were more frequently used to treat stage I NSCLC than daily regimens by a factor of 3:1, and QOD 5-fraction SBRT became the most common dose schedule after 2012. Three-fraction QOD SBRT was associated with improved survival versus daily, whereas 5-fraction QOD SBRT was associated with worse survival versus daily.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 12","pages":"Article 101625"},"PeriodicalIF":2.2,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142527862","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}
Pub Date : 2024-09-04DOI: 10.1016/j.adro.2024.101614
Mahbubur Rahman PhD , Zohaib Iqbal PhD , David Parsons PhD , Denise Salazar BS , Justin Visak PhD , Xinran Zhong PhD , Siqiu Wang PhD , Dennis Stanley PhD , Andrew Godley PhD , Bin Cai PhD , David Sher MD , Mu-Han Lin PhD
Purpose
Online adaptive radiation therapy (oART) treatment planning requires evaluating the temporal robustness of reference plans and anticipating the potential changes during treatment courses that may even lead to risks unique to the adaptive workflow. This study conducted a risk analysis of the cone beam computed tomography guided adaptive workflow and is the first to assess an adaptive-specific reference planning review that mitigates risk in the planning process to prevent events and treatment deficiencies during adaptation.
Methods and Materials
A quality management team of medical physicists, residents, physicians, and radiation therapists performed a fault tree analysis and failure mode and effects analysis. Fault trees were created for under/overdosing targets and treatment deficiencies and assisted in identifying failure modes for the failure mode and effects analysis. Treatment deficiency was defined as a nonideal oART plan resulting in treatment with a lower quality plan (either oART or scheduled plan), treatment delay, or canceling treatment for the day. A reference planning checklist was created to catch failure modes before reaching the patient. Risk priority numbers (RPNs = severity * detectability * occurrence) were scored with and without the reference planning checklist to quantify risk mitigation. A root cause analysis was conducted for an event where an adaptive plan failed to generate.
Results
The reference planning checklist (with items covering patient background, contouring/planning robustness for anatomy variability, and machine limitations) reduced the RPN for all failure modes. Only 1 failure mode with an RPN > 150 occurred with the reference planning checklist compared with 29 failure modes without, including 14 adaptive-specific failure modes. Contouring, planning, setup, scheduling, and documentation errors were identified during the fault tree analysis. Twenty-nine of 70 errors were adaptive-specific. The reference planning checklist could address 23 of 33 errors for over- or underdosing and 28 of 37 errors for treatment deficiency. The root cause analysis highlighted the need to check the setup prior to adaptive plan delivery and the time-out checklist.
Conclusions
The reference planning checklist improved the detection of the failure modes and improved the quality and robustness of the plans produced for oART. It is ideally performed before the physician plan review to prevent last-minute replan (before or after first adaptive treatment) and delay of patient start. The checklist presented can be modified based on failures specific to individual clinics and used at various planning steps based on available resources.
{"title":"Mitigating Risks in Cone Beam Computed Tomography Guided Online Adaptive Radiation Therapy: A Preventative Reference Planning Review Approach","authors":"Mahbubur Rahman PhD , Zohaib Iqbal PhD , David Parsons PhD , Denise Salazar BS , Justin Visak PhD , Xinran Zhong PhD , Siqiu Wang PhD , Dennis Stanley PhD , Andrew Godley PhD , Bin Cai PhD , David Sher MD , Mu-Han Lin PhD","doi":"10.1016/j.adro.2024.101614","DOIUrl":"10.1016/j.adro.2024.101614","url":null,"abstract":"<div><h3>Purpose</h3><div>Online adaptive radiation therapy (oART) treatment planning requires evaluating the temporal robustness of reference plans and anticipating the potential changes during treatment courses that may even lead to risks unique to the adaptive workflow. This study conducted a risk analysis of the cone beam computed tomography guided adaptive workflow and is the first to assess an adaptive-specific reference planning review that mitigates risk in the planning process to prevent events and treatment deficiencies during adaptation.</div></div><div><h3>Methods and Materials</h3><div>A quality management team of medical physicists, residents, physicians, and radiation therapists performed a fault tree analysis and failure mode and effects analysis. Fault trees were created for under/overdosing targets and treatment deficiencies and assisted in identifying failure modes for the failure mode and effects analysis. Treatment deficiency was defined as a nonideal oART plan resulting in treatment with a lower quality plan (either oART or scheduled plan), treatment delay, or canceling treatment for the day. A reference planning checklist was created to catch failure modes before reaching the patient. Risk priority numbers (RPNs = severity * detectability * occurrence) were scored with and without the reference planning checklist to quantify risk mitigation. A root cause analysis was conducted for an event where an adaptive plan failed to generate.</div></div><div><h3>Results</h3><div>The reference planning checklist (with items covering patient background, contouring/planning robustness for anatomy variability, and machine limitations) reduced the RPN for all failure modes. Only 1 failure mode with an RPN > 150 occurred with the reference planning checklist compared with 29 failure modes without, including 14 adaptive-specific failure modes. Contouring, planning, setup, scheduling, and documentation errors were identified during the fault tree analysis. Twenty-nine of 70 errors were adaptive-specific. The reference planning checklist could address 23 of 33 errors for over- or underdosing and 28 of 37 errors for treatment deficiency. The root cause analysis highlighted the need to check the setup prior to adaptive plan delivery and the time-out checklist.</div></div><div><h3>Conclusions</h3><div>The reference planning checklist improved the detection of the failure modes and improved the quality and robustness of the plans produced for oART. It is ideally performed before the physician plan review to prevent last-minute replan (before or after first adaptive treatment) and delay of patient start. The checklist presented can be modified based on failures specific to individual clinics and used at various planning steps based on available resources.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 11","pages":"Article 101614"},"PeriodicalIF":2.2,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142322681","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}
To investigate the outcome and toxicity of patients affected by malignant peripheral nerve sheath tumors (MPNSTs) treated with high-dose carbon ion radiation therapy (CIRT).
Methods and Materials
We retrospectively analyzed the outcome of 23 patients with MPNSTs treated between July 2013 and December 2020. Out of these, 13 patients (56.5%) had incompletely resected tumors, 8 patients (34.7%) experienced recurrence after surgery, and 2 patients (8.7%) had unresectable tumors. Before CIRT treatment, 4 patients underwent a second surgery after the first local recurrence (LR), and 1 patient underwent a third surgery for the second local relapse of the disease. Six (26%) patients received neoadjuvant chemotherapy. The most frequent tumor site was the brachial plexus (n = 9; 39.1%). In 5 patients (21.7%), neurofibromatosis type 1 disorder was found, while 4 patients (17, 4%) had radiation-induced MPNSTs. The median CIRT prescribed total dose was 69.8 Gy (relative biological effectiveness; range, 54-76.8) delivered in a median of 16 fractions (range, 15-22). Eleven patients (47.82%) were treated according to a sequential boost protocol with a median prescribed dose to clinical target volume LR of 45 Gy (relative biological effectiveness; range, 41.4-54).
Results
After a median follow-up time of 23 months (range, 3-100 months), the overall survival rates at 1 and 2 years were 82.38% and 61.51%, respectively. The 1-year and 2-year local relapse-free survival rates were 65.07% and 48.80%, respectively, and the 1-year and 2-year progression-free survival rates were 56.37% and 40.99%, respectively. No patients showed acute or late grade 4 toxicity or any treatment-related deaths. Ten patients (43.48%) reported acute toxicities of grade ≥ 2, which included dermatitis in 6 patients, mucositis in 2 patients, and peripheral neuropathy in 4 patients. Eight patients (34.78%) reported late toxicities of grade ≥ 2, mainly due to loco-regional neuropathy.
Conclusions
High-dose CIRT shows favorable local effects with acceptable toxicities in patients with gross residual and LR after surgery or unresectable malignant peripheral nerve sheath tumors. Advanced treatment modalities such as particle therapy should be considered for MPNSTs.
{"title":"Clinical Outcomes of Carbon Ion Radiation Therapy for Malignant Peripheral Nerve Sheath Tumors","authors":"Maria Rosaria Fiore MD , Agnieszka Chalaszczyk MD , Amelia Barcellini MD , Viviana Vitolo MD , Giulia Fontana MSc , Stefania Russo MSc , Marco Rotondi MD , Silvia Molinelli MSc , Alfredo Mirandola MSc , Alessia Bazani MSc , Ester Orlandi MD","doi":"10.1016/j.adro.2024.101619","DOIUrl":"10.1016/j.adro.2024.101619","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the outcome and toxicity of patients affected by malignant peripheral nerve sheath tumors (MPNSTs) treated with high-dose carbon ion radiation therapy (CIRT).</div></div><div><h3>Methods and Materials</h3><div>We retrospectively analyzed the outcome of 23 patients with MPNSTs treated between July 2013 and December 2020. Out of these, 13 patients (56.5%) had incompletely resected tumors, 8 patients (34.7%) experienced recurrence after surgery, and 2 patients (8.7%) had unresectable tumors. Before CIRT treatment, 4 patients underwent a second surgery after the first local recurrence (LR), and 1 patient underwent a third surgery for the second local relapse of the disease. Six (26%) patients received neoadjuvant chemotherapy. The most frequent tumor site was the brachial plexus (n = 9; 39.1%). In 5 patients (21.7%), neurofibromatosis type 1 disorder was found, while 4 patients (17, 4%) had radiation-induced MPNSTs. The median CIRT prescribed total dose was 69.8 Gy (relative biological effectiveness; range, 54-76.8) delivered in a median of 16 fractions (range, 15-22). Eleven patients (47.82%) were treated according to a sequential boost protocol with a median prescribed dose to clinical target volume LR of 45 Gy (relative biological effectiveness; range, 41.4-54).</div></div><div><h3>Results</h3><div>After a median follow-up time of 23 months (range, 3-100 months), the overall survival rates at 1 and 2 years were 82.38% and 61.51%, respectively. The 1-year and 2-year local relapse-free survival rates were 65.07% and 48.80%, respectively, and the 1-year and 2-year progression-free survival rates were 56.37% and 40.99%, respectively. No patients showed acute or late grade 4 toxicity or any treatment-related deaths. Ten patients (43.48%) reported acute toxicities of grade ≥ 2, which included dermatitis in 6 patients, mucositis in 2 patients, and peripheral neuropathy in 4 patients. Eight patients (34.78%) reported late toxicities of grade ≥ 2, mainly due to loco-regional neuropathy.</div></div><div><h3>Conclusions</h3><div>High-dose CIRT shows favorable local effects with acceptable toxicities in patients with gross residual and LR after surgery or unresectable malignant peripheral nerve sheath tumors. Advanced treatment modalities such as particle therapy should be considered for MPNSTs.</div></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 11","pages":"Article 101619"},"PeriodicalIF":2.2,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142427447","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}
Pub Date : 2024-09-01DOI: 10.1016/j.adro.2024.101559
Scott C. Lester MD , Emma F. Johnson MD , William G. Breen MD , Arushi Khurana MBBS
{"title":"Taming the Lion: A Report of Pencil Beam Scanning Proton Therapy for Severe Leonine Facies","authors":"Scott C. Lester MD , Emma F. Johnson MD , William G. Breen MD , Arushi Khurana MBBS","doi":"10.1016/j.adro.2024.101559","DOIUrl":"10.1016/j.adro.2024.101559","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 9","pages":"Article 101559"},"PeriodicalIF":2.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001222/pdfft?md5=c48b749ffdbd104509e36d03732e9738&pid=1-s2.0-S2452109424001222-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142239286","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}
Pub Date : 2024-09-01DOI: 10.1016/j.adro.2024.101567
Steven D. Pan MD , Joseph R. Osborne MD, PhD , Gloria C. Chiang MD , Rohan Ramakrishna MD , Apostolos J. Tsiouris MD , Howard A. Fine MD , Jana Ivanidze MD, PhD
{"title":"Positron Emission Tomography and Magnetic Resonance Imaging Findings in the Diagnosis of Stroke-Like Migraine Attacks after Radiation Therapy Syndrome: A Case Report","authors":"Steven D. Pan MD , Joseph R. Osborne MD, PhD , Gloria C. Chiang MD , Rohan Ramakrishna MD , Apostolos J. Tsiouris MD , Howard A. Fine MD , Jana Ivanidze MD, PhD","doi":"10.1016/j.adro.2024.101567","DOIUrl":"10.1016/j.adro.2024.101567","url":null,"abstract":"","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 9","pages":"Article 101567"},"PeriodicalIF":2.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001301/pdfft?md5=03ff47fddf290720d3cdda47ae1a384c&pid=1-s2.0-S2452109424001301-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141689929","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}
Pub Date : 2024-09-01DOI: 10.1016/j.adro.2024.101566
Gabriela Studer MD, David Jeller, Tino Streller PhD, Dirk Huebner, Christoph Glanzmann MD
Purpose
Lattice radiation therapy (LRT), a form of spatially fractionated radiation therapy, holds promise for treating large tumors. Despite its introduction in clinical practice around 2010, there remains limited information on its time-related outcomes despite consistently high response rates and tolerability. We assessed the time-related outcome of our palliative LRT cohort.
Methods and Materials
We conducted an analysis of our LRT program, which involved 45 palliative patients with 56 lesions larger than 7 cm, treated between January 2022 and November 2023. Prospectively defined treatment protocols included delivering 20 to 25 Gy/5 fractions to the tumor with a stereotactic simultaneously integrated boost (SIB) of 60 to 65 Gy to lattice vertices (n = 45/56) or, mainly in preirradiated lesions, single fraction stereotaxy with 1 × 15 to 20 Gy to vertices only (n = 11/56). Follow-up (FU) intervals were determined based on clinical considerations, considering the mostly highly palliative situation of included patients. Outcome assessments focused on subjective benefit and objective radiologic FU response.
Results
The mean/median FU was 5.5/4.0 months (0.3-21 months). A total of 25/45 (56%) patients died after a mean/median of 3.9/2.0 months (0.3-14 months). Fourteen of 56 lesions (25%) were previously irradiated, with a mean/median of 18/13 months (4-72 months) prior to LRT. The mean/median gross tumor volume (GTV) measured 797/415 cc (54-4027 cc) and 14/13 cm (7-28 cm). Subjective statements at LRT completion were available from 37 symptomatic patients: 32/37 (87%) reported fast symptom relief, and 5/37 felt no change under LRT or at LRT completion. Early tolerance was excellent (G0-1). FU imaging was available from 40/56 lesions (71%): progression in 3/40 at first exam one at 1.5 and 4 months post-LRT, and stable disease (±10%) in 5/40 assessed at 2, 3, 3, and 4 months post-LRT. First measure shrinkage of 48%/30% (10%-100%) was found in 32/40 lesions (80%) after a mean/median of 2.8/3 months (0.3-7 months). Maximum shrinkage over time based on 21 cases with at least 1 FU imaging measured a mean/median of 62%/60% after 6.2/5.5 months. The duration of radiologic response was a mean/median of 7.4/7.0 months (1-21 months).
Conclusions
Short-course LRT emerged as an effective and well-tolerated palliative option for very large lesions, whether treatment-naïve or previously irradiated. Nearly 90% of symptomatic patients reported significant subjective benefit, and 80% of assessed lesions demonstrated tumor shrinkage ≥10%, with a mean response duration of >6 months.
{"title":"Time-Related Outcome Following Palliative Spatially Fractionated Stereotactic Radiation Therapy (Lattice) of Large Tumors – A Case Series","authors":"Gabriela Studer MD, David Jeller, Tino Streller PhD, Dirk Huebner, Christoph Glanzmann MD","doi":"10.1016/j.adro.2024.101566","DOIUrl":"10.1016/j.adro.2024.101566","url":null,"abstract":"<div><h3>Purpose</h3><p>Lattice radiation therapy (LRT), a form of spatially fractionated radiation therapy, holds promise for treating large tumors. Despite its introduction in clinical practice around 2010, there remains limited information on its time-related outcomes despite consistently high response rates and tolerability. We assessed the time-related outcome of our palliative LRT cohort.</p></div><div><h3>Methods and Materials</h3><p>We conducted an analysis of our LRT program, which involved 45 palliative patients with 56 lesions larger than 7 cm, treated between January 2022 and November 2023. Prospectively defined treatment protocols included delivering 20 to 25 Gy/5 fractions to the tumor with a stereotactic simultaneously integrated boost (SIB) of 60 to 65 Gy to lattice vertices (n = 45/56) or, mainly in preirradiated lesions, single fraction stereotaxy with 1 × 15 to 20 Gy to vertices only (n = 11/56). Follow-up (FU) intervals were determined based on clinical considerations, considering the mostly highly palliative situation of included patients. Outcome assessments focused on subjective benefit and objective radiologic FU response.</p></div><div><h3>Results</h3><p>The mean/median FU was 5.5/4.0 months (0.3-21 months). A total of 25/45 (56%) patients died after a mean/median of 3.9/2.0 months (0.3-14 months). Fourteen of 56 lesions (25%) were previously irradiated, with a mean/median of 18/13 months (4-72 months) prior to LRT. The mean/median gross tumor volume (GTV) measured 797/415 cc (54-4027 cc) and 14/13 cm (7-28 cm). Subjective statements at LRT completion were available from 37 symptomatic patients: 32/37 (87%) reported fast symptom relief, and 5/37 felt no change under LRT or at LRT completion. Early tolerance was excellent (G0-1). FU imaging was available from 40/56 lesions (71%): progression in 3/40 at first exam one at 1.5 and 4 months post-LRT, and stable disease (±10%) in 5/40 assessed at 2, 3, 3, and 4 months post-LRT. First measure shrinkage of 48%/30% (10%-100%) was found in 32/40 lesions (80%) after a mean/median of 2.8/3 months (0.3-7 months). Maximum shrinkage over time based on 21 cases with at least 1 FU imaging measured a mean/median of 62%/60% after 6.2/5.5 months. The duration of radiologic response was a mean/median of 7.4/7.0 months (1-21 months).</p></div><div><h3>Conclusions</h3><p>Short-course LRT emerged as an effective and well-tolerated palliative option for very large lesions, whether treatment-naïve or previously irradiated. Nearly 90% of symptomatic patients reported significant subjective benefit, and 80% of assessed lesions demonstrated tumor shrinkage ≥10%, with a mean response duration of >6 months.</p></div>","PeriodicalId":7390,"journal":{"name":"Advances in Radiation Oncology","volume":"9 9","pages":"Article 101566"},"PeriodicalIF":2.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2452109424001295/pdfft?md5=b573b2ed77b74b99693c0d7fa8815038&pid=1-s2.0-S2452109424001295-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141705705","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号