EP-1404: Early results of proton beam therapy in sarcomas at the West German Proton Therapy Center Essen

Purpose: Proton Beam Therapy (PBT) is an emerging radiotherapy technique using beams of proton to treat cancer. As the first report addressing the topic, the principal aim is to highlight the present status of PBT research and development in Iran as a developing country. Materials and Methods: To do so, the demand for PBT in Iran and Iran National Ion Therapy Center (IRNitc) was investigated and introduced. Then, Scopus and PubMed were searched for studies that dealt with PBT research in Iran and subsequently 6 major subfields of interest were identified. Furthermore, international collaborations were extracted from the bibliographic data. To combine both research and development sides, a SWOT analysis was performed through collecting viewpoints of 48 radiotherapy experts about PBT, and then strengths, weaknesses, opportunities, and threats of it were examined. Results: Iran contributes to approximately 1% of global PBT sciences. Proton dose calculation using Monte Carlo simulation is the dominant subject of interest for Iranian researchers. Italy is recognized as the major foreign partner in PBT researches. Clinical advantages over conventional radiotherapy modalities are the main strength of PBT development in Iran while the high installation cost remains the most weakness. Finally, 10 general considerations for the launching of a PBT facility in Iran were presented based upon both Iranian experts’ viewpoints and IAEA recommendations. Conclusion: This research reveals that while PBT research and development in Iran are still in their infancy, there are promising trends in both the research and development sides of PBT.

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PS1 - 183 Recommendations for the Referral of Patients from Proton Beam Therapy, an Alberta Health Services Report: A Model for Canada?

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2016.361 ◽

2016 ◽

Vol 43 (S4) ◽

pp. S11-S11

Author(s):

S. Patel ◽

X. Kostaras ◽

M. Parliament ◽

I.A. Olivotto ◽

R. Nordal ◽

...

Keyword(s):

Health Services ◽

Proton Beam ◽

Proton Therapy ◽

Proton Beam Therapy ◽

Sufficient Evidence ◽

Draft Report ◽

Term Survival ◽

Travel Abroad ◽

Alberta Health

Proton beam therapy (PBT) offers compelling advantages in physical dose distribution compared to photon therapy. There are increasing numbers of gantry-based proton facilities worldwide but no such facilities exist in Canada. To access PBT, Canadian patients must travel abroad for treatment at high cost. In the face of limited access, this report seeks to provide recommendations for the selection of patients most likely to benefit from PBT and suggests an out-of-country referral process. METHODS: A systematic literature search for studies between January 1990 and May 2014 evaluating clinical outcomes after PBT. A draft report was developed through review of evidence, externally reviewed, and approved by the Alberta Health Services Cancer Care Proton Therapy Guidelines steering committee. RESULTS: Proton therapy is often used to treat tumours close to radiosensitive tissues, and children at risk of developing significant late effects of radiation therapy (RT). Local control rates with PBT appear similar to or, in some cases, higher than photon RT in uncontrolled and retrospective studies. Randomized trials comparing equivalent doses of PBT and photon RT are not available. SUMMARY: Referral for PBT is recommended for patients being treated with curative intent, with an expectation for long-term survival, and who are able and willing to travel abroad to a proton facility. Commonly accepted indications for referral include chordoma and chondrosarcoma, intraocular melanoma, and solid tumours in children and adolescents occurring in patients with greatest risk of long-term sequelae. Current data do not provide sufficient evidence to recommend routine referral of patients with most head and neck, breast, lung, gastrointestinal tract, and pelvic cancers including prostate cancer. It is recommended that all referrals be considered by a multidisciplinary team to select appropriate cases.

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A pilot study of proton beam theary for mucosal melanoma of the head and neck

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e17042 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e17042-e17042

Author(s):

S. Zenda ◽

M. Kawashima ◽

R. Kohno ◽

S. Arahira ◽

T. Nishio ◽

...

Keyword(s):

Head And Neck ◽

Proton Beam ◽

Proton Therapy ◽

Progression Free Survival ◽

Late Toxicity ◽

Distant Metastases ◽

Proton Beam Therapy ◽

Mucosal Melanoma ◽

Cervical Lymph Nodes ◽

Number Of Patients

e17042 Background: The aim of this study is to clarify the clinical profile of proton beam therapy for mucosal melanoma of the head and neck. Methods: Patients with mucosal melanoma of the head and neck fulfilling the following criteria were enrolled: histologically confirmed malignant melanoma; N0 and M0 disease. Proton therapy was delivered three times a week with planned total dose of 60 GyE in 15 fractions. Results: From January 2004 through January 2007, thirteen patients were enrolled in this study. Patients’ characteristics were as follows: median age, 75 years (range, 56 to 79); male/female, 7/6; T1/2/3/4/rec, 3/2/0/7/1. All could receive the full dose of proton therapy. The most common acute toxicities were mucositis (grade 3: 15%) and dermatitis (grade 2: 15%). One patient had unilateral impairment of visual acuity possibly related with treatment. Initial local control rate was 77.0% (10/13, 95%CI: 46.2–95.0%). With median follow up period of 33.7 months, median progression free survival was 18.9 months and median survival time was not reached. 2-year overall survival rate was 69.7% (95%CI: 31.6–86.1%). Most frequent site of first failure was cervical lymph nodes outside of PTV. Four patients died of disease; cachexia caused by distant metastases in three and carotid blowout because of nodal disease in one. Conclusions: Proton beam therapy for mucosal melanoma of the head and neck achieved favorable results in this limited number of patients, although further investigation about late toxicity is needed. Now, the phase II study of this treatment is ongoing. No significant financial relationships to disclose.

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Acute toxicity profile of patients with low-grade gliomas and meningiomas receiving proton therapy.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e12508 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e12508-e12508

Author(s):

Genevieve Maquilan ◽

Surbhi Grover ◽

Michelle Alonso-Basanta ◽

Robert A. Lustig

Keyword(s):

Proton Beam ◽

Proton Therapy ◽

Radiation Treatment ◽

Treatment Protocol ◽

Proton Beam Therapy ◽

University Of Pennsylvania ◽

Low Grade ◽

Beam Radiation ◽

Low Grade Gliomas ◽

Starting Point

e12508 Background: Quality of life is not often studied but is an important outcome to measure when evaluating types of radiation treatment. This study attempts to provide data on the treatment effects of proton beam therapy on patients with low grade gliomas and meningiomas, using the National Cancer Institute Common Terminology Criteria (CTCAE) version 4.0 to analyze the severity and frequency of symptoms experienced acutely during and after radiotherapy. Methods: 23 patients diagnosed with low grade gliomas or meningiomas were enrolled in a prospective proton beam radiation treatment protocol (NCT01024907) and were treated and followed between April 2010 and August 2011 in the University of Pennsylvania Radiation Oncology Department. Patients received 54 Gy [relative biologic effectiveness (RBE)] in 1.8 Gy (RBE) per fraction and were assessed at the time of consult, weekly during treatment, and followed up at 1, 3, 6, and 9 months after treatment. Symptoms were graded based on the CTCAE version 4.0. Results: At week 1 of treatment, 4/23 patients experienced Grade 1 anorexia. At week 3, 5/23 patients had Grade 1 nausea, 10/23 patients had Grade 1 headaches, and 1/23 patients had a Grade 3 headache. At the end of treatment at week 6, 13/23 patients had Grade 1 fatigue, 6/23 patients had Grade 2 fatigue, 3/23 patients had Grade 1 nausea, 4/23 patients had Grade 1 headaches, 7/23 patients had Grade 1 insomnia, and 1/23 patients had Grade 2 insomnia. At the 1-month follow-up, 3/23 patients had Grade 1 fatigue, 1/23 patients had Grade 2 fatigue, 2/23 patients had Grade 1 anorexia, 1/23 patients had a Grade 1 headache, and 2/23 patients had Grade 1 insomnia. No patients were reported to have experienced vomiting at any of the 4 time points. Conclusions: Proton therapy has a favorable side effect profile--most patients experienced mild fatigue, headaches, and insomnia that largely resolved by one month after treatment. This study provides a useful starting point for larger-scale studies which could directly compare the acute side effects of proton and conventional radiotherapy.

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