RONC-04. RE-IRRADIATION AFTER TREATMENT OF MEDULLOBLASTOMA; RELAPSED CASES AND SECOND CANCER CASES

Abstract PURPOSE Late complications such as brainstem necrosis are great concern of re-irradiation for brain tumor. Proton beam therapy can reduce radiation dose of organs at risk such as brainstem, so is expected to reduce late complications. PATIENTS AND METHODS Patients with medulloblastoma treated with re-irradiation from January 2015 to February 2019 at the Kobe Children’s Hospital and the Kobe Proton Center were reviewed. There were three cases of relapsed medulloblastoma and three cases of second cancer (glioblastomas). RESULTS In relapsed cases, all three cases treated with 12 Gy in 8 fractions cranio-spinal irradiation followed by gamma knife radiosurgery (one) or 28.8 Gy (RBE) in 16 fractions of proton beam therapy (two). Follow-up periods were 8 to 19 months (median 12 months) and all three cases survived without relapse. In second cancer cases, all three cases were treated with 40.05 Gy per 15 fractions of radiation therapy (2 cases were treated with photon and one case with proton). However, all cases relapsed and two cases died of disease. CONCLUSION Twelve Gy in 8 fractions cranio-spinal irradiation followed by 28.8 Gy (RBE) in 16 fractions of proton beam therapy is thought to be useful for the relapsed case. Re-irradiation for second cancer was disappointing and further study is warranted.

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Outcomes and Toxicities of Proton and Photon Radiation Therapy for Testicular Seminoma

International Journal of Particle Therapy ◽

10.14338/ijpt-20-00018.1 ◽

2020 ◽

Vol 7 (2) ◽

pp. 11-20

Author(s):

Dario Pasalic ◽

Surendra Prajapati ◽

Ethan B. Ludmir ◽

Chad Tang ◽

Seungtaek Choi ◽

...

Keyword(s):

At Risk ◽

Radiation Therapy ◽

Survival Rate ◽

Proton Beam ◽

Organs At Risk ◽

Proton Beam Therapy ◽

Photon Radiation ◽

Secondary Malignancies ◽

Testicular Seminoma

Abstract Purpose To determine the clinical outcomes and toxicities of proton beam therapy (PBT) versus 3D-conformal photon radiation therapy (XRT) in patients with testicular seminoma. Materials and Methods This observational study evaluated consecutive patients with testicular seminoma who were treated with inguinal orchiectomy and radiation therapy at a single, tertiary, high-volume center in 2008-19. Acute toxicity was scored with the Common Terminology Criteria for Adverse Events V 4.0. Organs at risk were contoured retrospectively by 2 investigators. Recurrences and secondary malignancies were based on routine follow-up imaging, either computed tomography or magnetic resonance imaging. Results Fifty-five patients were treated with radiation therapy, 11 in the PBT-arm and 44 in the XRT-arm, with a median follow-up interval of 61 months (interquartile range [IQR]: 32-79 months). Acute treatment-related diarrhea, grade 1 to 2, was more common among XRT-treated patients (0% vs 29.5%, P = .039), and dermatitis, grade 1, was more likely among PBT-treated patients (27.3% vs 2.3%, P = .004). Dosimetrically, PBT-treated patients, relative to XRT-treated patients, had lower dose to organs at risk including the kidney, bladder, femoral head, spinal cord, bowel, pancreas, and stomach. The 5-year overall survival rate was 100% and disease-free survival rate was 96.4% for all patients. Two patients, all in the XRT-arm, had disease recurrence: 1 in the pelvis and 1 in the lung. Three patients, all in the XRT-arm, were diagnosed with a secondary malignancy: 1 in-field pancreaticoblastoma, 1 in-field colon adenocarcinoma, and a stage IV T-cell lymphoma. Conclusion Proton beam therapy for testicular seminoma resulted in excellent clinical outcomes and was associated with lower rates of acute diarrhea but higher rates of acute dermatitis. Proton beam therapy resulted in no in-field secondary malignancies and a more favorable dosimetric profile for organs at risk relative to XRT. Reduced dose to organs at risk, such as the kidneys, may result in long-term improvement in function.

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Proton Beam Therapy in the Treatment of Periorbital Malignancies

International Journal of Particle Therapy ◽

10.14338/ijpt-20-00025.1 ◽

2021 ◽

Vol 7 (4) ◽

pp. 42-51

Author(s):

Nicholas J. Damico ◽

Anna K. Wu ◽

Michael Z. Kharouta ◽

Tal Eitan ◽

Rajesh Pidikiti ◽

...

Keyword(s):

Overall Survival ◽

Radiation Therapy ◽

Pituitary Gland ◽

Proton Beam ◽

Organs At Risk ◽

Proton Beam Therapy ◽

Lacrimal Glands ◽

Optic Nerves ◽

Volumetric Arc Therapy ◽

Arc Therapy

Abstract Purpose Periorbital tumor location presents a significant challenge with 3-dimensional conformal radiation therapy or intensity modulated radiation therapy due to high tumor dose needed in the setting of close proximity to orbital structures with lower tolerance. Proton beam therapy (PBT) is felt to be an effective modality in such cases due to its sharp dose gradient. Materials and Methods We reviewed our institutional PBT registry and identified 17 patients with tumor epicenters within 2 cm of the eye and optic apparatus treated with passive scatter PBT with comparison volumetric arc therapy plans available. Maximum and mean doses to organs at risk of interest, including optic nerves, optic chiasm, lens, eye ball, pituitary, cochlea, lacrimal gland, and surrounding brain, were compared using the paired Wilcoxon signed rank test. Overall survival was determined using the Kaplan-Meier method. Results Median age was 67. Median follow-up was 19.7 months. Fourteen patients underwent upfront resection and received postoperative radiation and 3 received definitive radiation. One patient received elective neck radiation, 2 underwent reirradiation, and 3 had concurrent chemotherapy. There was a statistically significant reduction in mean dose to the optic nerves and chiasm, brain, pituitary gland, lacrimal glands, and cochlea as well as in the maximum dose to the optic nerves and chiasm, pituitary gland, lacrimal glands, and cochlea with PBT. The 18-month cumulative incidence of local failure was 19.1% and 1-year overall survival was 80.9%. Conclusion Proton beam therapy resulted in significant dose reductions to several periorbital and optic structures compared with volumetric arc therapy. Proton beam therapy appears to be the optimal radiation modality in such cases to minimize risk of toxicity to periorbital organs at risk.

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Predicted Cardiac and Second Cancer Risks in Hodgkin Lymphoma Patients Treated With Advanced Proton Beam Therapy Compared to Photon Radiation Therapy

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2017.06.454 ◽

2017 ◽

Vol 99 (2) ◽

pp. S181

Author(s):

G. Ntentas ◽

K. Dedeckova ◽

M. Andrilik ◽

M.C. Aznar ◽

B. George ◽

...

Keyword(s):

Radiation Therapy ◽

Hodgkin Lymphoma ◽

Proton Beam ◽

Proton Beam Therapy ◽

Photon Radiation ◽

Second Cancer ◽

Cancer Risks

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Mothers’ Experiences about Decisions to Use Children’s Proton Beam Therapy

Children ◽

10.3390/children8040274 ◽

2021 ◽

Vol 8 (4) ◽

pp. 274

Author(s):

Noriko Ozawa ◽

Rieko Fukuzawa ◽

Kayuri Furuya

Keyword(s):

Decision Making ◽

Radiation Therapy ◽

Proton Beam ◽

Proton Beam Therapy ◽

Structured Interview ◽

Late Complications ◽

Decision Making Process ◽

Theory Approach ◽

Grounded Theory Approach ◽

Mothers Experiences

Recently, proton beam therapy has been recommended in radiation therapy for child-hood cancer. However, facilities for children are limited, and parents who choose this treatment for their children face a variety of challenges. This study reveals mothers’ experiences about the decision to use the aforementioned therapy. A semi-structured interview was conducted with 16 mothers of children who received proton beam therapy in Japan, and a grounded theory approach was adopted. The results revealed that mothers were very worried about late complications concerning their children due to radiation. While the mothers strongly expected proton beam therapy to reduce the risk of late complications, they felt uncertainty and anxiety throughout the entire decision-making process. Despite having to deal with their feelings, they had to transfer to another hospital and prepare support for their children to begin treatment, and this put a lot of strain on them. From decision-making to start of treatment, these emotional fluctuations and the need for psychological support became apparent.

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Radiation Induced Cavernomas in the Treatment of Pediatric Medulloblastoma: Comparative Study Between Proton and Photon Radiation Therapy

Frontiers in Oncology ◽

10.3389/fonc.2021.760691 ◽

2021 ◽

Vol 11 ◽

Author(s):

S. Joy Trybula ◽

Mark W. Youngblood ◽

Hanna R. Kemeny ◽

Jeffrey R. Clark ◽

Constantine L. Karras ◽

...

Keyword(s):

Radiation Therapy ◽

Proton Beam ◽

Surgical Resection ◽

Proton Beam Therapy ◽

Photon Radiation ◽

External Beam Radiation ◽

Beam Radiation ◽

Significant Difference ◽

Radiation Induced

Radiation induced cavernomas among children with medulloblastoma are common following external beam radiation (XRT) treatment with either photon or proton beams. However, with the increased utilization of proton beam therapy over the last decade we sought to determine if there was any difference in the development or natural history of these cavernous malformations (CM) or CM-like lesions. We performed a retrospective analysis of 79 patients from 2003 to 2019 who had undergone resection of medulloblastoma and subsequent XRT (30 photon or 49 proton beam therapy). The average age of patients at radiation treatment was 8.7 years old. Average follow up for patients who received photon beam therapy was 105 months compared to 56.8 months for proton beam therapy. A total of 68 patients (86.1%) developed post-radiation CMs, including 26 photon and 42 proton patients (86.7% and 85.7% respectively). The time to cavernoma development was significantly different, with a mean of 40.2 months for photon patients and 18.2 months for proton patients (p = 1.98 x 10-4). Three patients, one who received photon and two who received proton beam radiation, required surgical resection of a cavernoma. Although CM or CM-like lesions are detected significantly earlier in patients after receiving proton beam therapy, there appears to be no significant difference between the two radiation therapy modalities in the development of significant CM requiring surgical resection or intervention other than continued follow up and surveillance.

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Radiation Therapy (Hypofractionated Proton Beam Therapy or IMRT) for the Treatment of Recurrent, Oligometastatic Prostate Cancer Following Primary Localized Treatment

Case Medical Research ◽

10.31525/ct1-nct04190446 ◽

2019 ◽

Author(s):

Keyword(s):

Prostate Cancer ◽

Radiation Therapy ◽

Proton Beam ◽

Proton Beam Therapy ◽

Oligometastatic Prostate Cancer ◽

Localized Treatment

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Feasibility of Proton Beam Therapy as a Rescue Therapy in Heavily Pre-Treated Retinoblastoma Eyes

Cancers ◽

10.3390/cancers13081862 ◽

2021 ◽

Vol 13 (8) ◽

pp. 1862

Author(s):

Eva Biewald ◽

Tobias Kiefer ◽

Dirk Geismar ◽

Sabrina Schlüter ◽

Anke Manthey ◽

...

Keyword(s):

Proton Beam ◽

Rescue Therapy ◽

Therapeutic Option ◽

Proton Beam Therapy ◽

External Beam Radiation ◽

Time Interval ◽

Beam Radiation ◽

Primary Tumors ◽

Increased Risk

Despite the increased risk of subsequent primary tumors (SPTs) external beam radiation (EBRT) may be the only therapeutic option to preserve a retinoblastoma eye. Due to their physical properties, proton beam therapy (PBT) offers the possibility to use the effectiveness of EBRT in tumor treatment and to decisively reduce the treatment-related morbidity. We report our experiences of PBT as rescue therapy in a retrospectively studied cohort of 15 advanced retinoblastoma eyes as final option for eye-preserving therapy. The average age at the initiation of PBT was 35 (14–97) months, mean follow-up was 22 (2–46) months. Prior to PBT, all eyes were treated with systemic chemotherapy and a mean number of 7.1 additional treatments. Indication for PBT was non-feasibility of intra-arterial chemotherapy (IAC) in 10 eyes, tumor recurrence after IAC in another 3 eyes and diffuse infiltrating retinoblastoma in 2 eyes. Six eyes (40%) were enucleated after a mean time interval of 4.8 (1–8) months. Cataract formation was the most common complication affecting 44.4% of the preserved eyes, yet 77.8% achieved a visual acuity of >20/200. Two of the 15 children treated developed metastatic disease during follow-up, resulting in a 13.3% metastasis rate. PBT is a useful treatment modality as a rescue therapy in retinoblastoma eyes with an eye-preserving rate of 60%. As patients are at lifetime risk of SPTs consistent monitoring is mandatory.

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455 Proton Beam Therapy in Rectal Cancer: A Systematic Review and Meta-Analysis

British Journal of Surgery ◽

10.1093/bjs/znab135.020 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

M Fok ◽

S Toh ◽

J E Maducolil ◽

H Fowler ◽

R Clifford ◽

...

Keyword(s):

Rectal Cancer ◽

Proton Beam ◽

Organs At Risk ◽

Meta Analysis ◽

Locally Advanced ◽

Significant Risk ◽

Proton Beam Therapy ◽

Recurrent Rectal Cancer ◽

Pelvic Bone ◽

Dosimetric Data

Abstract Introduction Radiotherapy for locally advanced rectal cancer is conventionally performed using photon-based radiotherapy (PBR), carrying significant risk of toxicity to organs at risk (OAR). Proton beam therapy (PBT) potentially delivers equivalent dosimetric radiation to the targeted tissue with improved sparing of OAR. We aimed to compare dosimetric irradiation of OAR for PBT versus PBR in patients with rectal cancer and assess any oncological outcomes. Method An extensive electronic literature search was performed from inception till April 2020 and subsequent meta-analysis performed. Results Six articles met the inclusion criteria. Dosimetric data of irradiation delivered to OAR for PBT and PBR were calculated for the same patients. PBT had significantly less irradiated small bowel compared to 3DCRT and IMRT, (MD -16.95, 95% CI [-24.03, -9.88], p < 0.00001) and (MD -6.96, 95% CI [-12.99, -0.94], p = 0.02) respectively. Similar results were observed for bladder and pelvic bone marrow. Two studies reported clinical and oncological results for PBT in recurrent rectal cancer with overall survival reported as 43% and 68%. Conclusions Dosimetric treatment plans have less irradiation of OAR for rectal cancer with PBT compared to PBR. There is a need for further research in PBT and rectal cancer, as promising results have been shown in recurrent rectal cancer.

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