Proton beam therapy for liver cancer is well tolerated: Outcomes from the Proton Collaborative Group REG001-09 trial.

389 Background: The liver is one of the most radiosensitive organs, making radiation therapy (RT) for liver tumors extremely challenging. RT is appropriate only for a minority of liver patients with limited tumor burden; a reduction in the prescribed radiation dose may be needed to lower the probability of radiation-induced liver disease especially in the presence of cirrhosis. Proton beam therapy (PBT) delivers less dose to the liver than photon therapy and is expected to reduce toxicity while also permitting safe dose escalation for some patients with liver tumors. Methods: The Proton Collaborative Group REG001-09 trial (NCT01255748) prospectively collects data for PBT patients with a variety of cancer types. To better understand treatment details and outcomes associated with liver PBT, patients enrolled on the PCG registry trial from 5 institutions who received liver PBT for any cancer between 2012 and 2016 were analyzed. Results: A total of 43 liver cancer patients were included, most with hepatocellular carcinoma (48.8%) or cholangiocarcinoma (25.6%). The vast majority did not have surgery at any time (86%). Most were treatment naive prior to PBT; 2 previously had RT and 8 had prior chemotherapy (mostly cholangiocarcinoma patients). The median total prescribed PBT dose was 58.05 Gy(RBE) (range 21.7-67.5). The median number of prescribed fractions was 15 (range 12-37). PBT was delivered to only the liver in 90.7% of patients; inclusion of lymph nodes was rare. Uniform scanning was used in 26 (72.1%) and pencil beam scanning in 2 patients (4.7%); the delivery technique used for the remaining patients was unknown (23.2%). With median follow up of 4.4 months (range 1.3-17.9), 3 patients (7%) had an intrahepatic recurrence, 2 patients (4.6%) developed distant metastasis, and 10 patients (23.3%) died. No grade 3 or higher toxicity was reported although 17 patients (39.5%) had grade 2 toxicity predominantly fatigue, anorexia, nausea, or vomiting. Conclusions: Although longer follow up is needed to assess late toxicities as well as disease control, early outcomes from the PCG registry trial for liver cancer patients shows that predominantly hypofractionated PBT has a very favorable acute toxicity profile.

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Treatment interruptions affect biochemical failure rates in prostate cancer patients treated with proton beam therapy: Report from the multi-institutional proton collaborative group registry

Clinical and Translational Radiation Oncology ◽

10.1016/j.ctro.2020.10.003 ◽

2020 ◽

Vol 25 ◽

pp. 94-101

Author(s):

James E. Han ◽

John Chang ◽

Lane Rosen ◽

William Hartsell ◽

Henry Tsai ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Patients ◽

Proton Beam ◽

Proton Beam Therapy ◽

Biochemical Failure ◽

Collaborative Group ◽

Failure Rates ◽

Treatment Interruptions

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Hypofractionated Proton Beam Radiotherapy in Patients With Unresectable Liver Tumors: Multi-institutional Prospective Results From the Proton Collaborative Group

10.21203/rs.3.rs-70862/v1 ◽

2020 ◽

Author(s):

Jacob S Parzen ◽

William Hartsell ◽

John Chang ◽

Smith Apisarnthanarax ◽

Jason Molitoris ◽

...

Keyword(s):

Proton Beam ◽

Liver Tumors ◽

Target Volume ◽

Collaborative Group ◽

Median Dose ◽

Bulky Disease ◽

Proton Beam Radiotherapy ◽

Low Toxicity ◽

Grade 3

Abstract Background: Recent advances in radiotherapy techniques have allowed ablative doses to be safely delivered to inoperable liver tumors. In this setting, proton beam radiotherapy (PBT) provides the means to escalate radiation dose to the target volume while sparing the uninvolved liver. This study evaluated the safety and efficacy of hypofractionated PBT for liver tumors, predominantly hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC).Methods: We evaluated the prospective registry of the Proton Collaborative Group for patients undergoing definitive PBT for liver tumors. Demographic, clinicopathologic, toxicity, and dosimetry information were compiled.Results: To date, 63 patients have been treated at 9 institutions between 2013-2019. Thirty (48%) had HCC and 25 (40%) had ICC. The median dose and biological equivalent dose (BED) delivered was 58.05 GyE (range, 32.5-75) and 80.5 GyE (range, 53.6-100), respectively. The median mean liver BED was 13.9 GyE. Three (4.8%) patients experienced at least one grade ³3 toxicity. With median follow-up of 5.1 months (range, 0.1-40.8), the local control (LC) rate at 1 year was 91.2% for HCC and 90.9% for ICC. The 1-year LC was significantly higher (95.7%) for patients receiving BED greater than 75.2 GyE than for patients receiving BED of 75.2 GyE or lower (84.6%, p = 0.029). The overall survival rate at 1 year was 65.6% for HCC and 81.8% for ICC. Conclusions: Hypofractionated PBT results in excellent LC, sparing of the uninvolved liver, and low toxicity, even in the setting of dose-escalation. Higher dose correlates with improved LC, highlighting the importance of PBT especially in patients with recurrent or bulky disease.

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Hypofractionated proton beam radiotherapy in patients with unresectable liver tumors: multi-institutional prospective results from the Proton Collaborative Group

Radiation Oncology ◽

10.1186/s13014-020-01703-3 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Jacob S. Parzen ◽

William Hartsell ◽

John Chang ◽

Smith Apisarnthanarax ◽

Jason Molitoris ◽

...

Keyword(s):

Proton Beam ◽

Liver Tumors ◽

Target Volume ◽

Collaborative Group ◽

Median Dose ◽

Bulky Disease ◽

Proton Beam Radiotherapy ◽

Low Toxicity ◽

Grade 3

Abstract Background Recent advances in radiotherapy techniques have allowed ablative doses to be safely delivered to inoperable liver tumors. In this setting, proton beam radiotherapy (PBT) provides the means to escalate radiation dose to the target volume while sparing the uninvolved liver. This study evaluated the safety and efficacy of hypofractionated PBT for liver tumors, predominantly hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). Methods We evaluated the prospective registry of the Proton Collaborative Group for patients undergoing definitive PBT for liver tumors. Demographic, clinicopathologic, toxicity, and dosimetry information were compiled. Results To date, 63 patients have been treated at 9 institutions between 2013 and 2019. Thirty (48%) had HCC and 25 (40%) had ICC. The median dose and biological equivalent dose (BED) delivered was 58.05 GyE (range 32.5–75) and 80.5 GyE (range 53.6–100), respectively. The median mean liver BED was 13.9 GyE. Three (4.8%) patients experienced at least one grade ≥ 3 toxicity. With median follow-up of 5.1 months (range 0.1–40.8), the local control (LC) rate at 1 year was 91.2% for HCC and 90.9% for ICC. The 1-year LC was significantly higher (95.7%) for patients receiving BED greater than 75.2 GyE than for patients receiving BED of 75.2 GyE or lower (84.6%, p = 0.029). The overall survival rate at 1 year was 65.6% for HCC and 81.8% for ICC. Conclusions Hypofractionated PBT results in excellent LC, sparing of the uninvolved liver, and low toxicity, even in the setting of dose-escalation. Higher dose correlates with improved LC, highlighting the importance of PBT especially in patients with recurrent or bulky disease.

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Hypofractionated proton beam radiotherapy in patients with unresectable liver tumors: multi-institutional prospective results from the Proton Collaborative Group

10.21203/rs.3.rs-70862/v2 ◽

2020 ◽

Author(s):

Jacob S Parzen ◽

William Hartsell ◽

John Chang ◽

Smith Apisarnthanarax ◽

Jason Molitoris ◽

...

Keyword(s):

Proton Beam ◽

Liver Tumors ◽

Target Volume ◽

Collaborative Group ◽

Median Dose ◽

Bulky Disease ◽

Proton Beam Radiotherapy ◽

Low Toxicity ◽

Grade 3

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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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Secondary radiation doses of intensity-modulated radiotherapy and proton beam therapy in patients with lung and liver cancer

Radiotherapy and Oncology ◽

10.1016/j.radonc.2011.01.018 ◽

2011 ◽

Vol 98 (3) ◽

pp. 335-339 ◽

Cited By ~ 18

Author(s):

Seonkyu Kim ◽

Byung Jun Min ◽

Myonggeun Yoon ◽

Jinsung Kim ◽

Dong Ho Shin ◽

...

Keyword(s):

Liver Cancer ◽

Proton Beam ◽

Intensity Modulated Radiotherapy ◽

Proton Beam Therapy ◽

Secondary Radiation ◽

Radiation Doses ◽

Intensity Modulated

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Longitudinal Changes in Brain Diffusion MRI Indices during and after Proton Beam Therapy in a Child with Pilocytic Astrocytoma: A Case Report

Diagnostics ◽

10.3390/diagnostics12010026 ◽

2021 ◽

Vol 12 (1) ◽

pp. 26

Author(s):

Lisa Novello ◽

Nivedita Agarwal ◽

Sabina Vennarini ◽

Stefano Lorentini ◽

Domenico Zacà ◽

...

Keyword(s):

Proton Beam ◽

Pilocytic Astrocytoma ◽

Tumor Volume ◽

Diffusion Tensor ◽

Free Water ◽

Pediatric Brain Tumor ◽

Proton Beam Therapy ◽

Microstructural Changes ◽

Fluid Content

Proton beam therapy (PBT) is an effective pediatric brain tumor treatment. However, the resulting microstructural changes within and around irradiated tumors are unknown. We retrospectively applied diffusion tensor imaging (DTI) and free-water imaging (FWI) on diffusion-weighted magnetic resonance imaging (dMRI) data to monitor microstructural changes during the PBT and after 8 months in a pilocytic astrocytoma (PA) and normal-appearing white matter (NAWM). We evaluated the conventional MRI- and dMRI-derived indices from six MRI sessions (t0–t5) in a Caucasian child with a hypothalamic PA: at baseline (t0), during the PBT (t1–t4) and after 8 months (t5). The tumor voxels were classified as “solid” or “fluid” based on the FWI. While the tumor volume remained stable during the PBT, the dMRI analyses identified two different response patterns: (i) an increase in fluid content and diffusivity with anisotropy reductions in the solid voxels at t1, followed by (ii) smaller variations in fluid content but higher anisotropy in the solid voxels at t2–t4. At follow-up (t5), the tumor volume, fluid content, and diffusivity in the solid voxels increased. The NAWM showed dose-dependent microstructural changes. The use of the dMRI and FWI showed complex dynamic microstructural changes in the irradiated mass during the PBT and at follow-up, opening new avenues in our understanding of radiation-induced pathophysiologic mechanisms in tumors and the surrounding tissues.

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A literature survey on Cost-Effectiveness of Proton Beam Therapy in the Management of Breast Cancer Patients

Iranian Journal of Cancer Prevention ◽

10.17795/ijcp-4373 ◽

2015 ◽

Vol 8 (6) ◽

Cited By ~ 3

Author(s):

Reza Reiazi ◽

Amir Norozi

Keyword(s):

Breast Cancer ◽

Cost Effectiveness ◽

Cancer Patients ◽

Proton Beam ◽

Proton Beam Therapy ◽

Literature Survey ◽

Breast Cancer Patients

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Proton beam therapy for malignant transformation of intracranial epidermoid cyst

BMJ Case Reports ◽

10.1136/bcr-2019-229388 ◽

2019 ◽

Vol 12 (7) ◽

pp. e229388

Author(s):

Zhe Chen ◽

Masayuki Araya ◽

Hiroshi Onishi

Keyword(s):

Proton Beam ◽

Malignant Transformation ◽

Epidermoid Cyst ◽

Clinical Case ◽

Proton Beam Therapy ◽

Facial Paresis ◽

Surgical Interventions ◽

Radiation Induced ◽

Intracranial Epidermoid

We report the first clinical case on the successful use of proton beam therapy in the management of malignant transformation of intracranial epidermoid cyst. A 43-year-old man was initially diagnosed as this disease with left facial paresis, hypesthesia and hypoalgesia in the territories of the trigeminal nerve. After failure of surgical interventions, he was referred to our radiation centre. We performed a postoperative proton beam therapy for treatment. We delivered a total dose of 57 GyE in 31 fractions. He tolerated the treatment well with mild acute toxicities and remained healthy and functional by 2-year follow-up postradiotherapy. No evidence of delayed radiation-induced neurotoxicity was observed.

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