scholarly journals Hadrontherapy for Thymic Epithelial Tumors: Implementation in Clinical Practice

2021 ◽  
Vol 11 ◽  
Author(s):  
Pierre Loap ◽  
Viviana Vitolo ◽  
Amelia Barcellini ◽  
Ludovic De Marzi ◽  
Alfredo Mirandola ◽  
...  
Keyword(s):  
Proton Therapy ◽  
Negative Impact ◽  
Organs At Risk ◽  
Current Status ◽  
Thymic Epithelial Tumors ◽  
Epithelial Tumors ◽  
Treatment Techniques ◽  
Ion Therapy ◽  
Radiation Induced ◽  
Therapy Studies

Radiation therapy is part of recommendations in the adjuvant settings for advanced stage or as exclusive treatment in unresectable thymic epithelial tumors (TETs). However, first-generation techniques delivered substantial radiation doses to critical organs at risk (OARs), such as the heart or the lungs, resulting in noticeable radiation-induced toxicity. Treatment techniques have significantly evolved for TET irradiation, and modern techniques efficiently spare normal surrounding tissues without negative impact on tumor coverage and consequently local control or patient survival. Considering its dosimetric advantages, hadrontherapy (which includes proton therapy and carbon ion therapy) has proved to be worthwhile for TET irradiation in particular for challenging clinical situations such as cardiac tumoral involvement. However, clinical experience for hadrontherapy is still limited and mainly relies on small-size proton therapy studies. This critical review aims to analyze the current status of hadrontherapy for TET irradiation to implement it at a larger scale.

scholarly journals Development and Implementation of Proton Therapy for Hodgkin Lymphoma: Challenges and Perspectives

Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3744
Author(s):  
Pierre Loap ◽  
Ludovic De Marzi ◽  
Alfredo Mirandola ◽  
Remi Dendale ◽  
Alberto Iannalfi ◽  
...  
Keyword(s):  
At Risk ◽  
Radiation Therapy ◽  
Hodgkin Lymphoma ◽  
Proton Therapy ◽  
Early Stage ◽  
Organs At Risk ◽  
Intensity Modulated Radiation Therapy ◽  
Progression Free Survival ◽  
Treatment Techniques ◽  
Increased Risk

Consolidative radiation therapy for early-stage Hodgkin lymphoma (HL) improves progression-free survival. Unfortunately, first-generation techniques, relying on large irradiation fields, were associated with an increased risk of secondary cancers, and of cardiac and lung toxicity. Fortunately, the use of smaller target volumes combined with technological advances in treatment techniques currently allows efficient organs-at-risk sparing without altering tumoral control. Recently, proton therapy has been evaluated for mediastinal HL treatment due to its potential to significantly reduce the dose to organs-at-risk, such as cardiac substructures. This is expected to limit late radiation-induced toxicity and possibly, second-neoplasm risk, compared with last-generation intensity-modulated radiation therapy. However, the democratization of this new technique faces multiple issues. Determination of which patient may benefit the most from proton therapy is subject to intense debate. The development of new effective systemic chemotherapy and organizational, societal, and political considerations might represent impediments to the larger-scale implementation of HL proton therapy. Based on the current literature, this critical review aims to discuss current challenges and controversies that may impede the larger-scale implementation of mediastinal HL proton therapy.

scholarly journals Reduced radiation-induced toxicity by using proton therapy for the treatment of oropharyngeal cancer

2020 ◽  
Vol 93 (1107) ◽  
pp. 20190955 ◽  
Author(s):  
Tineke W.H. Meijer ◽  
Dan Scandurra ◽  
Johannes A. Langendijk
Keyword(s):  
Squamous Cell Carcinoma ◽  
Side Effects ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Proton Therapy ◽  
Oropharyngeal Cancer ◽  
Organs At Risk ◽  
Tube Feeding ◽  
Well Being ◽  
Radiation Induced

Patients with squamous cell carcinoma of the oropharynx are generally treated with (chemo) radiation. Patients with oropharyngeal cancer have better survival than patients with squamous cell carcinoma of other head and neck subsites, especially when related to human papillomavirus. However, radiotherapy results in a substantial percentage of survivors suffering from significant treatment-related side-effects. Late radiation-induced side-effects are mostly irreversible and may even be progressive, and particularly xerostomia and dysphagia affect health-related quality of life. As the risk of radiation-induced side-effects highly depends on dose to healthy normal tissues, prevention of radiation-induced xerostomia and dysphagia and subsequent improvement of health-relatedquality of life can be obtained by applying proton therapy, which offers the opportunity to reduce the dose to both the salivary glands and anatomic structures involved in swallowing. This review describes the results of the first cohort studies demonstrating that proton therapy results in lower dose levels in multiple organs at risk, which translates into reduced acute toxicity (i.e. up to 3 months after radiotherapy), while preserving tumour control. Next to reducing mucositis, tube feeding, xerostomia and distortion of the sense of taste, protons can improve general well-being by decreasing fatigue and nausea. Proton therapy results in decreased rates of tube feeding dependency and severe weight loss up to 1 year after radiotherapy, and may decrease the risk of radionecrosis of the mandible. Also, the model-based approach for selecting patients for proton therapy in the Netherlands is described in this review and future perspectives are discussed.

scholarly journals Proton therapy for adults with mediastinal lymphomas: the International Lymphoma Radiation Oncology Group guidelines

Blood ◽  
2018 ◽  
Vol 132 (16) ◽  
pp. 1635-1646 ◽  
Author(s):  
Bouthaina Shbib Dabaja ◽  
Bradford S. Hoppe ◽  
John P. Plastaras ◽  
Wayne Newhauser ◽  
Katerina Rosolova ◽  
...  
Keyword(s):  
At Risk ◽  
Radiation Dose ◽  
Proton Therapy ◽  
Radiation Treatment ◽  
Organs At Risk ◽  
Cardiac Morbidity ◽  
Advantages And Disadvantages ◽  
Treatment Techniques ◽  
Choice Of Treatment ◽  
Patients At Risk

Abstract Among adult lymphoma survivors, radiation treatment techniques that increase the excess radiation dose to organs at risk (OARs) put patients at risk for increased side effects, especially late toxicities. Minimizing radiation to OARs in adults patients with Hodgkin and non-Hodgkin lymphomas involving the mediastinum is the deciding factor for the choice of treatment modality. Proton therapy may help to reduce the radiation dose to the OARs and reduce toxicities, especially the risks for cardiac morbidity and second cancers. Because proton therapy may have some disadvantages, identifying the patients and the circumstances that may benefit the most from proton therapy is important. We present modern guidelines to identify adult lymphoma patients who may derive the greatest benefit from proton therapy, along with an analysis of the advantages and disadvantages of proton treatment.

scholarly journals Advances in proton therapy in lung cancer

2018 ◽  
Vol 12 ◽  
pp. 175346661878387 ◽  
Author(s):  
Melissa A.L. Vyfhuis ◽  
Nasarachi Onyeuku ◽  
Tejan Diwanji ◽  
Sina Mossahebi ◽  
Neha P. Amin ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Proton Therapy ◽  
Early Stage ◽  
Organs At Risk ◽  
Locally Advanced ◽  
Cardiac Injury ◽  
The United States ◽  
Treatment Techniques ◽  
Proton Treatment ◽  
Nsclc Patients

Lung cancer remains the leading cause of cancer deaths in the United States (US) and worldwide. Radiation therapy is a mainstay in the treatment of locally advanced non-small cell lung cancer (NSCLC) and serves as an excellent alternative for early stage patients who are medically inoperable or who decline surgery. Proton therapy has been shown to offer a significant dosimetric advantage in NSCLC patients over photon therapy, with a decrease in dose to vital organs at risk (OARs) including the heart, lungs and esophagus. This in turn, can lead to a decrease in acute and late toxicities in a population already predisposed to lung and cardiac injury. Here, we present a review on proton treatment techniques, studies, clinical outcomes and toxicities associated with treating both early stage and locally advanced NSCLC.

Молекулярная биология менингиом головного мозга

2017 ◽  
pp. 82-91
Author(s):  
В.А. Бывальцев ◽  
И.А. Степанов ◽  
Е.Г. Белых ◽  
А.И. Яруллина
Keyword(s):  
Gene Therapy ◽  
Proton Therapy ◽  
Genetic Factors ◽  
Intracranial Tumor ◽  
Molecular Profile ◽  
Genetic Changes ◽  
Treatment Techniques ◽  
Downstream Effects ◽  
Si Rna ◽  
The Relationship

Цель обзора - анализ современных данных литературы о нарушении внутриклеточных сигнальных путей, играющих ведущую роль в развитии менингиом, генетических и молекулярных профилях данной группы опухолей. К настоящему времени изучено множество аберрантных сигнальных внутриклеточных путей, которые играют важнейшую роль в развитии менингиом головного мозга. Четкое понимание поврежденных внутриклеточных каскадов поможет изучить влияние генетических мутаций и их эффектов на менингиомогенез. Подробное исследование генетического и молекулярного профиля менингиом позволит сделать первый уверенный шаг в разработке более эффективных методов лечения данной группы интракраниальных опухолей. Хромосомы 1, 10, 14, 22 и связанные с ними генные мутации ответственны за рост и прогрессию менингиом. Предполагается, что только через понимание данных генетических повреждений будут реализованы новейшие эффективные методы лечения. Будущая терапия будет включать в себя комбинации таргетных молекулярных агентов, в том числе генную терапию, малые интерферирующие РНК, протонную терапию и другие методы воздействия, как результат дальнейшего изучения генетических и биологических изменений, характерных для менингеальных опухолей. Meningiomas are by far the most common tumors arising from the meninges. A myriad of aberrant signaling pathways involved with meningioma tumorigenesis, have been discovered. Understanding these disrupted pathways will aid in deciphering the relationship between various genetic changes and their downstream effects on meningioma pathogenesis. An understanding of the genetic and molecular profile of meningioma would provide a valuable first step towards developing more effective treatments for this intracranial tumor. Chromosomes 1, 10, 14, 22, their associated genes, have been linked to meningioma proliferation and progression. It is presumed that through an understanding of these genetic factors, more educated meningioma treatment techniques can be implemented. Future therapies will include combinations of targeted molecular agents including gene therapy, si-RNA mediation, proton therapy, and other approaches as a result of continued progress in the understanding of genetic and biological changes associated with meningiomas.

The tumor doubling time is a useful parameter for predicting the histological type of thymic epithelial tumors

Surgery Today ◽  
2019 ◽  
Vol 49 (8) ◽  
pp. 656-660 ◽  
Author(s):  
Koichi Fukumoto ◽  
Takayuki Fukui ◽  
Koji Kawaguchi ◽  
Shota Nakamura ◽  
Shuhei Hakiri ◽  
...  
Keyword(s):  
Doubling Time ◽  
Histological Type ◽  
Tumor Doubling Time ◽  
Thymic Epithelial Tumors ◽  
Epithelial Tumors

scholarly journals Prognostic Significance of Metabolic Parameters by 18F-FDG PET/CT in Thymic Epithelial Tumors

Cancers ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 712
Author(s):  
Joohee Lee ◽  
Young Seok Cho ◽  
Jhingook Kim ◽  
Young Mog Shim ◽  
Kyung-Han Lee ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prognostic Factors ◽  
Fdg Pet ◽  
Univariate Analysis ◽  
Thymic Epithelial Tumors ◽  
Epithelial Tumors ◽  
Masaoka Stage ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

Background: Imaging tumor FDG avidity could complement prognostic implication in thymic epithelial tumors. We thus investigated the prognostic value of volume-based 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT parameters in thymic epithelial tumors with other clinical prognostic factors. Methods: This is a retrospective study that included 83 patients who were diagnosed with thymic epithelial tumors and underwent pretreatment 18F-FDG PET/CT. PET parameters, including maximum and average standardized uptake values (SUVmax, SUVavg), metabolic tumor volume (MTV), and total lesion glycolysis (TLG), were measured with a threshold of SUV 2.5. Univariate and multivariate analysis of PET parameters and clinicopathologic variables for time-to-progression was performed by using a Cox proportional hazard regression model. Results: There were 21 low-risk thymomas (25.3%), 27 high-risk thymomas (32.5%), and 35 thymic carcinomas (42.2%). Recurrence or disease progression occurred in 24 patients (28.9%). On univariate analysis, Masaoka stage (p < 0.001); histologic types (p = 0.009); treatment modality (p = 0.001); and SUVmax, SUVavg, MTV, and TLG (all p < 0.001) were significant prognostic factors. SUVavg (p < 0.001) and Masaoka stage (p = 0.001) were independent prognostic factors on multivariate analysis. Conclusion: SUVavg and Masaoka stage are independent prognostic factors in thymic epithelial tumors.

296 Immune correlates of clinical response to Avelumab in patients with advanced thymic epithelial tumors

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A323-A323
Author(s):  
Yo-Ting Tsai ◽  
Arun Rajan ◽  
James Gulley ◽  
Jeffrey Schlom ◽  
Renee Donahue
Keyword(s):  
Clinical Response ◽  
Mononuclear Cells ◽  
Predictive Biomarkers ◽  
Lymphocytic Infiltration ◽  
Peripheral Blood Mononuclear ◽  
Thymic Epithelial Tumors ◽  
Link Type ◽  
Epithelial Tumors ◽  
Immune Correlates ◽  
Tcr Diversity

BackgroundThymic epithelial tumors (TET), consisting of thymomas and thymic carcinomas, are PD-L1-expressing tumors characterized by varying degrees of lymphocytic infiltration and a predisposition towards the development of paraneoplastic autoimmunity. As part of a phase I study (NCT01772004), the anti-tumor activity of patients with relapsed, advanced TET to avelumab (anti-PD-L1), was demonstrated and was accompanied by a high frequency of immune related adverse events (irAE). The current study aimed to identify immune related signatures that associate with clinical response and/or the development of irAE.MethodsEight patients with recurrent TET were treated with avelumab at doses of 10 mg/kg to 20 mg/kg every 2 weeks until disease progression or development of intolerable side effects. Peripheral blood mononuclear cells (PBMC) were obtained before and during therapy, and interrogated by multicolor flow cytometry to evaluate 123 immune subsets, as well as by T-cell receptor (TCR) sequencing to evaluate TCR diversity.ResultsFour of 8 TET patients had partial responses and 3 had stable disease. All responders developed irAEs that resolved with immunosuppressive therapy, compared to only 1 of 4 non responders. Analyses of PBMC subsets prior to therapy showed that responders had higher absolute lymphocyte counts, and lower frequencies of B cells, Tregs, conventional dendritic cells (cDCs), and NK cells, compared to non-responders. There was also a trend towards a higher level of TCR diversity in those patients who subsequently had a radiological response and developed irAE.ConclusionsImmune profiling identified specific immune measures prior to therapy that differed between responders and non-responders, that may serve as predictive biomarkers to identify patients with relapsed TET most likely to benefit from avelumab and/or to develop irAE.Trial RegistrationNCT01772004Ethics ApprovalAll patients provided written informed consent for participation in a clinical trial that was approved by the Institutional Review Board at the National Cancer Institute (NCT01772004).

scholarly journals Epidemiology of thymic epithelial tumors: 22‐years experience from a single‐institution

2020 ◽  
Author(s):  
Patricia Rioja ◽  
Rossana Ruiz ◽  
Marco Galvez‐Nino ◽  
Sophia Lozano ◽  
Natalia Valdiviezo ◽  
...  
Keyword(s):  
Single Institution ◽  
Thymic Epithelial Tumors ◽  
Epithelial Tumors
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