Investigation of Suitable Detection Angles for Carbon-Ion Radiotherapy Monitoring in Depth by Means of Secondary-Ion Tracking

The dose conformity of carbon-ion beam radiotherapy, which allows the reduction of the dose deposition in healthy tissue and the escalation of the dose to the tumor, is associated with a high sensitivity to anatomical changes during and between treatment irradiations. Thus, the monitoring of inter-fractional anatomical changes is crucial to ensure the dose conformity, to potentially reduce the size of the safety margins around the tumor and ultimately to reduce the irradiation of healthy tissue. To do so, monitoring methods of carbon-ion radiotherapy in depth using secondary-ion tracking are being investigated. In this work, the detection and localization of a small air cavity of 2 mm thickness were investigated at different detection angles of the mini-tracker relative to the beam axis. The experiments were conducted with a PMMA head phantom at the Heidelberg Ion-Beam Therapy Center (HIT) in Germany. In a clinic-like irradiation of a single field of 3 Gy (RBE), secondary-ion emission profiles were measured by a 2 cm2 mini-tracker composed of two silicon pixel detectors. Two positions of the cavity in the head phantom were studied: in front and in the middle of the tumor volume. The significance of the cavity detection was found to be increased at smaller detection angles, while the accuracy of the cavity localization was improved at larger detection angles. Detection angles of 20° – 30° were found to be a good compromise for accessing both, the detectability and the position of the air cavity along the depth in the head of a patient.

Download Full-text

Comparing the dosimetric impact of interfractional anatomical changes in photon, proton and carbon ion radiotherapy for pancreatic cancer patients

Physics in Medicine and Biology ◽

10.1088/1361-6560/aa6419 ◽

2017 ◽

Vol 62 (8) ◽

pp. 3051-3064 ◽

Cited By ~ 12

Author(s):

Antonetta C Houweling ◽

Koen Crama ◽

Jorrit Visser ◽

Kyohei Fukata ◽

Coen R N Rasch ◽

...

Keyword(s):

Pancreatic Cancer ◽

Cancer Patients ◽

Carbon Ion Radiotherapy ◽

Carbon Ion ◽

Anatomical Changes

Download Full-text

Robustness of daily dose for each beam angle and accumulated dose for inter-fractional anatomical changes in passive carbon-ion radiotherapy for pancreatic cancer: Bone matching versus tumor matching

Radiotherapy and Oncology ◽

10.1016/j.radonc.2021.01.011 ◽

2021 ◽

Vol 157 ◽

pp. 85-92

Author(s):

Yoshiki Kubota ◽

Masahiko Okamoto ◽

Shintaro Shiba ◽

Shohei Okazaki ◽

Toshiaki Matsui ◽

...

Keyword(s):

Pancreatic Cancer ◽

Carbon Ion Radiotherapy ◽

Beam Angle ◽

Carbon Ion ◽

Anatomical Changes ◽

Daily Dose ◽

Accumulated Dose

Download Full-text

Impact of anatomical changes on radiation absorbed dose of prostate and bladder in a potential scenario of magnetic resonance imaging (MRI)-guided carbon-ion radiotherapy (MRgCT) of prostate cancer

Measurement ◽

10.1016/j.measurement.2020.108772 ◽

2021 ◽

Vol 171 ◽

pp. 108772

Author(s):

M. Akbari ◽

A. Karimian

Keyword(s):

Magnetic Resonance Imaging ◽

Prostate Cancer ◽

Magnetic Resonance ◽

Absorbed Dose ◽

Carbon Ion Radiotherapy ◽

Resonance Imaging ◽

Carbon Ion ◽

Anatomical Changes ◽

Mri Guided ◽

Magnetic Resonance Imaging Mri

Download Full-text

Impact of Inter-fractional Anatomical Changes on Dose Distributions in Passive Carbon-Ion Radiotherapy for Prostate Cancer: Comparison of Vertical and Horizontal Fields

Frontiers in Oncology ◽

10.3389/fonc.2020.01264 ◽

2020 ◽

Vol 10 ◽

Cited By ~ 1

Author(s):

Ayaka Yokoyama ◽

Yoshiki Kubota ◽

Hidemasa Kawamura ◽

Yuhei Miyasaka ◽

Nobuteru Kubo ◽

...

Keyword(s):

Prostate Cancer ◽

Carbon Ion Radiotherapy ◽

Dose Distributions ◽

Carbon Ion ◽

Anatomical Changes

Download Full-text

Carbon ion radiotherapy as definitive treatment in non-metastasized pancreatic cancer: study protocol of the prospective phase II PACK-study

BMC Cancer ◽

10.1186/s12885-020-07434-8 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Jakob Liermann ◽

Patrick Naumann ◽

Adriane Hommertgen ◽

Moritz Pohl ◽

Meinhard Kieser ◽

...

Keyword(s):

Pancreatic Cancer ◽

Overall Survival ◽

Phase Ii ◽

Ion Beam ◽

Locally Advanced ◽

Advanced Pancreatic Cancer ◽

Carbon Ion Radiotherapy ◽

Definitive Treatment ◽

Tumor Control ◽

Carbon Ion

Abstract Background Radiotherapy is known to improve local tumor control in locally advanced pancreatic cancer (LAPC), although there is a lack of convincing data on a potential overall survival benefit of chemoradiotherapy over chemotherapy alone. To improve efficacy of radiotherapy, new approaches need to be evolved. Carbon ion radiotherapy is supposed to be more effective than photon radiotherapy due to a higher relative biological effectiveness (RBE) and due to a steep dose-gradient making dose delivery highly conformal. Methods The present Phase II PACK-study investigates carbon ion radiotherapy as definitive treatment in LAPC as well as in locally recurrent pancreatic cancer. A total irradiation dose of 48 Gy (RBE) will be delivered in twelve fractions. Concurrent chemotherapy is accepted, if indicated. The primary endpoint is the overall survival rate after 12 months. Secondary endpoints are progression free survival, safety, quality of life and impact on tumor markers CA 19–9 and CEA. A total of twenty-five patients are planned for recruitment over 2 years. Discussion Recently, Japanese researches could show promising results in a Phase I/II-study evaluating chemoradiotherapy of carbon ion radiotherapy and gemcitabine in LAPC. The present prospective PACK-study investigates the efficacy of carbon ion radiotherapy in pancreatic cancer at Heidelberg Ion Beam Therapy Center (HIT) in Germany. Trial registration The trial is registered at ClinicalTrials.gov: NCT04194268 (Retrospectively registered on December, 11th 2019).

Download Full-text

Carbon ion radiotherapy as definitive treatment in locally recurrent pancreatic cancer

Strahlentherapie und Onkologie ◽

10.1007/s00066-021-01827-9 ◽

2021 ◽

Author(s):

Jakob Liermann ◽

Edgar Ben-Josef ◽

Mustafa Syed ◽

Juergen Debus ◽

Klaus Herfarth ◽

...

Keyword(s):

Pancreatic Cancer ◽

Overall Survival ◽

Local Control ◽

Ion Beam ◽

Carbon Ion Radiotherapy ◽

Definitive Treatment ◽

Carbon Ions ◽

Carbon Ion ◽

Recurrent Pancreatic Cancer ◽

Locally Recurrent

Abstract Purpose Data on management of locally recurrent pancreatic cancer (LRPC) after primary resection are limited. Recently, surprisingly high overall survival rates were reported after irradiation with carbon ions. Here, we report on our clinical experience using carbon ion radiotherapy as definitive treatment in LRPC at the Heidelberg Ion-Beam Therapy Center (HIT). Methods Between 2015 and 2019, we treated 13 patients with LRPC with carbon ions with a median total dose of 48 Gy (RBE) in 12 fractions using an active raster-scanning technique at a rotating gantry. No concomitant chemotherapy was administered. Overall survival, local control, and toxicity rates were evaluated 18 months after the last patient finished radiotherapy. Results With a median follow-up time of 9.5 months, one patient is still alive (8%). Median OS was 12.7 months. Ten patients (77%) developed distant metastases. Additionally, one local recurrence (8%) and two regional tumor recurrences (15%) were observed. The estimated 1‑year local control and locoregional control rates were 87.5% and 75%, respectively. During radiotherapy, we registered one gastrointestinal bleeding CTCAE grade III (8%) due to gastritis. The bleeding was sufficiently managed with conservative therapy. No further higher-grade acute or late toxicities were observed. Conclusion We demonstrate high local control rates in a rare cohort of LRPC patients treated with carbon ion radiotherapy. The observed median overall survival rate was not improved compared to historical in-house data using photon radiotherapy. This is likely due to a high rate of distant tumor progression, highlighting the necessity of additional chemotherapy.

Download Full-text

Intensity Modulated Radiotherapy with Carbon Ion Radiotherapy Boost for Acinic Cell Carcinoma of the Salivary Glands

Cancers ◽

10.3390/cancers13010124 ◽

2021 ◽

Vol 13 (1) ◽

pp. 124

Author(s):

Maximilian P. Schmid ◽

Thomas Held ◽

Kristin Lang ◽

Klaus Herfarth ◽

Juliane Hörner-Rieber ◽

...

Keyword(s):

Cell Carcinoma ◽

Salivary Glands ◽

Ion Beam ◽

Intensity Modulated Radiotherapy ◽

Acinic Cell Carcinoma ◽

Carbon Ion Radiotherapy ◽

Definitive Treatment ◽

Carbon Ion ◽

Intensity Modulated ◽

Acinic Cell

Aim: to report clinical outcome in patients with acinic cell carcinoma of the salivary glands treated with intensity-modulated radiotherapy (IMRT) and carbon ion radiotherapy (CIRT) boost. Materials and Methods: all patients with acinic cell carcinoma of the salivary glands treated at the Heidelberg Ion-Beam Therapy Center were considered for this retrospective analysis. All patients received a CIRT boost with 18–24 Gy radiobiologic effectiveness (RBE)-weighted dose in 3 Gy RBE-weighted dose per fraction followed by IMRT, with 50–54 Gy in 2 Gy per fraction. Disease outcome was evaluated for local (LR), nodal (NR), distant recurrence (DR), and disease-free (DFS) and overall survival (OS). Morbidity was scored based on Common Terminology Criteria for Adverse Events (CTCAE) version 5. Descriptive statistics and the Kaplan-Meier method were used for analysis. Results: fifteen patients were available for analysis. Median follow-up after radiotherapy was 43 months. Six patients were treated for primary disease and nine for recurrent disease. Eight patients were treated with radiotherapy for macroscopic disease. Disease recurrence was observed in four patients: 1 LR, 2 NR, and 2 DR; 5-year local control, DFS, and OS were 80%, 52%, and 80%, respectively. No radiotherapy-related G3-5 morbidity was observed. Conclusion: In acinic cell carcinoma, IMRT with carbon ion radiotherapy boost leads to excellent results after R1-resection and is a promising treatment modality for definitive treatment in inoperable patients.

Download Full-text

Accelerated Hypofractionated Active Raster-Scanned Carbon Ion Radiotherapy (CIRT) for Laryngeal Malignancies: Feasibility and Safety

Cancers ◽

10.3390/cancers10100388 ◽

2018 ◽

Vol 10 (10) ◽

pp. 388 ◽

Cited By ~ 1

Author(s):

Sati Akbaba ◽

Kristin Lang ◽

Thomas Held ◽

Olcay Bulut ◽

Matthias Mattke ◽

...

Keyword(s):

Local Control ◽

Lung Metastases ◽

Ion Beam ◽

Progression Free Survival ◽

Carbon Ion Radiotherapy ◽

Carbon Ions ◽

Carbon Ion ◽

Swallowing Problems ◽

Grade 3

(1) Background: The authors present the first results of active raster-scanned carbon ion radiotherapy (CIRT) for radioresistant laryngeal malignancies regarding efficacy and toxicity. (2) Methods: 15 patients with laryngeal adenoid cystic carcinoma (ACC; n = 8; 53.3%) or chondrosarcoma (CS; n = 7; 46.7%) who underwent radiotherapy with carbon ions (C12) at the Heidelberg Ion Beam Therapy Center (HIT) between 2013 and 2018 were identified retrospectively and analyzed for local control (LC), overall survival (OS), and distant progression-free survival using the Kaplan–Meier method. CIRT was applied either alone (n = 7, 46.7%) or in combination with intensity modulated radiotherapy (IMRT) (n = 8, 53.3%). The toxicity was assessed according to the Common Toxicity Terminology Criteria for Adverse Events (CTCAE) v4.03. (3). Results: the median follow-up was 24 months (range 5–61 months). Overall, the therapy was tolerated very well. No grade >3 acute and chronic toxicity could be identified. The most reported acute grade 3 side effects were acute dysphagia (n = 2; 13%) and acute odynophagia (n = 3; 20%), making supportive nutrition via gastric tube (n = 2; 13.3%) and via high caloric drinks (n = 1; 6.7%) necessary due to swallowing problems (n = 4; 27%). Overall, chronic grade 3 toxicity in the form of chronic hoarseness occurred in 7% of the patients (n = 1; 7%). At the last follow-up, all the patients were alive. No local or locoregional recurrence could be identified. Only one patient with laryngeal ACC developed lung metastases three years after the first diagnosis. (4) Conclusions: the accelerated hypofractionated active raster-scanned carbon ion radiotherapy for radioresistant laryngeal malignancies is feasible in practice with excellent local control rates and moderate acute and late toxicity. Further follow-ups are necessary to evaluate the long-term clinical outcome.

Download Full-text