Radiographic changes of the mandible after proton beam radiotherapy for oral cancer: A case report

Background: The management of primary or recurrent vaginal tumours in an aging population is challenging for gynecologic and radiation oncologists. In patients unsuited for surgery and already irradiated on the pelvis, proton beam radiotherapy may be worthwhile due to its ballistic advantages. Case report: We report the case of an 80-year-old woman with a squamous cell carcinoma of the vagina after a history of pelvic radiation and vaginal brachytherapy delivered for a previous endometrial adenocarcinoma. She received proton beam radiotherapy with a complete response after 12 months and mild toxicity. Conclusions: The complexity of reirradiation management in the frail and elderly population requires attention. Efforts should be focused on maintaining autonomy and quality of life in order to improve adherence and clinical compliance to the treatment. In the era of the tailored approach, hadrontherapy can play an important role to minimize toxicity, obtain good local control, and reduce the overall treatment time.

Download Full-text

Evaluation and treatment of children with radiation-induced cerebral vasculopathy

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.7.peds19188 ◽

2019 ◽

Vol 24 (6) ◽

pp. 680-688

Author(s):

David S. Hersh ◽

Kenneth Moore ◽

Vincent Nguyen ◽

Lucas Elijovich ◽

Asim F. Choudhri ◽

...

Keyword(s):

Radiation Therapy ◽

Proton Beam ◽

Tumor Imaging ◽

Clinic Visit ◽

Surgical Patient ◽

Beam Radiation ◽

Proton Beam Radiotherapy ◽

Cranial Radiation ◽

Delayed Complication ◽

Radiation Induced

OBJECTIVEStenoocclusive cerebral vasculopathy is an infrequent delayed complication of ionizing radiation. It has been well described with photon-based radiation therapy but less so following proton-beam radiotherapy. The authors report their recent institutional experience in evaluating and treating children with radiation-induced cerebral vasculopathy.METHODSEligible patients were age 21 years or younger who had a history of cranial radiation and subsequently developed vascular narrowing detected by MR arteriography that was significant enough to warrant cerebral angiography, with or without ischemic symptoms. The study period was January 2011 to March 2019.RESULTSThirty-one patients met the study inclusion criteria. Their median age was 12 years, and 18 (58%) were male. Proton-beam radiation therapy was used in 20 patients (64.5%) and photon-based radiation therapy was used in 11 patients (35.5%). Patients were most commonly referred for workup as a result of incidental findings on surveillance tumor imaging (n = 23; 74.2%). Proton-beam patients had a shorter median time from radiotherapy to catheter angiography (24.1 months [IQR 16.8–35.4 months]) than patients who underwent photon-based radiation therapy (48.2 months [IQR 26.6–61.1 months]; p = 0.04). Eighteen hemispheres were revascularized in 15 patients. One surgical patient suffered a contralateral hemispheric infarct 2 weeks after revascularization; no child treated medically (aspirin) has had a stroke to date. The median follow-up duration was 29.2 months (IQR 21.8–54.0 months) from the date of the first catheter angiogram to last clinic visit.CONCLUSIONSAll children who receive cranial radiation therapy from any source, particularly if the parasellar region was involved and the child was young at the time of treatment, require close surveillance for the development of vasculopathy. A structured and detailed evaluation is necessary to determine optimal treatment.

Download Full-text

GCT-08. PROTON BEAM RADIOTHERAPY FOR PEDIATRIC AND YOUNG-ADULT PATIENTS WITH INTRACRANIAL GERM CELL TUMOR

Neuro-Oncology ◽

10.1093/neuonc/noaa222.229 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii329-iii329

Author(s):

Minako Sugiyama ◽

Takayuki Hashimoto ◽

Takashi Mori ◽

Kazuya Hara ◽

Yukayo Terashita ◽

...

Keyword(s):

Young Adult ◽

Adverse Events ◽

Germ Cell ◽

Cell Count ◽

Proton Beam ◽

Adult Patients ◽

Short Term ◽

Intracranial Germ Cell Tumor ◽

X Ray ◽

Proton Beam Radiotherapy

Abstract BACKGROUND To reduce treatment-related adverse events in pediatric and young-adult patients with brain tumors, proton beam radiotherapy (PBT) has recently been performed instead of conventional X-ray radiotherapy. However, whether PBT is as effective as X-ray radiotherapy has not been sufficiently investigated, especially in patients receiving whole-ventricular irradiation. METHODS We report a retrospective observation of 15 patients with intracranial germ cell tumors (GCT), who received PBT at our institution from April 2014 to September 2019. We evaluated their clinical course, short-term adverse events, and prognosis. RESULTS/ CONCLUSION Fifteen patients (9 males and 6 females; median age 13 years) who received PBT following induction chemotherapy were analyzed. Nine patients received 23.4–27.0 GyE of whole-ventricular irradiation due to GCT in the pituitary gland, pineal body, or hypothalamic area. Three patients received 23.4 GyE of whole-brain irradiation: one of them had boost irradiation for basal ganglia. Three patients received 30.6 GyE of craniospinal irradiation (CSI). Six of the 15 patients experienced nausea (grade 2, according to the CTCAE version 4.0). Four patients, including two who received CSI, showed myelosuppression: decrease in white blood cell count, lymphocyte cell count, and neutrophil count (grade 3). No other severe short-term adverse events of >grade 2 was observed in any of the patients. At a median follow-up of 21 months (2-62 months) after irradiation. all patients are alive without recurrence. Our results may be encouraging and further investigations with a larger scale is warranted.

Download Full-text

Proton beam radiotherapy of locally advanced or recurrent conjunctival squamous cell carcinoma: experience of the CATANA Centre

Journal of Radiotherapy in Practice ◽

10.1017/s1460396920000953 ◽

2020 ◽

pp. 1-8

Author(s):

Roberto Milazzotto ◽

Rocco Luca Emanuele Liardo ◽

Giuseppe Privitera ◽

Luigi Raffaele ◽

Vincenzo Salamone ◽

...

Keyword(s):

Overall Survival ◽

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Proton Beam ◽

Squamous Cell ◽

Locally Advanced ◽

Disease Free Survival ◽

Proton Beam Radiotherapy ◽

Conjunctival Squamous Cell Carcinoma ◽

The Impact

Abstract Aim: Conjunctival squamous cell carcinoma (SCC) is a rare tumour of the ocular region and microscopic radical surgical is difficult. There are no single guidelines for therapeutic management and the role of radiation therapy is not clearly defined although conventionally photon or electron beams are used. Proton beam radiotherapy (PBRT) is a new option for a conservative approach and allows good sparing of the organs at risk. Materials and methods: After surgical resection, we collected 15 cases treated at our institution with PBRT. The dose delivered was between 48 and 60 Gy relative biological effectiveness (RBE), with fractions of 12–15 Gy RBE. Results: After an average period of 48 months, the patients achieved excellent disease control (overall survival and disease-free survival: 86·6%), with minimal acute and late toxicity. Findings: In this work, we present our experience on the use of PBRT technique in SCC treatment. A larger sample of patients is needed to draw conclusions about the impact of this treatment on disease recurrence and overall survival.

Download Full-text

MR Imaging–Pathologic Correlation of Uveal Melanomas Undergoing Secondary Enucleation after Proton Beam Radiotherapy

Applied Sciences ◽

10.3390/app11094310 ◽

2021 ◽

Vol 11 (9) ◽

pp. 4310

Author(s):

Pietro Valerio Foti ◽

Corrado Inì ◽

Mario Travali ◽

Renato Farina ◽

Stefano Palmucci ◽

...

Keyword(s):

Mr Imaging ◽

Proton Beam ◽

Uveal Melanoma ◽

Vitreous Hemorrhage ◽

Nerve Degeneration ◽

Proton Beam Radiotherapy ◽

Iris Neovascularization ◽

Weighted Sequences ◽

Histopathologic Findings ◽

Optic Nerve Degeneration

Background: Currently, radiotherapy represents the most widely employed therapeutic option in patients with uveal melanoma. Although the effects of proton beam radiotherapy on uveal melanoma end ocular tissues have been histologically documented, their appearance at MR imaging is still poorly understood. The purpose of our study was to elucidate the magnetic resonance (MR) semiotics of radiotherapy-induced changes to neoplastic tissues and ocular structures in patients with uveal melanoma undergoing secondary enucleation after proton beam radiotherapy. Methods: Nine patients with uveal melanoma who had undergone proton beam radiotherapy, MR imaging, and subsequent secondary enucleation were retrospectively selected. The histopathologic findings evaluated for irradiated tumors were necrosis, fibrosis, and viable tumor, while the histopathologic findings evaluated for extratumoral ocular/periocular tissues were radiation-related intraocular inflammation, vitreous hemorrhage, optic nerve degeneration, iris neovascularization, and periocular fibrotic adhesions. On MR images, the appearance of the abovementioned histologic features was assessed on conventional and diffusion-weighted sequences. Results: T2-weighted sequences performed better in detecting radiation-induced necrosis, fibrosis, optic nerve degeneration, and periocular fibrotic adhesions. T1-weighted sequences were preferable for identifying cataracts, vitreous hemorrhage, and inflammatory complications. Contrast-enhanced T1-weighted sequences were irreplaceable in assessing iris neovascularization, and in confirming inflammatory complications. Conclusions: In the light of their increasing role in the multidisciplinary management of patients with uveal melanoma, radiologists should be aware of the MR appearance of the effects of radiotherapy on neoplastic and ocular tissue, in order to improve the accuracy of follow-up MR examinations.

Download Full-text

Proton Beam Radiotherapy

10.1007/978-981-13-7454-8 ◽

2020 ◽

Keyword(s):

Proton Beam ◽

Proton Beam Radiotherapy

Download Full-text

Revision surgery for incomplete resection or recurrence of cervical spine chordoma: a consecutive case series of 24 patients

European Spine Journal ◽

10.1007/s00586-021-06946-6 ◽

2021 ◽

Author(s):

Peter Obid ◽

Tamás Fekete ◽

Philipp Drees ◽

Daniel Haschtmann ◽

Frank Kleinstück ◽

...

Keyword(s):

Overall Survival ◽

Cervical Spine ◽

Survival Rate ◽

Local Recurrence ◽

Proton Beam ◽

Revision Surgery ◽

Patient Specific ◽

Incomplete Resection ◽

Pharyngeal Wall ◽

Proton Beam Radiotherapy

Abstract Purpose Chordomas are rare tumors with an annual incidence of approximately one per million. Chordomas rarely metastasize but show a high local recurrence rate. Therefore, these patients present a major clinical challenge, and there is a paucity of the literature regarding the outcome after revision surgery of cervical spine chordomas. Available studies suggest a significantly worse outcome in revision scenarios. The purpose of this study is to analyze the survival rate, and complications of patients that underwent revision surgery for local recurrence or incomplete resection of chordoma at the craniocervical junction or at the cervical spine. Methods 24 consecutive patients that underwent revision surgery for cervical spine chordoma remnants or recurrence at a single center were reviewed retrospectively. We analyzed patient-specific surgical treatment strategies, complications, and outcome. Kaplan–Meier estimator was used to analyze five-year overall survival. Results Gross total resection was achieved in 17 cases. Seven patients developed dehiscence of the pharyngeal wall, being the most common long-term complication. No instability was observed. Postoperatively, four patients received proton beam radiotherapy and 12 patients had combined photon and proton beam radiotherapy. The five-year overall survival rate was 72.6%. Conclusion With thorough preoperative planning, appropriate surgical techniques, and the addition of adjuvant radiotherapy, results similar to those in primary surgery can be achieved.

Download Full-text