A Patient Selection Approach Based on NTCP Models and DVH Parameters for Definitive Proton Therapy in Locally Advanced Sinonasal Cancer Patients

Mirandola, A.; Russo, Stefania; Bonora, Maria; Vischioni, Barbara; Camarda, Anna Maria; Ingargiola, Rossana; Molinelli, S.; Ronchi, Sara; Rossi, Eleonora; Vai, A.; Iacovelli, Nicola Alessandro; Thariat, Juliette; Ciocca, Mario; Orlandi, Ester

doi:10.3390/cancers14112678

Cited by 7 publications

(6 citation statements)

References 46 publications

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“…In recent years, the role of particle-beam radiation therapy (PBRT) typically using accelerated proton or carbon-ion has been studied in the treatment of patients with SNMs 22 , 23 . Hu et.…”

Section: Discussionmentioning

confidence: 99%

“…These results warrant further investigation as PBRT seems to offer similar disease control but with fewer long-term complications. However, at present, the patients who may benefit the most from PBRT modality should be selected wisely due to the higher costs and limited availability of this radiation modality 23 .…”

Section: Discussionmentioning

confidence: 99%

“…al. 21 In recent years, the role of particle-beam radiation therapy (PBRT) typically using accelerated proton or carbon-ion has been studied in the treatment of patients with SNMs 23 showed, based on normal tissue complication probability models and additional explanatory dose-volume histogram parameters, that patients with locally advanced sinonasal cancer and orbital invasion could profit from proton therapy compared to IMRT in terms of optical and central nervous system organs at risk sparing. These results warrant further investigation as PBRT seems to offer similar disease control but with fewer long-term complications.…”

Section: Discussionmentioning

confidence: 99%

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Long-term complications associated with the management of sinonasal malignancies: a single center experience

G. Levin,

Tzelnick,

Yaacobi

et al. 2023

Acta Otorhinolaryngol Ital

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SUMMARY Objective The aim of this study was to review the long-term complications associated with treatment of patients with sinonasal malignancies (SNMs) and risk factors for these complications. Methods A retrospective analysis of all patients treated for SNMs at a tertiary care center between 2001 and 2018. A total of 77 patients were included. The primary outcome measure was post-treatment long-term complications. Results Overall, long-term complications were identified in 41 patients (53%), and the most common were sinonasal (22 patients, 29%) and orbital/ocular-related (18 patients, 23%). In a multivariate regression analysis, irradiation was the only significant predictor of long-term complications (p = 0.001, OR = 18.86, CI = 3.31-107.6). No association was observed between long-term complications and tumour stage, surgical modality, or radiation dose/modality. Mean radiation dose ≥ 50 Gy to the optic nerve was associated with grade ≥ 3 visual acuity impairment (100% vs 3%; p = 0.006). Radiation therapy for disease recurrence was associated with additional long-term complications (56% vs 11%; p = 0.04). Conclusions Treatment of SNMs has substantial long-term complications, which are significantly associated with radiation therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Long-term complications associated with the management of sinonasal malignancies: a single center experience

G. Levin,

Tzelnick,

Yaacobi

et al. 2023

Acta Otorhinolaryngol Ital

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“…The TCP and NTCP indices may reflect more closely the clinical outcome of radiation therapy compared to physical dose-volume quantities [ 6 ]. The above radiobiological indices have been widely employed for the analysis and evaluation of radiation therapy plans [ 27 , 28 , 29 ]. However, many treatment planning systems can not directly provide TCP and NTCP calculations.…”

Section: Discussionmentioning

confidence: 99%

Automatic Radiobiological Comparison of Radiation Therapy Plans: An Application to Gastric Cancer

Mazonakis

Tzanis

Lyraraki

et al. 2022

Cancers

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(1) Aim: This study was conducted to radiobiologically compare radiotherapy plans for gastric cancer with a newly developed software tool. (2) Methods: Treatment planning was performed on two computational phantoms simulating adult male and female patients. Three-dimensional conformal radiotherapy (3D-CRT), intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) plans for gastric cancer were generated with three-photon beam energies. The equivalent uniform dose (EUD), tumor control probability (TCP) of the target and normal tissue control probability (NTCP) of eight different critical organs were calculated. A new software was employed for these calculations using the EUD-based model and dose-volume-histogram data. (3) Results: The IMRT and VMAT plan led to TCPs of 51.3–51.5%, whereas 3D-CRT gave values up to 50.2%. The intensity-modulated techniques resulted in NTCPs of (5.3 × 10−6–3.3 × 10−1)%. The corresponding NTCPs from 3D-CRT were (3.4 × 10−7–7.4 × 10−1)%. The above biological indices were automatically calculated in less than 40 s with the software. (4) Conclusions: The direct and quick radiobiological evaluation of radiotherapy plans is feasible using the new software tool. The IMRT and VMAT reduced the probability of the appearance of late effects in most of the surrounding critical organs and slightly increased the TCP compared to 3D-CRT.

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“…In this scenario, non-surgical options, such as re-irradiation (re-RT) with photons or particles RT, may play a role, although the potential toxicity and benefits need to be considered on a case-by-case basis. PT and CIRT are frequently considered for re-RT due to their favorable physical characteristics that allow for the delivery of high doses to the tumor target, sparing the surrounding normal tissues [ 9 ]. In addition, CIRT, in consideration of the much higher radiobiological effectiveness in comparison to conventional photon RT, reduced oxygen enhancement ratio (OER) and the induction of clustered DNA damages, is potentially capable of effectively killing radioresistant tumor clones [ 10 , 11 ], such as the ones deriving from several hystotypes from the sinonasal region.…”

Section: Introductionmentioning

confidence: 99%

Particle Reirradiation of Malignant Epithelial and Neuroectodermal Sinonasal Tumors: A Case Series from CNAO

Vischioni

Ingargiola

Bonora

et al. 2023

JCM

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Sinonasal cancers (SNCs) are rare and heterogeneous in histology and biological behavior. The prognosis is generally unfavorable, especially in inoperable cases. In recent years, for some histologies, such as undifferentiated sinonasal carcinoma (SNUC), multimodal treatment with a combination of induction chemotherapy, surgery, and chemo/radiotherapy (RT) has improved the prognosis. Nevertheless, still about half of the patients treated incur a recurrence, in most of the cases at the local site. Surgery with and without RT is usually the treatment choice in cases of recurrence after previous RT in combination with systemic therapy or RT in a histology-driven fashion. In the case of inoperable disease or contraindications to surgery, RT is still a valid treatment option. In this context, hadron therapy with protons (PT) or carbon ions (CIRT) is often preferred due to the physical and biological characteristics of charged particles, allowing the administration of high doses to the tumor target while sparing the surrounding healthy tissues and potentially limiting the side effects due to the high cumulative dose. In the absence of a standard of care for the recurrent setting, we aimed to investigate the role of re-RT with PT or CIRT. We retrospectively analysed 15 patients with recurrent, previously irradiated, SNCs treated at our institution between 2013 and 2020. Local control (LC) and overall survival (OS) were estimated by the Kaplan–Meier method. Acute and late toxicities were scored according to the National Cancer Institute’s Common Terminology Criteria for Adverse Events CTCAE version 5.0. A total of 13 patients received CIRT and 2 patients received PT. The median re-RT dose was 54 GyRBE (range 45–64 GyRBE) delivered in 3 or 4 GyRBE/fr (fraction) for the CIRT, and 2 Gy RBE/fr for the PT schedule. LC was 44% at the 1-year follow-up and 35.2% at the 3-year follow-up. OS at 1 and 3 years were 92.9% and 38.2%, respectively. Fourteen patients developed G1–G2 acute toxicity (dermatitis and mucositis), and no patients developed G3–G5. Regarding late toxicity, 10 patients encountered at maximum G1–2 events, and 4 did not experience any toxicity. Only for one patient G3 late toxicity was reported (dysphagia requiring a percutaneous endoscopic gastrostomy).

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A Patient Selection Approach Based on NTCP Models and DVH Parameters for Definitive Proton Therapy in Locally Advanced Sinonasal Cancer Patients

Cited by 7 publications

References 46 publications

Long-term complications associated with the management of sinonasal malignancies: a single center experience

Long-term complications associated with the management of sinonasal malignancies: a single center experience

Automatic Radiobiological Comparison of Radiation Therapy Plans: An Application to Gastric Cancer

Particle Reirradiation of Malignant Epithelial and Neuroectodermal Sinonasal Tumors: A Case Series from CNAO

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