Advanced Treatment Planning

Wedenberg, Minna; Beltran, Chris; Mairani, A.; Alber, M.

doi:10.1002/mp.12943

Cited by 14 publications

(13 citation statements)

References 95 publications

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“…Carbon ions are more cytotoxic per unit dose than X-rays by~2.5-to 3-fold, depending on the cell type; thus, the RBE for carbon ion radiation is 2.5-3. RBE values are important parameters used in radiotherapy treatment planning [66,71,72].…”

Section: Radiation-induced Dna Damage and The Importance Of Clusteredmentioning

confidence: 99%

Clustered DNA Double-Strand Breaks: Biological Effects and Relevance to Cancer Radiotherapy

Nickoloff

Sharma

Taylor

2020

Genes

144

108

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Cells manage to survive, thrive, and divide with high accuracy despite the constant threat of DNA damage. Cells have evolved with several systems that efficiently repair spontaneous, isolated DNA lesions with a high degree of accuracy. Ionizing radiation and a few radiomimetic chemicals can produce clustered DNA damage comprising complex arrangements of single-strand damage and DNA double-strand breaks (DSBs). There is substantial evidence that clustered DNA damage is more mutagenic and cytotoxic than isolated damage. Radiation-induced clustered DNA damage has proven difficult to study because the spectrum of induced lesions is very complex, and lesions are randomly distributed throughout the genome. Nonetheless, it is fairly well-established that radiation-induced clustered DNA damage, including non-DSB and DSB clustered lesions, are poorly repaired or fail to repair, accounting for the greater mutagenic and cytotoxic effects of clustered lesions compared to isolated lesions. High linear energy transfer (LET) charged particle radiation is more cytotoxic per unit dose than low LET radiation because high LET radiation produces more clustered DNA damage. Studies with I-SceI nuclease demonstrate that nuclease-induced DSB clusters are also cytotoxic, indicating that this cytotoxicity is independent of radiogenic lesions, including single-strand lesions and chemically “dirty” DSB ends. The poor repair of clustered DSBs at least in part reflects inhibition of canonical NHEJ by short DNA fragments. This shifts repair toward HR and perhaps alternative NHEJ, and can result in chromothripsis-mediated genome instability or cell death. These principals are important for cancer treatment by low and high LET radiation.

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Section: Radiation-induced Dna Damage and The Importance Of Clusteredmentioning

confidence: 99%

Clustered DNA Double-Strand Breaks: Biological Effects and Relevance to Cancer Radiotherapy

Nickoloff

Sharma

Taylor

2020

Genes

144

108

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“…As a result, a theoretically more accurate dose map of the target and OARs of the treatment can be constructed. This information can serve as a valuable reference for protecting OARs from excessive dose [ 87 , 88 ]. In the case of prostate treatment, if variance of RBE is incorporated into robust optimization, biological dose for critical organs such as the rectum and bladder could be minimized to protect these organs.…”

Section: Opportunities For Improvement With New Technologies and Inno...mentioning

confidence: 99%

Proton Therapy for Prostate Cancer: Challenges and Opportunities

Poon

et al. 2022

Cancers

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The dosimetric advantages of proton therapy (PT) treatment plans are demonstrably superior to photon-based external beam radiotherapy (EBRT) for localized prostate cancer, but the reported clinical outcomes are similar. This may be due to inadequate dose prescription, especially in high-risk disease, as indicated by the ASCENDE-RT trial. Alternatively, the lack of clinical benefits with PT may be attributable to improper dose delivery, mainly due to geometric and dosimetric uncertainties during treatment planning, as well as delivery procedures that compromise the dose conformity of treatments. Advanced high-precision PT technologies, and treatment planning and beam delivery techniques are being developed to address these uncertainties. For instance, external magnetic resonance imaging (MRI)-guided patient setup rooms are being developed to improve the accuracy of patient positioning for treatment. In-room MRI-guided patient positioning systems are also being investigated to improve the geometric accuracy of PT. Soon, high-dose rate beam delivery systems will shorten beam delivery time to within one breath hold, minimizing the effects of organ motion and patient movements. Dual-energy photon-counting computed tomography and high-resolution Monte Carlo-based treatment planning systems are available to minimize uncertainties in dose planning calculations. Advanced in-room treatment verification tools such as prompt gamma detector systems will be used to verify the depth of PT. Clinical implementation of these new technologies is expected to improve the accuracy and dose conformity of PT in the treatment of localized prostate cancers, and lead to better clinical outcomes. Improvement in dose conformity may also facilitate dose escalation, improving local control and implementation of hypofractionation treatment schemes to improve patient throughput and make PT more cost effective.

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“…Due to the well-defined range of protons, proton therapy is also assumed to be more sensitive to delivery uncertainties than conventional radiotherapy with photons, resulting in the development of sophisticated tools for evaluating and optimizing the robustness of proton plans to set-up and range uncertainties. [25][26][27][28][29] These tools are now being increasingly employed in the clinic, leading to new concepts of uncertainty management in proton therapy that move away from the conventional planning target volume (PTV) concept. Additional parameters that account for factors such as anatomical variations and/or respiratory motion may also need to be considered to best exploit the advantages of proton therapy for pediatric cases, as will be discussed in the following section.…”

Section: Recent Advances In Proton Therapy That Are Relevant To Pediatric Patientsmentioning

confidence: 99%

Advances in radiotherapy technology for pediatric cancer patients and roles of medical physicists: COG and SIOP Europe perspectives

Hua

Mascia

Seravalli

et al. 2021

Pediatric Blood & Cancer

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Over the last two decades, rapid technological advances have dramatically changed radiation delivery to children with cancer, enabling improved normal‐tissue sparing. This article describes recent advances in photon and proton therapy technologies, image‐guided patient positioning, motion management, and adaptive therapy that are relevant to pediatric cancer patients. For medical physicists who are at the forefront of realizing the promise of technology, challenges remain with respect to ensuring patient safety as new technologies are implemented with increasing treatment complexity. The contributions of medical physicists to meeting these challenges in daily practice, in the conduct of clinical trials, and in pediatric oncology cooperative groups are highlighted. Representing the perspective of the physics committees of the Children's Oncology Group (COG) and the European Society for Paediatric Oncology (SIOP Europe), this paper provides recommendations regarding the safe delivery of pediatric radiotherapy. Emerging innovations are highlighted to encourage pediatric applications with a view to maximizing the therapeutic ratio.

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Advanced Treatment Planning

Cited by 14 publications

References 95 publications

Clustered DNA Double-Strand Breaks: Biological Effects and Relevance to Cancer Radiotherapy

Clustered DNA Double-Strand Breaks: Biological Effects and Relevance to Cancer Radiotherapy

Proton Therapy for Prostate Cancer: Challenges and Opportunities

Advances in radiotherapy technology for pediatric cancer patients and roles of medical physicists: COG and SIOP Europe perspectives

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