Assessing Equity of Access to Proton Beam Therapy: A Literature Review

Gaito, S.; Aznar, Marianne C.; Burnet, N.G.; Crellin, A.; France, Anna; Indelicato, Daniel J.; Kirkby, Karen J; Pan, S.; Whitfield, Gillian A; Smith, Ed

doi:10.1016/j.clon.2023.05.014

Cited by 13 publications

(8 citation statements)

References 31 publications

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“…In addition, the capacity of PBT may still be limited and therefore patient selection remains crucial. Also, access is not equitable in most countries and it needs to be clear that in a wide territory with a high incidence of NPC, patients can still be treated with gold-standard XRT without jeopardizing their outcomes [ 44 , 45 ].…”

Section: Discussionmentioning

confidence: 99%

Risk of temporal lobe necrosis between proton beam and volumetric modulated arc therapies in patients with different head and neck cancers

Liu,

Lin,

Huang

et al. 2023

Radiat Oncol

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Background To investigate the frequency of temporal lobe necrosis (TLN) soon after radiotherapy (RT) and identify differences among patients with various types of head and neck cancer (HNC) and between different RT methods. Methods We retrospectively reviewed 483 patients with HNC who had completed RT in our hospital after January, 2015. These patients were followed-up at the radio-oncology department and received contrast-enhanced magnetic resonance imaging (MRI) or computed tomography (CT) to identify metastases or recurrence of cancer at regular intervals. Meanwhile, the occurrence of TLN, graded according to the Common Terminology Criteria for Adverse Events V5.0, was recorded. We categorized the patients into nasopharyngeal carcinoma (NPC) and non-NPC groups and compared the cumulative occurrence of TLN between the groups using Kaplan–Meier and Cox regression analyses. We further compared the cumulative occurrence of TLN between proton beam therapy (PBT) and volumetric modulated arc therapy (VMAT) in patients with any HNC, NPC, and non-NPC HNC. Results Compared with the non-NPC group, the NPC group had a higher frequency of TLN (5.6% vs. 0.4%, p < 0.01) and were more commonly associated with TLN in the Kaplan–Meier analysis (p < 0.01) and the Cox regression model after covariates were adjusted for (adjusted hazard ratio: 13.35, 95% confidence interval: 1.37–130.61) during the follow-up period. Furthermore, the frequency of TLN was similar between patients receiving PBT and those receiving VMAT (PBT vs. VMAT: 4.7% vs. 6.3%, p = 0.76). Kaplan–Meier analysis revealed that the accumulated risks of TLN were similar between PBT and VMAT in patients with any HNC (p = 0.44), NPC (p = 0.84), and non-NPC HNC (p = 0.70). Conclusion Our study demonstrated that patients with NPC are susceptible to TLN during the early period after RT. In addition, PBT may be associated with an equivalent risk of TLN when compared with VMAT in patients with NPC or other HNCs.

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Section: Discussionmentioning

confidence: 99%

Risk of temporal lobe necrosis between proton beam and volumetric modulated arc therapies in patients with different head and neck cancers

Liu,

Lin,

Huang

et al. 2023

Radiat Oncol

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“…Comprehensive neuropsychological assessments are also needed to detect core neurocognitive functions [7]. Systematic and standardized neuropsychological follow-up before and after RT at specific time points is highly recommended [7,[57][58][59]. This is also important for other diagnoses receiving high RT doses to different brain structures important for neurocognitive networks, such as head and neck cancer [60].…”

Section: Discussionmentioning

confidence: 99%

Neurocognition and mean radiotherapy dose to vulnerable brain structures: new organs at risk?

et al. 2023

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Background Children with brain tumors are at high risk of neurocognitive decline after radiotherapy (RT). However, there is a lack of studies on how RT doses to organs at risk (OARs) impacts neurocognition. The aim of this study was to examine dose-risk relationships for mean RT dose to different brain structures important for neurocognitive networks. We explored previously established OARs and potentially new OARs. Methods A sample of 44 pediatric brain tumor survivors who had received proton and/or photon RT were included. Correlations between mean RT doses to OARs and IQ were analyzed. Previously established OARs were cochleae, optic chiasm, optic nerve, pituitary gland, hypothalamus, hippocampus and pons. Potential new OARs for RT-induced neurocognitive decline were cerebellum, vermis and thalamus. Results Mean RT dose to different OARs correlated with several IQ subtests. Higher mean RT dose to cochleae, optic nerve, cerebellum, vermis and pons was correlated with lower performance on particularly full-scale IQ (FIQ), Perceptual Reasoning (PRI), Working Memory (WMI) and Processing Speed Index (PSI). Higher mean RT dose to hippocampus correlated with lower performance on processing speed and working memory. For those receiving whole brain RT (WBRT), higher mean RT dose to the pituitary gland correlated with lower performance on working memory. Conclusion A high dose-risk correlation was found between IQ subtests and mean RT dose in established and potential new OARs. Thus, in the lack of validated dose constraints for vulnerable brain structures, a parsimonious approach in RT planning should be considered to preserve neurocognitive networks.

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“…where N A is the number of Avogadro, r e is the classical radius of electron, m e is the electron mass, z is the projectile charge, Z is the atomic number irradiated material, A is the atomic weight of irradiated material, c is light speed, β = v/c, where v is the Cumulative number of proton treatment rooms opened since 1964 and those projected until 2026 [1].…”

Section: Protons Energy Lossmentioning

confidence: 99%

“…Figure 1.Cumulative number of proton treatment rooms opened since 1964 and those projected until 2026[1].…”

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confidence: 99%

Interaction of proton beam with human tissues in proton therapy

Hazem

2023

Proton Therapy - Scientific Questions and Future Direction

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Proton therapy is an effective and safe method to treat tumors in human body. Instead of conventional radiation (X-rays), this technique uses a heavy charged particles (protons) to treat cancer. This chapter reviews the basic aspects of the physics of proton therapy, including proton beam properties, proton interaction mechanisms, and radiation effects induced in the human tissue. A more highly conformal technique of proton therapy called “pencil beam scanning”, based on intensity-modulated proton therapy (IMPT), will be also developed. The uncertainty in the determination of the relative biological effectiveness (RBE) will also be discussed in light of recent experimental results. We conclude the chapter by discussing future developments and potential challenges of proton therapy.

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Assessing Equity of Access to Proton Beam Therapy: A Literature Review

Cited by 13 publications

References 31 publications

Risk of temporal lobe necrosis between proton beam and volumetric modulated arc therapies in patients with different head and neck cancers

Risk of temporal lobe necrosis between proton beam and volumetric modulated arc therapies in patients with different head and neck cancers

Neurocognition and mean radiotherapy dose to vulnerable brain structures: new organs at risk?

Interaction of proton beam with human tissues in proton therapy

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