Assessment of potential advantages of relevant ions for particle therapy: A model based study

Grün, Rebecca; Friedrich, Thomas; Krämer, M.; Zink, Klemens; Durante, Marco; Engenhart‐Cabillic, Rita; Scholz, M.

doi:10.1118/1.4905374

Cited by 76 publications

(66 citation statements)

References 45 publications

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“…Biologic treatment planning for scanned proton therapy and scanned carbon ion therapy was performed using the TRiP98 treatment planning system (TPS) [25,27] and the Local Effect Model [41] in its recent implementation Version IV (LEMIV) [12,16,18,41]. For all patients, scanned proton and scanned carbon treatment plans were prepared as follows.…”

Section: Methodsmentioning

confidence: 99%

“…Recently, a patient-outcome study investigated second cancer incidence after therapy with photons or protons [4], and from those data it appears that protons offer a significantly lower rate of carcinogenesis than photons. Due to the sharper physical dose gradients [47] and differential relative biological effectiveness (RBE) [12], carbon-ion therapy might provide reduced dose to normal tissues compared to proton therapy [12,18,38]. However, the capacity of high LET radiation to induce late effects is much less understood than that of low LET radiation and could increase risks of second cancer after radiotherapy.…”

Section: Introductionmentioning

confidence: 99%

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Comparative Risk Predictions of Second Cancers After Carbon-Ion Therapy Versus Proton Therapy

Eley

Friedrich

Homann

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

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The purpose of this work was to propose a theoretical framework that enables comparative risk predictions for second cancer incidence after particle-beam therapy for different ion species for individual patients, accounting for differences in relative biological effectiveness (RBE) for the competing processes of tumor initiation and cell inactivation. Our working hypothesis was that using carbon-ion therapy instead of proton therapy would show a difference in the predicted risk of second cancer incidence in the breast for a sample of Hodgkin lymphoma (HL) patients. We generated biologic treatment plans and calculated relative predicted risks of second cancer in the breast using two proposed methods: a full model derived from the linear-quadratic model and a simpler linear-no-threshold model. For our reference calculation, we found the ratio of predicted risk of breast cancer incidence for carbon-ion versus proton plans to be 0.75±0.07 but not significantly smaller than 1 (p=0.180). Our findings suggest that second cancers risks are, on average, comparable between proton therapy and carbon-ion therapy.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparative Risk Predictions of Second Cancers After Carbon-Ion Therapy Versus Proton Therapy

Eley

Friedrich

Homann

et al. 2016

International Journal of Radiation Oncology*Biology*Physics

Self Cite

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“…intensity-modulated radiotherapy (IMRT) or particle therapy, have been introduced because it was believed from the initial investigations and dose distribution modelling to be of benefit for patients, and this has been generally supported by clinical experience. [3][4][5] The goal of IMRT or particle therapy, as compared to three dimensional conformal radiotherapy, was and is to provide treatment with either higher probability for tumour control (dealing with the major immediate risk to the patient; i.e. the disease progressing and not being cured) and/or lower rates and severity of side effects (dealing with the next worst risk for the patient; i.e.…”

Section: Risks Must Be Addressed and Judged In A Realistic Contextmentioning

confidence: 99%

Does a too risk-averse approach to the implementation of new radiotherapy technologies delay their clinical use?

Garcia

Nyström²,

Fiorino

et al. 2015

BJR

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Radiotherapy is a generally safe treatment modality in practice; nevertheless, recent well-reported accidents also confirm its potential risks. However, this may obstruct or delay the introduction of new technologies and treatment strategies/techniques into clinical practice. Risks must be addressed and judged in a realistic context: risks must be assessed realistically. Introducing new technology may introduce new possibilities of errors. However, delaying the introduction of such new technology therefore means that patients are denied the potentially better treatment opportunities. Despite the difficulty in quantitatively assessing the risks on both sides of the possible choice of actions, including the "lost opportunity", the best estimates should be included in the overall risk-benefit and cost-benefit analysis. Radiotherapy requires a sufficiently high level of support for the safety, precision and accuracy required: radiotherapy development and implementation is exciting. However, it has been anxious with a constant awareness of the consequences of mistakes or misunderstandings. Recent history can be used to show that for introduction of advanced radiotherapy, the risk-averse medical physicist can act as an electrical fuse in a complex circuit. The lack of sufficient medical physics resource or expertise can short out this fuse and leave systems unsafe. Future technological developments will continue to present further safety and risk challenges. The important evolution of radiotherapy brings different management opinions and strategies. Advanced radiotherapy technologies can and should be safely implemented in as timely a manner as possible for the patient groups where clinical benefit is indicated.

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“…A good compromise ion species might be He, which is currently under research for cancer therapy . The ion shows less fragmentation than 12 C and requires smaller accelerators.…”

Section: Requirements For a Clinical Applicationmentioning

confidence: 99%

Noninvasive cardiac arrhythmia ablation with particle beams

Graeff

Bert

2018

Medical Physics

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Cardiac arrhythmias are a major health burden, associated with reduced quality of life and substantial morbidity and mortality. Current therapy includes moderately effective medication and catheter‐based ablation of arrhythmogenic substrates in the heart. Catheter interventions frequently have to be repeated due to recurrent arrhythmia, can have rare but severe side‐effects and are less suited especially for potentially lethal left ventricular tachycardia. Noninvasive alternatives are therefore warranted. Photon and ion beam radiotherapy has been studied in animal models and first patient cases have been reported using photons. Ion beams might offer the possibility to greatly reduce dose to surrounding healthy tissue, including critical cardiac substructures. Based on a recently conducted animal study, we report advantages and disadvantages of 4D‐ion beam therapy, and strategies necessary for a clinical transition. Motion management of both respiration and heartbeat are discussed, as well as range uncertainty resulting from both regular motion and interfractional anatomic changes. Image guidance both in 3D and 4D has to be employed for a safe irradiation, but also population‐based data on motion variability and time behavior of interfractional changes are necessary. Range verification could play a crucial role at least during development of clinical protocols. For clinical realization, it appears necessary to suppress or conformally mitigate the large respiratory motion to avoid normal tissue complications. Cardiac motion has to be incorporated into treatment planning, either through adequate range‐considering internal margins or through more conformal strategies such as ECG‐based gating or even 4D‐optimization. The latter strategies would necessitate online 4D image guidance.

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Assessment of potential advantages of relevant ions for particle therapy: A model based study

Cited by 76 publications

References 45 publications

Comparative Risk Predictions of Second Cancers After Carbon-Ion Therapy Versus Proton Therapy

Comparative Risk Predictions of Second Cancers After Carbon-Ion Therapy Versus Proton Therapy

Does a too risk-averse approach to the implementation of new radiotherapy technologies delay their clinical use?

Noninvasive cardiac arrhythmia ablation with particle beams

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