Dose Reduction to Small Bowel and Other Relevant Structures in Rectal Carcinoma With Proton Therapy

Palmer, Matthew; Mok, Henry; Ciura, Katherine; Georges, R.; Nguyen, Bao Ngoc; Crawford, C.; Beddar, Sam; Zhu, Ronald X.; Crane, Christopher H.; Das, P.

doi:10.1016/j.ijrobp.2012.07.2264

Cited by 11 publications

(4 citation statements)

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“…The excellent dose distribution of proton beams reduces the damage of surrounding tissue and enables the use of higher doses for the target region. Pre- and postoperative proton therapy for locally advanced rectal cancer seems to reduce the exposure toward the small bowel, bladder, femoral heads, and pelvic bone marrow [ 49 , 50 , 51 , 52 , 53 ]. To the best of our knowledge, no previous study has used CRC organoids to investigate proton irradiation, yet.…”

Section: Discussionmentioning

confidence: 99%

Sensitization of Patient-Derived Colorectal Cancer Organoids to Photon and Proton Radiation by Targeting DNA Damage Response Mechanisms

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Lößner

William

et al. 2022

Cancers

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Pathological complete response (pCR) has been correlated with overall survival in several cancer entities including colorectal cancer. Novel total neoadjuvant treatment (TNT) in rectal cancer has achieved pathological complete response in one-third of the patients. To define better treatment options for nonresponding patients, we used patient-derived organoids (PDOs) as avatars of the patient’s tumor to apply both photon- and proton-based irradiation as well as single and combined chemo(radio)therapeutic treatments. While response to photon and proton therapy was similar, PDOs revealed heterogeneous responses to irradiation and different chemotherapeutic drugs. Radiotherapeutic response of the PDOs was significantly correlated with their ability to repair irradiation-induced DNA damage. The classical combination of 5-FU and irradiation could not sensitize radioresistant tumor cells. Ataxia-telangiectasia mutated (ATM) kinase was activated upon radiation, and by inhibition of this central sensor of DNA damage, radioresistant PDOs were resensitized. The study underlined the capability of PDOs to define nonresponders to irradiation and could delineate therapeutic approaches for radioresistant patients.

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Section: Discussionmentioning

confidence: 99%

Sensitization of Patient-Derived Colorectal Cancer Organoids to Photon and Proton Radiation by Targeting DNA Damage Response Mechanisms

Pape

Lößner

William

et al. 2022

Cancers

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“…Dose-volume histogram (DVH)-analyses revealed significantly reduced doses to OARs including the small bowel, testes, and bladder using protons. In another study of 10 preoperative patients with T3 node negative disease, PBT achieved comparable dose heterogeneity and significant dose reductions to the femoral heads, sigmoid/colon, pelvic bone, bladder, bowel, and normal tissue compared to IMRT and 3DCRT (48). Notably, small bowel receiving 15 Gy was significantly reduced to 90 cc compared to 157 and 138 cc for 3DCRT and IMRT, respectively.…”

Section: Rectal Cancermentioning

confidence: 97%

Proton beam radiotherapy for anal and rectal cancers

Vaios¹,

Wo²

2020

J Gastrointest Oncol

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This review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (1). Eligibility criteria included published work evaluating treatment plans and clinical outcomes of proton radiation therapy for anal or rectal cancer. Sources of information for this review included PubMed and EMBASE, those found in references from the major articles identified, and articles known to the authors. The searches were conducted to identify any and all articles addressing clinical outcomes of proton radiotherapy for anal or rectal neoplasms in adults with the following headings: protons, proton radiation therapy, proton beam therapy (PBT), pencil-beam, intensitymodulated PBT (IMPT), anal, anal cancer, rectal, or rectal cancer. Due to the limited amount of overall data, search terms were not restricted by publication year or number of patients. Searches were completed by October 4th, 2018.Based on the initial searches, a total of 575 articles and abstracts were identified. Care was taken to ensure that the inclusion criteria were sufficiently broad. To avoid missing potentially relevant publications, sources were excluded by individual screening rather than the initial database search. After duplicates were removed and the papers were independently screened for the described criteria, a further 528 studies were excluded. Articles without specific assessment of dosimetry or clinically relevant outcomes (e.g., survival, toxicity) of proton radiation therapy (RT) for anorectal cancers in adults were excluded. Of the 47 publications remaining, 17 review articles and 30 original investigations (15 published articles, 11 abstracts, and 4 case

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“…Later studies compared proton plans with more advanced photon techniques. One study compared passively scattered protons to IMRT and 3D-CRT [ 70 ]. Although all plans had comparable dose homogeneity, IMRT/3D-CRT covered the PTV to a slightly better degree, while PBT significantly spared the OARs more.…”

Section: Anorectal Cancermentioning

confidence: 99%

“…Although all plans had comparable dose homogeneity, IMRT/3D-CRT covered the PTV to a slightly better degree, while PBT significantly spared the OARs more. For example, the small bowel volume exposed to 15 Gy was 90 cc, 138 cc, and 157 cc for PBT, IMRT, and 3D-CRT, respectively ( p < 0.05) [ 70 ]. Another comparative study between passively scattered protons and VMAT/3D-CRT demonstrated a numeric reduction in the doses received by the bowels and the bladder, but the decrease was not statistically significant [ 71 ].…”

Section: Anorectal Cancermentioning

confidence: 99%

Proton Therapy in the Management of Luminal Gastrointestinal Cancers: Esophagus, Stomach, and Anorectum

Kobeissi

Simone

Hilal

et al. 2022

Cancers

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While the role of proton therapy in gastric cancer is marginal, its role in esophageal and anorectal cancers is expanding. In esophageal cancer, protons are superior in sparing the organs at risk, as shown by multiple dosimetric studies. Literature is conflicting regarding clinical significance, but the preponderance of evidence suggests that protons yield similar or improved oncologic outcomes to photons at a decreased toxicity cost. Similarly, protons have improved sparing of the organs at risk in anorectal cancers, but clinical data is much more limited to date, and toxicity benefits have not yet been shown clinically. Large, randomized trials are currently underway for both disease sites.

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Dose Reduction to Small Bowel and Other Relevant Structures in Rectal Carcinoma With Proton Therapy

Cited by 11 publications

References 0 publications

Sensitization of Patient-Derived Colorectal Cancer Organoids to Photon and Proton Radiation by Targeting DNA Damage Response Mechanisms

Sensitization of Patient-Derived Colorectal Cancer Organoids to Photon and Proton Radiation by Targeting DNA Damage Response Mechanisms

Proton beam radiotherapy for anal and rectal cancers

Proton Therapy in the Management of Luminal Gastrointestinal Cancers: Esophagus, Stomach, and Anorectum

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