Long-term toxic effects of proton radiotherapy for paediatric medulloblastoma: a phase 2 single-arm study

Yock, Torunn I.; Yeap, Beow Y.; Ebb, David H.; Weyman, Elizabeth A.; Eaton, Bree R.; Sherry, Nicole; Jones, Robin M.; MacDonald, Shannon M.; Pulsifer, Margaret B.; Lavally, Beverly; Abrams, Annah N.; Huang, Mary; Marcus, Karen J.; Tarbell, Nancy J.

doi:10.1016/s1470-2045(15)00167-9

Cited by 287 publications

(229 citation statements)

References 53 publications

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“…However, nearly all published data on late toxicity after CSI concern neuro-cognitive decline, endocrinopathies or growth retardation, in fact problems inherent to the treatment of the target volume [18][19][20][21]. In contrast, fewer results have been published on late toxicity outside the craniospinal target volume despite the use of the conventional 3D-CRT for decades [27][28][29][30][31][32].…”

Section: Discussionmentioning

confidence: 99%

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Dosimetric comparison of five different techniques for craniospinal irradiation across 15 European centers: analysis on behalf of the SIOP-E-BTG (radiotherapy working group)

et al. 2018

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Purpose: Conventional techniques (3D-CRT) for craniospinal irradiation (CSI) are still widely used. Modern techniques (IMRT, VMAT, TomoTherapy V R , proton pencil beam scanning [PBS]) are applied in a limited number of centers. For a 14-year-old patient, we aimed to compare dose distributions of five CSI techniques applied across Europe and generated according to the participating institute protocols, therefore representing daily practice. Material and methods: A multicenter (n ¼ 15) dosimetric analysis of five different techniques for CSI (3D-CRT, IMRT, VMAT, TomoTherapy V R , PBS; 3 centers per technique) was performed using the same patient data, set of delineations and dose prescription (36.0/1.8 Gy). Different treatment plans were optimized based on the same planning target volume margin. All participating institutes returned their best treatment plan applicable in clinic. Results: The modern radiotherapy techniques investigated resulted in superior conformity/homogeneity-indices (CI/HI), particularly in the spinal part of the target (CI: 3D-CRT:0.3 vs. modern:0.6; HI: 3D-CRT:0.2 vs. modern:0.1), and demonstrated a decreased dose to the thyroid, heart, esophagus and pancreas. Dose reductions of >10.0 Gy were observed with PBS compared to modern photon techniques for parotid glands, thyroid and pancreas. Following this technique, a wide range in dosimetry among centers using the same technique was observed (e.g., thyroid mean dose: VMAT: 5.6-24.6 Gy; PBS: 0.3-10.1 Gy). Conclusions: The investigated modern radiotherapy techniques demonstrate superior dosimetric results compared to 3D-CRT. The lowest mean dose for organs at risk is obtained with proton therapy. However, for a large number of organs ranges in mean doses were wide and overlapping between techniques making it difficult to recommend one radiotherapy technique over another. ARTICLE HISTORY

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Section: Discussionmentioning

confidence: 99%

“…However, the vast majority of late effects reported after CSI in childhood arise from irradiation of the target volume [18][19][20][21]. Dose and age influence toxicity outcome and are the justification for dose reduction, altered fractionation regimens, a combination with systemic agents or target volume adaptations [22][23][24][25][26].…”

Section: Introductionmentioning

confidence: 99%

Dosimetric comparison of five different techniques for craniospinal irradiation across 15 European centers: analysis on behalf of the SIOP-E-BTG (radiotherapy working group)

et al. 2018

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“…The eventual gold standard might be to use dose and LET maps to provide a more appropriately weighted dose, using agreed radiobiological input data. At the present time, greater resources are being devoted to clinical reporting and analysis of LET and RBE, 32,33 although sharing of human data nationally or internationally may provide greater statistical power to detect subtle but important findings.…”

Section: Discussionmentioning

confidence: 99%

Why RBE must be a variable and not a constant in proton therapy

Jones

2016

BJR

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Objective: This article considered why the proton therapy (PT) relative biological effect (RBE) should be a variable rather than a constant. Methods: The reasons for a variable proton RBE are enumerated, with qualitative and quantitative arguments. The heterogeneous data sets collated by Paganetti et al (2002) and the more homogeneous data of Britten et al (2013) are further analyzed using linear regression fitting and RBE-inclusive adaptations of the linear-quadratic (LQ) radiation model.

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“…Research published in 2016 showed proton beam therapy achieves similar survival to conventional radiotherapy in children with medulloblastoma and may be less toxic 1. Another 2016 study analysed children with ependymomas treated through the UK proton beam therapy overseas programme.…”

Section: Growing Evidencementioning

confidence: 99%