Normal tissue complication probability models in plan evaluation of children with brain tumors referred to proton therapy

Stokkevåg, C.H.; Indelicato, Daniel J.; Herfarth, Klaus; Magelssen, Henriette; Evensen, Morten Egeberg; Ugland, Maren; Nordberg, Terje; Nystad, Tove A.; Hægeland, Camilla; Alsaker, M D K; Ulven, Kjetil; Dale, Jon Espen; Engeseth, Grete May; Boer, Camilla Grindeland; Toussaint, Laura; Kornerup, J. Ståhl; Pettersen, Helge Egil Seime; Brydøy, Marianne; Brandal, Petter; Muren, L.P.

doi:10.1080/0284186x.2019.1643496

Cited by 15 publications

(15 citation statements)

References 47 publications

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“…The decreased doses to organs at risk (OAR) result in fewer cognitive adverse effects (reported when doses exceed ≥18 Gy to the cranium), reducing developmental impairment [7,8]. Clinical outcomes including reduction in detrimental side effects of PT in paediatric patients have been highlighted in several publications [2,[9][10][11][12]. However, the degree of dose reduction PT offers compared to XRT has not been well quantified by tumour location, tumour volume and patient age.…”

Section: Introductionmentioning

confidence: 99%

Influence of Target Location, Size, and Patient Age on Normal Tissue Sparing- Proton and Photon Therapy in Paediatric Brain Tumour Patient-Specific Approach

Dell’Oro

Short

Wilson

et al. 2020

Cancers

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Background: Proton radiotherapy produces superior dose distributions compared to photon radiotherapy, reducing side effects. Differences between the two modalities are not fully quantified in paediatric patients for various intracranial tumour sites or age. Understanding these differences may help clinicians estimate the benefit and improve referral across available centres. Our aim was to compare intensity-modulated proton therapy (IMPT) and intensity-modulated photon radiotherapy (IMRT) radiation doses for select paediatric intracranial tumours. Methods: IMPT and IMRT dose distributions for gender-matched paediatric cranial CT-datasets (ages 5, 9 and 13 years) were retrospectively calculated to simulate irradiation of supratentorial (ependymoma) and infratentorial (medulloblastoma) target volumes diameters (1–3 cm) and position (central and 1–2 cm shifts). Results: Clinical dosimetric objectives were achieved for all 216 treatment plans. Whilst infratentorial IMPT plans achieved greater maximum dose sparing to optic structures (4.8–12.6 Gy optic chiasm), brainstem sparing was limited (~0.5 Gy). Mean dose difference for optic chiasm was associated with medulloblastoma target position (p < 0.0197). Supratentorial IMPT plans demonstrated greater dose reduction for the youngest patients (pituitary gland p < 0.001). Conclusions: Normal tissue sparing was achieved regardless of patient age for infratentorial tumours. However, for supratentorial tumours, there was a dosimetric advantage of IMPT across 9 vs. 13-year-old patients.

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Section: Introductionmentioning

confidence: 99%

Influence of Target Location, Size, and Patient Age on Normal Tissue Sparing- Proton and Photon Therapy in Paediatric Brain Tumour Patient-Specific Approach

Dell’Oro

Short

Wilson

et al. 2020

Cancers

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“…Publications addressing PT patient selection have been increasing since 2015. In order of the strength of evidence one publication was a systematic review, 13 five were government or medical college clinical indication lists, 18 , 19 , 20 , 21 , 22 eight were literature reviews, 4 , 5 , 6 , 10 , 15 , 30 , 31 , 32 five were prospective studies, 14 , 33 , 34 , 35 , 36 28 were retrospective studies, 3 , 7 , 11 , 12 , 16 , 23 , 25 , 26 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 one was a case‐control study, 57 and one was an expert opinion 58 . Thirty‐five publications were full‐text articles, nine were conference abstracts, and five were governm...…”

Section: Resultsmentioning

confidence: 99%

“…Additional to the five clinical indications lists and literature review describing paediatric PT indications, six publications focussed on paediatric patient selection. 10 , 42 , 43 , 44 , 56 , 61 Of these, two assessed cost‐effectiveness, 11 , 56 three used model‐based NTCPs, 42 , 43 , 44 and one used a combination of model‐based NTCPs, dosimetry and cost‐effectiveness. 10 Five publications applied dose comparison methods to the brain 11 , 42 , 43 , 44 , 56 and one applied dose comparison methods to various anatomical sites.…”

Section: Methodsmentioning

confidence: 99%

“…[18][19][20][21][22] This was substantiated if targets were in excess of 60 Gy, and/or multiple organs at risk (OARs) were nearby in order to spare normal tissues. 5,42 PT was also indicated for ocular tumours in the United States, 22 Canada, 21 Australia and New Zealand. 19 Verma et al 13 found PT a cost-effective option for both of these tumour types.…”

Section: Brain Skull Base Ocular and Head And Neck Tumoursmentioning

confidence: 99%

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A scoping review of patient selection methods for proton therapy

Zientara

Giles

et al. 2021

J of Medical Radiation Sci

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The aim was to explore various national and international clinical decisionmaking tools and dose comparison methods used for selecting cancer patients for proton versus X-ray radiation therapy. To address this aim, a literature search using defined scoping review methods was performed in Medline and Embase databases as well as grey literature. Articles published between 1 January 2015 and 4 August 2020 and those that clearly stated methods of proton versus X-ray therapy patient selection and those published in English were eligible for inclusion. In total, 321 studies were identified of which 49 articles met the study's inclusion criteria representing 13 countries. Six different clinical decision-making tools and 14 dose comparison methods were identified, demonstrating variability within countries and internationally. Proton therapy was indicated for all paediatric patients except those with lymphoma and re-irradiation where individualised model-based selection was required. The most commonly reported patient selection tools included the Normal Tissue Complication Probability model, followed by cost-effectiveness modelling and dosimetry comparison. Model-based selection methods were most commonly applied for head and neck clinical indications in adult cohorts (48% of studies). While no 'Gold Standard' currently exists for proton therapy patient selection with variations evidenced globally, some of the patient selection methods identified in this review can be used to inform future practice in Australia. As literature was not identified from all countries where proton therapy centres are available, further research is needed to evaluate patient selection methods in these jurisdictions for a comprehensive overview.

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“…One constant goal is to optimize the delivery of treatment in order to be most effective and with a minimal risk of treatment related morbidity. This was highlighted through the many presentations of particle therapy [56][57][58][59][60], and the associated introduction of new delivery concepts such as GRID therapy and FLASH [61]. The latter has received substantial attention recently and will be further explored in the coming years.…”

mentioning

confidence: 99%