Predicted Rate of Secondary Malignancies Following Adjuvant Proton Versus Photon Radiation Therapy for Thymoma

Vogel, Jennifer; Lin, Liyong; Litzky, Leslie A.; Berman, Abigail T.; Simone, Charles B.

doi:10.1016/j.ijrobp.2017.04.022

Cited by 36 publications

(30 citation statements)

References 31 publications

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“…In addition, multiple models accounting for lower integral dose to normal tissues with PBT predict a lower risk of secondary malignancy relative to photon‐based RT . Although long‐term clinical data are limited, several single‐institution and multi‐institution series comparing PBT with photon‐based RT have demonstrated decreased incidence of secondary malignancy after early follow‐up.…”

Section: Discussionmentioning

confidence: 99%

“…49 In addition, multiple models accounting for lower integral dose to normal tissues with PBT predict a lower risk of secondary malignancy relative to photon-based RT. 50,51 Although long-term clinical data are limited, several single-institution and multi-institution series comparing PBT with photon-based RT have demonstrated decreased incidence of secondary malignancy after early follow-up. One case-matched cohort analysis of 1176 patients treated with either PBT at the Harvard cyclotron or photon-based RT from the Surveillance, Epidemiology, and End Results database showed that PBT was associated with a nearly 2-fold decreased risk of secondary malignancy (adjusted hazard ratio, 0.52; 95% CI, 0.32-0.85; P = .009).…”

Section: Radiobiological Insights and Long-term Outcomesmentioning

confidence: 99%

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Comparative toxicity outcomes of proton‐beam therapy versus intensity‐modulated radiotherapy for prostate cancer in the postoperative setting

Santos

Barsky

Hwang

et al. 2019

Cancer

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Background Despite increasing utilization of proton‐beam therapy (PBT) in the postprostatectomy setting, no data exist regarding toxicity outcomes relative to intensity‐modulated radiotherapy (IMRT). The authors compared acute and late genitourinary (GU) and gastrointestinal (GI) toxicity outcomes in patients with prostate cancer (PC) who received treatment with postprostatectomy IMRT versus PBT. Methods With institutional review board approval, patients with PC who received adjuvant or salvage IMRT or PBT (70.2 gray with an endorectal balloon) after prostatectomy from 2009 through 2017 were reviewed. Factors including combined IMRT and PBT and/or concurrent malignancies prompted exclusion. A case‐matched cohort analysis was performed using nearest‐neighbor 3‐to‐1 matching by age and GU/GI disorder history. Logistic and Cox regressions were used to identify univariate and multivariate associations between toxicities and cohort/dosimetric characteristics. Toxicity‐free survival (TFS) was assessed using the Kaplan‐Meier method. Results Three hundred seven men (mean ± SD age, 59.7 ± 6.3 years; IMRT, n = 237; PBT, n = 70) were identified, generating 70 matched pairs. The median follow‐up was 48.6 and 46.1 months for the IMRT and PBT groups, respectively. Although PBT was superior at reducing low‐range (volumes receiving 10% to 40% of the dose, respectively) bladder and rectal doses (all P ≤ .01), treatment modality was not associated with differences in clinician‐reported acute or late GU/GI toxicities (all P ≥ .05). Five‐year grade ≥2 GU and grade ≥1 GI TFS was 61.1% and 73.7% for IMRT, respectively, and 70.7% and 75.3% for PBT, respectively; and 5‐year grade ≥3 GU and GI TFS was >95% for both groups (all P ≥ .05). Conclusions Postprostatectomy PBT minimized low‐range bladder and rectal doses relative to IMRT; however, treatment modality was not associated with clinician‐reported GU/GI toxicities. Future prospective investigation and ongoing follow‐up will determine whether dosimetric differences between IMRT and PBT confer clinically meaningful differences in long‐term outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Radiobiological Insights and Long-term Outcomesmentioning

confidence: 99%

Comparative toxicity outcomes of proton‐beam therapy versus intensity‐modulated radiotherapy for prostate cancer in the postoperative setting

Santos

Barsky

Hwang

et al. 2019

Cancer

View full text Add to dashboard Cite

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“…These were patients who received photon radiotherapy, so there are some uncertainties when applying these models to a proton radiotherapy cohort. However, this has been done in previous studies [14].…”

Section: Organmentioning

confidence: 94%

“…Based on the data presented by Schneider et al [13] for combined Hodgkin and atomic bomb survivor data, an a of 0.044 Gy À1 was chosen. The excess risk to each organ is presented in Vogel et al [14] as follows:…”

Section: Secondary Malignancy Calculationmentioning

confidence: 99%

Predicted Secondary Malignancies following Proton versus Photon Radiation for Oropharyngeal Cancers

Jain

Irmen

O’Reilly

et al. 2020

International Journal of Particle Therapy

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Purpose There has been a recent epidemic of human papillomavirus (HPV)–positive oropharyngeal cancer, accounting for 70% to 80% of diagnosed cases. These patients have an overall favorable prognosis and are typically treated with a combination of surgery, chemotherapy, and radiation. Because these patients live longer, they are at risk of secondary malignant neoplasms (SMNs) associated with radiation therapy. Therefore, we assessed the predicted risk of SMNs after adjuvant radiation therapy with intensity-modulated proton therapy (IMPT) compared with intensity modulated photon radiation therapy (IMRT) in patients with HPV- positive oropharyngeal cancers after complete resection. Materials and Methods Thirteen consecutive patients with HPV-positive oropharyngeal cancers treated with postoperative radiation alone were selected. All patients were treated with pencil beam scanning IMPT to a total dose of 60 Gy in 2 Gy fractions. The IMRT plans were generated for clinical backup and were used for comparative purposes. The SMN risk was calculated based on an organ equivalent dose model for the linear-exponential dose-response curve. Results Median age of the patient cohort was 63 years (range, 47-73 years). There was no difference in target coverage between IMPT and IMRT plans. We noted significant reductions in mean mandible, contralateral parotid, lung and skin organ equivalent doses with IMPT compared with IMRT plans (P < .001). Additionally, a significant decrease in the risk of SMNs with IMPT was observed for all the evaluated organs. Per our analysis, for patients with oropharyngeal cancers diagnosed at a national median age of 54 years with an average life expectancy of 27 years (per national Social Security data), 4 excess SMNs per 100 patients could be avoided by treating them with IMPT versus IMRT. Conclusions Treatment with IMPT can achieve comparable target dose coverage while significantly reducing the dose to healthy organs, which can lead to fewer predicted SMNs compared with IMRT.

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“…PBT decreases dose to the heart and lungs compared to conventional photon RT in breast cancer [25], as demonstrated by the minimal heart dose among our four patients. Furthermore, compared to conventional photon RT, PBT minimizes dose to surrounding tissue and decreases the rate of secondary malignancies following adjuvant RT for thymomas [26]. These potential benefits may be even more important in secondary breast angiosarcoma, as the surrounding tissues are at increased risk due to prior RT and have already demonstrated the capacity to develop secondary malignancy.…”

mentioning

confidence: 99%

First report of proton beam therapy for breast angiosarcoma from the prospective PCG registry

et al. 2018

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View related articles View Crossmark data manifestation is thought to be related to dosing interval and the cumulative number of chemotherapy cycles [1,2]. Even though nail and skin toxicity are not life threatening, effective management to ameliorate the symptoms is a necessity to allow patients to continue their chemotherapy regimen. In some cases, patients may require dose adjustment, as was the case in a series of three patients with PATEO syndrome described by Rodriguez-Lomba et al. [3] Despite development of PATEO syndrome, our patient was able to continue her chemotherapy regimen with use of a potent topical corticosteroid and cooling her hands in ice baths during subsequent paclitaxel infusions, an approach similar to Scott e et al's [4,5] frozen glove therapy that was found to significantly reduce nail and skin toxicity associated with taxane-based chemotherapy. We present this case to heighten awareness of this unique manifestation of handfoot syndrome specific to taxane chemotherapy and share a successful approach towards management.

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Predicted Rate of Secondary Malignancies Following Adjuvant Proton Versus Photon Radiation Therapy for Thymoma

Cited by 36 publications

References 31 publications

Comparative toxicity outcomes of proton‐beam therapy versus intensity‐modulated radiotherapy for prostate cancer in the postoperative setting

Comparative toxicity outcomes of proton‐beam therapy versus intensity‐modulated radiotherapy for prostate cancer in the postoperative setting

Predicted Secondary Malignancies following Proton versus Photon Radiation for Oropharyngeal Cancers

First report of proton beam therapy for breast angiosarcoma from the prospective PCG registry

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