Promise and Pitfalls of Heavy-Particle Therapy

Mitin, Timur; Zietman, Anthony L.

doi:10.1200/jco.2014.55.1945

Cited by 114 publications

(99 citation statements)

References 79 publications

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“…The high dose-gradient enables the delivery of high doses to the tumor while sparing critical organs distal to the target (Mitin and Zietman, 2014; Loeffler and Durante, 2013; Karger et al , 2010; Smith, 2009; Schardt et al , 2010). However, a small shift of the highly conformal high-dose area can cause the target tumor to be substantially under-dosed or the critical organs to be substantially over-dosed (McGowan et al , 2013; Engelsman et al , 2013; Kang et al , 2007; Mirkovic et al , 2007).…”

Section: Introductionmentioning

confidence: 99%

Comprehensive analysis of proton range uncertainties related to stopping-power-ratio estimation using dual-energy CT imaging

et al. 2017

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The dual-energy CT-based (DECT) approach holds promise in reducing the overall uncertainty in proton stopping-power-ratio (SPR) estimation as compared to the conventional stoichiometric calibration approach. The objective of this study was to analyze the factors contributing to uncertainty in SPR estimation using the DECT-based approach and to derive a comprehensive estimate of the range uncertainty associated with SPR estimation in treatment planning. Two state-of-the-art DECT-based methods, the Hünemohr-Saito method (2014, 2012) and the Bourque method (2014), were selected and implemented on a Siemens SOMATOM Force DECT scanner. The uncertainties were first divided into five independent categories. The uncertainty associated with each category was estimated for lung, soft and bone tissues separately. A single composite uncertainty estimate was eventually determined for three tumor sites (lung, prostate and head-and-neck) by weighting the relative proportion of each tissue group for that specific site. The uncertainties associated with the two selected DECT methods were found to be similar, therefore the following results applied to both methods. The overall uncertainty (1σ) in SPR estimation with the DECT-based approach was estimated to be 3.8%, 1.2% and 2.0% for lung, soft and bone tissues, respectively. The dominant factor contributing to uncertainty in the DECT approach was the imaging uncertainties, followed by the DECT modeling uncertainties. Our study showed that the DECT approach can reduce the overall range uncertainty to approximately 2.2% (2σ) in clinical scenarios, in contrast to the previously reported 1%.

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Section: Introductionmentioning

confidence: 99%

Comprehensive analysis of proton range uncertainties related to stopping-power-ratio estimation using dual-energy CT imaging

et al. 2017

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“…As has been correctly stated 41 , 'Hospital administrations must accept that a technology should neither be used for prestige nor for marketing, and their business models should be based on conservative, rather than optimistic, assumptions about patient accrual.' In future, mix and match of the beams of various properties to individualize the best treatment for each patient should evolve 42 . As is rightly said, 'Necessity is the mother of invention.'…”

Section: Resultsmentioning

confidence: 99%

Evolution and Progress in the Application of Radiation in Cancer Diagnosis and Therapy

Aggarwal¹

2017

Current Science

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Cancer is a ubiquitous health problem globally caused by poor food quality, environmental pollution, genetic factors, etc. Despite the manifold presumptive theories put forth for its causation, there is an extreme paucity of knowledge as regards the actual etiology of cancer, as well as any preventive or prophylactic therapy. The treatment options available include surgery, chemotherapy and radiation therapy (both internal and external). There have been technical and technological advancements in the fields of 'cancer surgery' and 'cancer chemotherapy', and radiotherapy in oncology is not too far behind. X-rays (from linear accelerators LINACs) and gamma rays (e.g. in Bhabhatron) are commonly used for radiation treatment of various types of cancers. New developments include proton beam therapy (PBT) and heavy ion beam therapy (IBT) (e.g. C +6 ion). These new developments of PBT and IBT offer significant advantages to treat paediatric patients, and to radiate deep-seated and radioresistant tumours. This article gives an overview of the various radiation therapies used worldwide, cost comparison of setting up these facilities, operational and treatment costs and advantages, limitations as well as the present status of different charged particle therapy facilities available worldwide.Keywords: Accelerators, cancer, diagnosis, oncology, radiation therapy. CANCER (a generic term for more than 100 different diseases characterized by uncontrolled, abnormal growth of cells) is one of the major killer diseases in humans whose origins are not yet well established despite extensive research in different international laboratories and hospitals all over the world. There are various kinds of cancers, e.g. breast cancer which accounts for 23% of all cancer cases in females, brain cancer, lung cancer, gastrointestinal (GI) cancer, cervical cancer, prostate cancer, etc. The treatment and prognosis are dependent upon the stage at which the cancer is detected, which in turn is governed by the accurate and sensitive cancer diagnostic methodology. Imaging techniques based on different radiations like X-rays and -rays are highly valuable, and are internationally recognized 'gold standards' for cancer diagnosis. X-rays, -rays, -particles, protons and heavy ions are useful for radiation therapy before or after the surgery of a cancerous organ. Radiation therapy can be given by internal radiation (brachytherapy) or external radiation for the treatment of cancer. About 4% of people in developed countries are diagnosed with cancer each year, and more than 50% of these patients are subjected to radiation therapy, along with surgery, as a part of their treatment protocols. Radiation therapy may be used with curative intent, or as a palliative treatment, where cure is not possible. It can be used alone or in combination with other approaches (surgery and chemotherapy) to treat localized solid tumours (e.g. cancers of the skin, brain, breast, or cervix), and also to treat cancers such as leukaemia and lymphoma. Radiation therapy works by ...

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“…Particle beams, including proton, and carbon are a totally different field of EBRT from conventional photon beams [39,53]. Proton and carbon ions have a common superior characteristic over photons.…”

Section: Techniques Of Ebrtmentioning

confidence: 99%

Consensus for Radiotherapy in Hepatocellular Carcinoma from The 5th Asia-Pacific Primary Liver Cancer Expert Meeting (APPLE 2014): Current Practice and Future Clinical Trials

Park

Cheng

et al. 2016

Liver Cancer

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A consensus meeting to develop practice guidelines and to recommend future clinical trials for radiation therapy (RT), including external beam RT (EBRT), and selective internal RT (SIRT) in hepatocellular carcinoma (HCC) was held at the 5th annual meeting of the Asia-Pacific Primary Liver Cancer Expert consortium. Although there is no randomized phase III trial evidence, the efficacy and safety of RT in HCC has been shown by prospective and retrospective studies using modern RT techniques. Based on these results, the committee came to a consensus on the utility and efficacy of RT in the management of HCC according to each disease stage as follows: in early and intermediate stage HCC, if standard treatment is not compatible, RT, including EBRT and SIRT can be considered. In locally advanced stage HCC, combined EBRT with transarterial chemoembolization or hepatic arterial infusion chemotherapy, and SIRT can be considered. In terminal stage HCC, EBRT can be considered for palliation of symptoms and reduction of morbidity caused by the primary tumor or its metastases. Despite the currently reported benefits of RT in HCC, the committee agreed that there is a compelling need for large prospective studies, including randomized phase III trial evidence evaluating the role of RT. Specifically studies evaluating the efficacy and safety of sequential combination of EBRT and SIRT are strongly recommended.

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Promise and Pitfalls of Heavy-Particle Therapy

Cited by 114 publications

References 79 publications

Comprehensive analysis of proton range uncertainties related to stopping-power-ratio estimation using dual-energy CT imaging

Comprehensive analysis of proton range uncertainties related to stopping-power-ratio estimation using dual-energy CT imaging

Evolution and Progress in the Application of Radiation in Cancer Diagnosis and Therapy

Consensus for Radiotherapy in Hepatocellular Carcinoma from The 5th Asia-Pacific Primary Liver Cancer Expert Meeting (APPLE 2014): Current Practice and Future Clinical Trials

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