Radiation-induced brain injury in patients with meningioma treated with proton or photon therapy

Song, Jiheon; Aljabab, Saif; Abduljabbar, Lulwah; Tseng, Yolanda D.; Rockhill, Jason K.; Fink, James R.; Chang, Lynn; Halasz, Lia M.

doi:10.1007/s11060-021-03758-y

Cited by 13 publications

(8 citation statements)

References 48 publications

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“…The short-term toxicities caused by proton therapy were mainly alopecia, headache, or fatigue. These common side-effects following proton therapy were the same as low-grade gliomas or other intracranial tumors [38][39][40]. In a phase II trial by Brown et al [12], there was no indication of improved survival outcomes with proton therapy compared to IMRT.…”

Section: Discussionmentioning

confidence: 99%

Charged particle therapy for high-grade gliomas in adults: a systematic review

et al. 2023

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High-grade gliomas are the most common intracranial malignancies, and their current prognosis remains poor despite standard aggressive therapy. Charged particle beams have unique physical and biological properties, especially high relative biological effectiveness (RBE) of carbon ion beam might improve the clinical treatment outcomes of malignant gliomas. We systematically reviewed the safety, efficacy, and dosimetry of carbon-ion or proton radiotherapy to treat high-grade gliomas. The protocol is detailed in the online PROSPERO database, registration No. CRD42021258495. PubMed, EMBASE, Web of Science, and The Cochrane Library databases were collected for data analysis on charged particle radiotherapy for high-grade gliomas. Until July 2022, two independent reviewers extracted data based on inclusion and exclusion criteria. Eleven articles were eligible for further analysis. Overall survival rates were marginally higher in patients with the current standard of care than those receiving concurrent intensity-modulated radiotherapy plus temozolomide. The most common side effects of carbon-ion-related therapy were grade 1–2 (such as dermatitis, headache, and alopecia). Long-term toxicities (more than three to six months) usually present as radiation necrosis; however, toxicities higher than grade 3 were not observed. Similarly, dermatitis, headache, and alopecia are among the most common acute side effects of proton therapy treatment. Despite improvement in survival rates, the method of dose-escalation using proton boost is associated with severe brain necrosis which should not be clinically underestimated. Regarding dosimetry, two studies compared proton therapy and intensity‐modulated radiation therapy plans. Proton therapy plans aimed to minimize dose exposure to non-target tissues while maintaining target coverage. The use of charged-particle radiotherapy seems to be effective with acceptable adverse effects when used either alone or as a boost. The tendency of survival outcome shows that carbon ion boost is seemingly superior to proton boost. The proton beam could provide good target coverage, and it seems to reduce dose exposure to contralateral organs at risk significantly. This can potentially reduce the treatment-related dose- and volume-related side effects in long-term survivors, such as neurocognitive impairment. High-quality randomized control trials should be conducted in the future. Moreover, Systemic therapeutic options that can be paired with charged particles are necessary.

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Section: Discussionmentioning

confidence: 99%

Charged particle therapy for high-grade gliomas in adults: a systematic review

et al. 2023

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“…However, several groups have shown that radiographic evidence of parenchymal central nervous system imaging changes are higher with particle therapy [ 14 ]. Song et al [ 15 ] reviewed treatment of 77 patients with meningioma; 38 received proton therapy and 39 received photon therapy. While grade 2 or higher adverse effects were 10% or less in both cohorts, the 2-year cumulative incidences of magnetic resonance imaging changes were 26.8% after proton therapy and 5.3% after photon therapy ( p = 0.02).…”

Section: Clinical Outcomes Datamentioning

confidence: 99%

Impact of Relative Biologic Effectiveness for Proton Therapy for Head and Neck and Skull-Base Tumors: A Technical and Clinical Review

Holtzman,

Mohammadi,

Furutani

et al. 2024

Cancers

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Proton therapy has emerged as a crucial tool in the treatment of head and neck and skull-base cancers, offering advantages over photon therapy in terms of decreasing integral dose and reducing acute and late toxicities, such as dysgeusia, feeding tube dependence, xerostomia, secondary malignancies, and neurocognitive dysfunction. Despite its benefits in dose distribution and biological effectiveness, the application of proton therapy is challenged by uncertainties in its relative biological effectiveness (RBE). Overcoming the challenges related to RBE is key to fully realizing proton therapy’s potential, which extends beyond its physical dosimetric properties when compared with photon-based therapies. In this paper, we discuss the clinical significance of RBE within treatment volumes and adjacent serial organs at risk in the management of head and neck and skull-base tumors. We review proton RBE uncertainties and its modeling and explore clinical outcomes. Additionally, we highlight technological advancements and innovations in plan optimization and treatment delivery, including linear energy transfer/RBE optimizations and the development of spot-scanning proton arc therapy. These advancements show promise in harnessing the full capabilities of proton therapy from an academic standpoint, further technological innovations and clinical outcome studies, however, are needed for their integration into routine clinical practice.

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“…Proton CSI patients also had a significantly lower incidence of grade ≥ 1 anemia than photon CSI patients, whereas the incidence of grade ≥ 1 leukopenia and thrombocytopenia did not differ significantly (Table 6). For cranial irradiation, Song et al (49) showed there were no statistically significant differences in grade ≥ 2 symptomatic brain injury, 2-year progression-free survival and OS between USPT/PBSPT and VMAT/tomotherapy for grade I-III meningioma. However, a retrospective study based on the National Cancer Database indicated that grade I-IV glioma patients treated with proton radiation therapy achieved superior 5-year OS compared to photon radiation therapy after propensity score weighting (50) (Table 6).…”

Section: Central Nervous System Cancer 361 Adult Cns Cancermentioning

confidence: 99%

Proton versus photon radiation therapy: A clinical review

et al. 2023

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While proton radiation therapy offers substantially better dose distribution characteristics than photon radiation therapy in certain clinical applications, data demonstrating a quantifiable clinical advantage is still needed for many treatment sites. Unfortunately, the number of patients treated with proton radiation therapy is still comparatively small, in some part due to the lack of evidence of clear benefits over lower-cost photon-based treatments. This review is designed to present the comparative clinical outcomes between proton and photon therapies, and to provide an overview of the current state of knowledge regarding the effectiveness of proton radiation therapy.

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Radiation-induced brain injury in patients with meningioma treated with proton or photon therapy

Cited by 13 publications

References 48 publications

Charged particle therapy for high-grade gliomas in adults: a systematic review

Charged particle therapy for high-grade gliomas in adults: a systematic review

Impact of Relative Biologic Effectiveness for Proton Therapy for Head and Neck and Skull-Base Tumors: A Technical and Clinical Review

Proton versus photon radiation therapy: A clinical review

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