Radiation Necrosis in Pediatric Patients with Brain Tumors Treated with Proton Radiotherapy

Kralik, Stephen F.; Ho, Chang Yueh; Finke, Whitney; Buchsbaum, J.; Haskins, Christopher P.; Shih, Chie Schin

doi:10.3174/ajnr.a4333

Cited by 101 publications

(68 citation statements)

References 22 publications

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“…In addition to a more accurate dose calculation, the MC calculation allows the inclusion of a relative biological effectiveness (RBE) model based on the dose-weighted linear energy transfer (LETd) of the protons [10]. This was deemed valuable given the uncertainty [11,12] of the proton RBE as a function of linear energy transfer (LET), the complexity of IMPT plans, and the recent reports of necrosis following PBT [13,14].…”

Section: Introductionmentioning

confidence: 99%

Clinical Implementation of a Proton Dose Verification System Utilizing a GPU Accelerated Monte Carlo Engine

Beltran

Tseung

Augustine

et al. 2016

International Journal of Particle Therapy

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Purpose: To develop a clinical infrastructure that allows for routine Monte Carlo dose calculation verification of spot scanning proton treatment plans and includes a simple biological model to aid in normal tissue protection. Materials and Methods: A graphical processing unit accelerated Monte Carlo dose engine was used as the calculation engine for dose verification on spot scanning proton plans. An infrastructure was built around this engine that allows for seamless exporting of treatment plans from the treatment planning system and importing of dose distribution from the Monte Carlo calculation via DICOM (digital imaging and communications in medicine). An easy-to-use Web-based interface was developed so that the application could be run from any computer. In addition to the standard relative biological effectiveness = 1.1 for proton therapy, a simple linear equation dependent on dose-weighted linear energy transfer was included. This was used to help detect possible high biological dose in critical structures. Results: More than 270 patients were treated at our proton center in the first year of operation. Because most plans underwent multiple iterations before final approval, more than 1000 plans have been run through the system from multiple users with minimal downtime. The average time from plan export to importing of the Monte Carlo doses was less than 15 minutes. Treatment plans have been modified based on the nominal Monte Carlo dose or the biological dose. Conclusion: Monte Carlo dose calculation verification of spot scanning proton treatment plans is feasible in a clinical environment. The 3-dimensional dose verification, particularly near heterogeneities, has resulted in plan modifications. The biological dose data provides actionable feedback for end of range effects, especially in pediatric patients.

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Section: Introductionmentioning

confidence: 99%

Clinical Implementation of a Proton Dose Verification System Utilizing a GPU Accelerated Monte Carlo Engine

Beltran

Tseung

Augustine

et al. 2016

International Journal of Particle Therapy

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“…Several clinical reports on the harms of PT have been published previously, 60,61 including the possibility of increased acute brain injury with use of PBT in children 62 with a high (31%) incidence of rates of radiation necrosis occurring in multiple areas in the brain remote to the initial tumour site and with a short time to onset. 60 Gunther et al reported more frequent MRI changes with PBT compared to IMRT for paediatric ependymoma. 20 There were higher rates of neurological adverse effects in the systematic review by Patel et al 12 in patients with paranasal sinus tumours.…”

Section: Discussionmentioning

confidence: 99%

Particle therapy toxicity outcomes: A systematic review

Hwang

Gorayski

et al. 2020

J Med Imag Rad Onc

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Owing to its physical properties, particle therapy (PT), including proton beam therapy (PBT) and carbon ion therapy (CIT), can enhance the therapeutic ratio in radiation therapy. The major factor driving PT implementation is the reduction in exit and integral dose compared to photon plans, which is expected to translate to reduced toxicity and improved quality of life. This study extends the findings from a recent systematic review by the current authors which concentrated on tumour outcomes for PT, to now examine toxicity as a separate focus. Together, these reviews provide a comprehensive collation of the evidence relating to PT outcomes in clinical practice. Three major databases were searched by two independent researchers, and evidence quality was classified according to the National Health and Medical Research Council evidence hierarchy. One hundred and seventy-nine studies were included. Most demonstrated acceptable and favourable toxicity results. Comparative evidence reported reduced morbidities and improvement in quality of life in head and neck, paediatrics, sarcomas, adult central nervous system, gastrointestinal, ocular and prostate cancers compared to photon radiotherapy. This suggestion for reduced morbidity must be counterbalanced by the overall low quality of evidence. A concerted effort in the design of appropriate comparative clinical trials is needed which takes into account integration of PT's pace of technological advancements, including evolving delivery techniques, image guidance availability and sophistication of planning algorithms.

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“…Several papers have identified this as a potential problem in proton therapy, specifically more brain necrosis than expected. This may be due to the RBE in normal brain for protons being higher than 1.1, which is likely only more probable if using carbon ions and a SOBP.…”

Section: Opening Statementsmentioning

confidence: 99%

Three discipline collaborative radiation therapy (3DCRT) special debate: The United States needs at least one carbon ion facility

Blakely

Faddegon

Tinkle

et al. 2019

J Applied Clin Med Phys

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Three discipline collaborative radiation therapy (3DCRT) special debate: The United States needs at least one carbon ion facility 1 | THREE DISCIPLINE COLLABORATIVE RAD IATION THERAPY (3DCRT) DEBATE SERIESRadiation oncology is a highly multidisciplinary medical specialty, drawing significantly from three scientific disciplinesmedicine, physics, and biology. As a result, discussion of controversies or changes in practice within radiation oncology involves input from all three disciplines. For this reason, significant effort has been expended recently to foster collaborative multidisciplinary research in radiation oncology, with substantial demonstrated benefit.( 1,2 ) In light of these results, we endeavor here to adopt this "team-science" approach to the traditional debates featured in this journal. This article is part of a series of special debates entitled "Three Discipline Collaborative Radiation Therapy (3DCRT)" in which each debate team will include a radiation oncologist, medical physicist, and radiobiologist. We hope that this format will not only be engaging for the readership but will also foster further collaboration in the science and clinical practice of radiation oncology. Dominello serves as the Assistant Program Director for the RadiationOncology Residency Program and as an instructor in courses for both graduate and undergraduate students at the university. Dr.Griffin is a professor of radiation biology at the University of Arkansas for Medical Sciences. His group studies living tissue response to high-dose radiotherapy (SBRT) and spatially fractionated radiation approaches with targeted drug delivery to tumors. He served as a ---

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Radiation Necrosis in Pediatric Patients with Brain Tumors Treated with Proton Radiotherapy

Cited by 101 publications

References 22 publications

Clinical Implementation of a Proton Dose Verification System Utilizing a GPU Accelerated Monte Carlo Engine

Clinical Implementation of a Proton Dose Verification System Utilizing a GPU Accelerated Monte Carlo Engine

Particle therapy toxicity outcomes: A systematic review

Three discipline collaborative radiation therapy (3DCRT) special debate: The United States needs at least one carbon ion facility

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