Reirradiation of Large-Volume Recurrent Glioma With Pulsed Reduced-Dose-Rate Radiotherapy

Adkison, Jarrod B.; Tomé, Wolfgang A.; Seo, Songwon; Richards, Gregory M.; Robins, H. Ian; Rassmussen, K.; Welsh, James S.; Mahler, Peter A.; Howard, Steven

doi:10.1016/j.ijrobp.2009.11.058

Cited by 73 publications

(96 citation statements)

References 27 publications

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“…[1][2][3][4] This involves spreading out a conventional radiation therapy dose into short pulses of dose with breaks in between. By example, a PLDR regimen may involve delivering a dose of 2 Gy as 10 pulses of 0.2 Gy, each 3 minutes apart.…”

Section: Introductionmentioning

confidence: 99%

Tissue TGF-β expression following conventional radiotherapy and pulsed low-dose-rate radiation

et al. 2017

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The release of inflammatory cytokines has been implicated in the toxicity of conventional radiotherapy (CRT). Transforming growth factor b (TGF-b) has been suggested to be a risk marker for pulmonary toxicity following radiotherapy. Pulsed low-dose rate radiotherapy (PLDR) is a technique that involves spreading out a conventional radiotherapy dose into short pulses of dose with breaks in between to reduce toxicities. We hypothesized that the more tolerable toxicity profile of PLDR compared with CRT may be related to differential expression of inflammatory cytokines such as TGF-b in normal tissues. To address this, we analyzed tissues from mice that had been subjected to lethal doses of CRT and PLDR by histology and immunohistochemistry (IHC). Equivalent physical doses of CRT triggered more cellular atrophy in the bone marrow, intestine, and pancreas when compared with PLDR as indicated by hematoxylin and eosin staining. IHC data indicates that TGF-b expression is increased in the bone marrow, intestine, and lungs of mice subjected to CRT as compared with tissues from mice subjected to PLDR. Our in vivo data suggest that differential expression of inflammatory cytokines such as TGF-b may play a role in the more favorable normal tissue late response following treatment with PLDR.

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Section: Introductionmentioning

confidence: 99%

Tissue TGF-β expression following conventional radiotherapy and pulsed low-dose-rate radiation

et al. 2017

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“…The remarkable potential gains in modeled tumor control probability in cell lines derived from human glioma in his first reference 1 were not, however, translated into improved survival in PRDR treatment for recurrent glioma in his second reference. 2 In that study, median survival from initiation of PRDR was 5.1 months for Grade 4, 5.6 months for Grade 3, and 11.4 months for tumors initially classified as low-grade. These dismal survival rates are essentially the same as those for other experimental treatments, such as the eight recurrent glioma Phase II drug trials reviewed in Ref.…”

Section: Opening Statementmentioning

confidence: 86%

“…2 For PRDR re-treatment of locally recurrent breast cancer described in his third reference, 3 a trend toward higher local control was indeed found compared to re-treatment with electron beams in a 1978 study with a similar follow-up period, 92% versus 69%. The 17 patients of the study, however, was a number too small for meaningful statistical significance, and, furthermore, the acute toxicity rate was 23%, which is higher than the 8% reported for the electron-beam re-treatments.…”

Section: Opening Statementmentioning

confidence: 87%

“…The improvement in radiobiological understanding has for a long time lagged behind this technological development, but it is expected to play a more significant role in the further advancement of radiotherapy for both curative and palliative care. The favorable outcomes of some pilot studies on radioresistant malignant tumors (8 patients), recurrent breast carcinoma (17 patients), and glioblastoma multiforme (103 patients) 2,3,14 not only demonstrated the clinical effectiveness of the PRDR technique for these body sites but also provided convincing evidence to support future large scale and=or randomized clinical trials to determine the efficacy of the PRDR technique for other recurrent and potentially radioresistant cancers.…”

Section: Opening Statementmentioning

confidence: 92%

“…The rich in-vitro and in-vivo experimental results have laid a strong radiobiological foundation for the PRDR technique and these have been used to guide pilot studies to find optimal doses, dose rates, and fractionation schemes for particular body sites. 2,3,8,14,15 A clear advantage of the PRDR technique over conventional radiotherapy is the reduced normal tissue damage at lower dose rates, which has offered hope for some recurrent patients with severe and=or life threatening symptoms, who have been otherwise considered unsuitable for re-irradiation with conventional radiotherapy. The fact that many radioresistant tumor cells exhibit higher RHS=IRR ratios at lower doses and dose rates 6 also suggests that the PRDR technique may be a better choice than conventional radiotherapy for some recurrent cancers because of the possible existence of such radioresistant tumor cells.…”

Section: Opening Statementmentioning

confidence: 99%

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Pulsed reduced dose rate radiation therapy is likely to become the treatment modality of choice for recurrent cancers

Charlie

Luxton

Orton³

2011

Medical Physics

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Dose‐rate dependence and IMRT QA suitability of EBT3 radiochromic films for pulse reduced dose‐rate radiotherapy (PRDR) dosimetry

Khan,

Radtke,

Hammer

et al. 2023

J Applied Clin Med Phys

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BackgroundPulsed reduced dose rate (PRDR) is an emerging radiotherapy technique for recurrent diseases. It is pertinent that the linac beam characteristics are evaluated for PRDR dose rates and a suitable dosimeter is employed for IMRT QA.PurposeThis study sought to investigate the pulse characteristics of a 6 MV photon beam during PRDR irradiations on a commercial linac. The feasibility of using EBT3 radiochromic film for use in IMRT QA was also investigated by comparing its response to a commercial diode array phantom.MethodsA plastic scintillator detector was employed to measure the photon pulse characteristics across nominal repetition rates (NRRs) in the 5–600 MU/min range. Film was irradiated with dose rates in the 0.033–4 Gy/min range to study the dose rate dependence. Five clinical PRDR treatment plans were selected for IMRT QA with the Delta4 phantom and EBT3 film sheets. The planned and measured dose were compared using gamma analysis with a criterion of 3%/3 mm. EBT3 film QA was performed using a cumulative technique and a weighting factor technique.ResultsNegligible differences were observed in the pulse width and height data between the investigated NRRs. The pulse width was measured to be 3.15 ± 0.01 and the PRF was calculated to be 3–357 Hz for the 5–600 MU/min NRRs. The EBT3 film was found to be dose rate independent within 3%. The gamma pass rates (GPRs) were above 99% and 90% for the Delta4 phantom and the EBT3 film using the cumulative QA method, respectively. GPRs as low as 80% were noted for the weighting factor EBT3 QA method.ConclusionsAltering the NRRs changes the mean dose rate while the instantaneous dose rate remains constant. The EBT3 film was found to be suitable for PRDR dosimetry and IMRT QA with minimal dose rate dependence.

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Reirradiation of Large-Volume Recurrent Glioma With Pulsed Reduced-Dose-Rate Radiotherapy

Cited by 73 publications

References 27 publications

Tissue TGF-β expression following conventional radiotherapy and pulsed low-dose-rate radiation

Tissue TGF-β expression following conventional radiotherapy and pulsed low-dose-rate radiation

Pulsed reduced dose rate radiation therapy is likely to become the treatment modality of choice for recurrent cancers

Dose‐rate dependence and IMRT QA suitability of EBT3 radiochromic films for pulse reduced dose‐rate radiotherapy (PRDR) dosimetry

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