Robust Proton Treatment Planning: Physical and Biological Optimization
Accurate prediction of tumor control and toxicities in radiation therapy faces many uncertainties. Besides interpatient variability in the response to radiation, there are also dosimetric uncertainties, that is, differences between the dose displayed in a treatment planning system and the dose actually delivered to the patient. These uncertainties originate from several sources including imperfect knowledge of the patient geometry, approximation in the physics of radiation interaction with tissues, and uncertainties in the biological effectiveness of radiation. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - April 1, 2018 Category: Cancer & Oncology Authors: Jan Unkelbach, Harald Paganetti Source Type: research
Will There Be a Clinically Significant Role for Protons in Patients With Gastrointestinal Malignancies?
Gastrointestinal malignancies inherently arise amidst visceral organs that are very radiation sensitive. While radiation therapy is an integral part of cancer treatment, its use has historically been limited by normal tissue toxicity. Proton therapy is a form of external-beam radiation associated with several dosimetric advantages as compared to photon therapy. Proton radiation may allow for the delivery of tumoricidal doses while minimizing side effects by decreasing the dose to adjacent organs at risk. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - April 1, 2018 Category: Cancer & Oncology Authors: Ann C. Raldow, Theodore S. Hong Source Type: research
Can Technological Improvements Reduce the Cost of Proton Radiation Therapy?
This article presents an overview of on-going technical developments, which have a reduction of the capital investment or operational costs either as a major goal or as a potential outcome. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - April 1, 2018 Category: Cancer & Oncology Authors: Jacobus Maarten Schippers, Anthony Lomax, Adriano Garonna, Katia Parodi Source Type: research
Clinical Trial Strategies to Compare Protons With Photons
The favorable beam properties of protons can be translated into clinical benefits by target dose escalation to improve local control without enhancing unacceptable radiation toxicity or to spare normal tissues to prevent radiation-induced side effects without jeopardizing local tumor control. For the clinical validation of the added value of protons to improve local control, randomized controlled trials are required. For the clinical validation of the added value of protons to prevent side effects, both model-based validation or randomized controlled trials can be used. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - April 1, 2018 Category: Cancer & Oncology Authors: Johannes A. Langendijk, Liesbeth J. Boersma, Coen R.N. Rasch, Marco van Vulpen, Johannes B. Reitsma, Arjen van der Schaaf, Ewoud Schuit Source Type: research
Potential Morbidity Reduction With Proton Radiation Therapy for Breast Cancer
Proton radiotherapy confers significant dosimetric advantages in the treatment of malignancies that arise adjacent to critical radiosensitive structures. To date, these advantages have been most prominent in the treatment of pediatric and central nervous system malignancies, although emerging data support the use of protons among other anatomical sites in which radiotherapy plays an important role.With advances in the overall treatment paradigm for breast cancer, most patients with localized disease now exhibit long-term disease control and, consequently, may manifest the late toxicities of aggressive treatment. (Source: S...
Source: Seminars in Radiation Oncology - April 1, 2018 Category: Cancer & Oncology Authors: Lior Z. Braunstein, Oren Cahlon Source Type: research
Charged Issues: Particle Radiation Therapy
This issue of Seminars in Radiation Oncology revisits the issue of protons and charged particle radiation, one that was addressed in the April 2013 (volume 23, number 2) issue. We refer the reader to that issue, which included many excellent articles focused on proton and charged particle radiation therapy. Since the time of that publication, the number of charged particle facilities in operation has continued to increase, there has been a significant migration to delivery with scanned beams, and multiple, randomized clinical trials to compare outcomes with protons compared to photons have been activated. (Source: Seminars...
Source: Seminars in Radiation Oncology - April 1, 2018 Category: Cancer & Oncology Authors: Thomas F. DeLaney Source Type: research
Comparing Intensity-Modulated Proton Therapy With Intensity-Modulated Photon Therapy for Oropharyngeal Cancer: The Journey From Clinical Trial Concept to Activation
Intensity-modulated proton therapy minimizes the incidental irradiation of normal tissues in patients with head and neck cancer relative to intensity-modulated photon (x-ray) therapy and has been associated with lesser treatment-related toxicity and improved quality of life. A phase II/III randomized trial sponsored by the US National Cancer Institute is currently underway to compare deintensification treatment strategies with intensity-modulated proton therapy vs intensity-modulated photon (x-ray) therapy for patients with advanced-stage oropharyngeal tumors. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - April 1, 2018 Category: Cancer & Oncology Authors: Steven J. Frank, Pierre Blanchard, J. Jack Lee, Erich M. Sturgis, Merrill S. Kies, Mitchell Machtay, Bhadrasain Vikram, Adam S. Garden, David I. Rosenthal, G. Brandon Gunn, C. David Fuller, Katherine Hutcheson, Stephen Lai, Paul M. Busse, Nancy Y. Lee, Al Source Type: research
Current Status and Future Directions of Treatment Deintensification in Human Papilloma Virus-associated Oropharyngeal Squamous Cell Carcinoma
The prevalence of patients with human papilloma virus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) is rapidly increasing, and it is now well known that these patients have a significantly better prognosis than patients with HPV-negative OPSCC. Though standard treatments result in excellent cancer control, they are also associated with substantial long-term toxicity. There is now great interest in evaluating less intensive (ie, deintensified) treatment regimens to improve the therapeutic ratio (maintain excellent cancer control and decrease toxicity). (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - November 24, 2017 Category: Cancer & Oncology Authors: Bhishamjit S. Chera, Robert J. Amdur Source Type: research
Organ-Sparing in Radiotherapy for Head-and-Neck Cancer: Improving Quality of Life
This is an overview of select studies characterizing the effect of radiation on normal tissues in the treatment of head-and-neck cancer. Recommendations for organ-at-risk dose constraints aiming to reduce risks of xerostomia and dysphagia, the factors which have the highest effect on patient quality of life, are discussed, along with their supporting evidence. Recent advances in technology and biology, and their implications for reducing toxicity are explored. Considerations related to organ-sparing in the setting of treatment deintensification for good-prognosis head-and-neck cancer are also discussed. (Source: Seminars i...
Source: Seminars in Radiation Oncology - November 24, 2017 Category: Cancer & Oncology Authors: Peter G. Hawkins, Amrut S. Kadam, William C. Jackson, Avraham Eisbruch Source Type: research
Molecular Imaging-Guided Radiotherapy for the Treatment of Head-and-Neck Squamous Cell Carcinoma: Does it Fulfill the Promises?
With the routine use of intensity modulated radiation therapy for the treatment of head-and-neck squamous cell carcinoma allowing highly conformed dose distribution, there is an increasing need for refining both the selection and the delineation of gross tumor volumes (GTV). In this framework, molecular imaging with positron emission tomography and magnetic resonance imaging offers the opportunity to improve diagnostic accuracy and to integrate tumor biology mainly related to the assessment of tumor cell density, tumor hypoxia, and tumor proliferation into the treatment planning equation. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - November 24, 2017 Category: Cancer & Oncology Authors: Vincent Gr égoire, Daniela Thorwarth, John Aldo Lee Source Type: research
Proton Therapy for Head and Neck Cancers
Because of its sharp lateral penumbra and steep distal fall-off, proton therapy offers dosimetric advantages over photon therapy. In head and neck cancer, proton therapy has been used for decades in the treatment of skull-base tumors. In recent years the use of proton therapy has been extended to numerous other disease sites, including nasopharynx, oropharynx, nasal cavity and paranasal sinuses, periorbital tumors, skin, and salivary gland, or to reirradiation. The aim of this review is to present the physical properties and dosimetric benefit of proton therapy over advanced photon therapy; to summarize the clinical benefi...
Source: Seminars in Radiation Oncology - November 24, 2017 Category: Cancer & Oncology Authors: Pierre Blanchard, Gary Brandon Gunn, Alexander Lin, Robert L. Foote, Nancy Y. Lee, Steven J. Frank Source Type: research
Therapeutic Implications of the Genetic Landscape of Head and Neck Cancer
Large-scale sequencing studies of head and neck squamous cell carcinoma (HNSCC) have elucidated the genetic changes that characterize HNSCC. These findings have supported the development of therapeutic strategies that target key components of aberrant signaling pathways and immune dysregulation. Cumulative evidence suggests that these agents in combination with radiotherapy may have synergistic effects. This review highlights the predictive biomarkers that have been identified from HNSCC genomic studies and implications on the development of molecular-targeting agents that may effectively treat patients with HNSCC, especia...
Source: Seminars in Radiation Oncology - November 24, 2017 Category: Cancer & Oncology Authors: Janice Cho, Daniel E. Johnson, Jennifer R. Grandis Source Type: research
Introduction
Recent advances in the treatment of head and neck cancer (HNC) described in this issue of Seminars include assessments of major recent development in the epidemiology, prognostic factors, and therapy of HNC. The implications of the changes in the biology of oropharyngeal cancers, better understanding of the genomic landscapes and their utilization in targeted therapy, the role of immunotherapy in conjuction with radiotherapy, technological advances and their effect on tumor control, toxicities and quality of life, are the subject of the articles in this issue. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - November 24, 2017 Category: Cancer & Oncology Authors: Avraham Eisbruch Source Type: research
The Current State of Biological and Clinical Implications of Human Papillomavirus-Related Oropharyngeal Cancer
In the effort to control human papillomavirus-related oropharyngeal cancer, the head and neck oncology community has devoted much effort to understanding its disease biology and clinical behavior, and refining strategies to address early diagnosis and optimal management for the affected population. This review identifies articles published up to March 2017 on tumor biology and clinical implications of human papillomavirus-related oropharyngeal cancer, and summarizes the findings in some key areas. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - November 24, 2017 Category: Cancer & Oncology Authors: Shao Hui Huang, Brian O'Sullivan, John Waldron Source Type: research
Head and Neck Cancer Survivorship: Learning the Needs, Meeting the Needs
Cancers of the head and neck and the treatments required to control them frequently result in serious and persistent impairments that can affect participation and quality of life. Increased recognition of the needs of cancer survivors and their caregivers has prompted research focused on the unique concerns of this complex group. Unmet needs have been identified among 60 –70% of patients and a similar proportion of their partners; impacts can include profound social effects, isolation, and psychiatric conditions. (Source: Seminars in Radiation Oncology)
Source: Seminars in Radiation Oncology - November 24, 2017 Category: Cancer & Oncology Authors: Jolie Ringash, Lori J. Bernstein, Gerald Devins, Colleen Dunphy, Meredith Giuliani, Rosemary Martino, Sara McEwen Source Type: research
