Pencil Beam Scanning Proton Therapy for Paediatric Neuroblastoma with Motion Mitigation Strategy for Moving Target Volumes
More efforts are required to minimise late radiation side-effects for paediatric patients. Pencil beam scanning proton beam therapy (PBS-PT) allows increased sparing of normal tissues while maintaining conformality, but is prone to dose degradation from interplay effects due to respiratory motion. W...
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| Veröffentlicht in: | Clinical oncology (Royal College of Radiologists (Great Britain)) 2020-07, Vol.32 (7), p.467-476 |
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| creator | Lim, P.S. Pica, A. Hrbacek, J. Bachtiary, B. Walser, M. Lomax, A.J. Weber, D.C. |
| description | More efforts are required to minimise late radiation side-effects for paediatric patients. Pencil beam scanning proton beam therapy (PBS-PT) allows increased sparing of normal tissues while maintaining conformality, but is prone to dose degradation from interplay effects due to respiratory motion. We report our clinical experience of motion mitigation with volumetric rescanning (vRSC) and outcomes of children with neuroblastoma.
Nineteen patients with high-risk (n = 16) and intermediate-risk (n = 3) neuroblastoma received PBS-PT. The median age at PBS-PT was 3.5 years (range 1.2–8.6) and the median PBS-PT dose was 21 Gy (relative biological effectiveness). Most children (89%) were treated under general anaesthesia. Seven patients (37%) underwent four-dimensional computed tomography for motion assessment and were treated with vRSC for motion mitigation.
The mean result of maximum organ motion was 2.7 mm (cranial–caudal), 1.2 mm (left–right), 1.0 mm (anterior–posterior). Four anaesthetised children (21%) showing |
| doi_str_mv | 10.1016/j.clon.2020.02.002 |
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Nineteen patients with high-risk (n = 16) and intermediate-risk (n = 3) neuroblastoma received PBS-PT. The median age at PBS-PT was 3.5 years (range 1.2–8.6) and the median PBS-PT dose was 21 Gy (relative biological effectiveness). Most children (89%) were treated under general anaesthesia. Seven patients (37%) underwent four-dimensional computed tomography for motion assessment and were treated with vRSC for motion mitigation.
The mean result of maximum organ motion was 2.7 mm (cranial–caudal), 1.2 mm (left–right), 1.0 mm (anterior–posterior). Four anaesthetised children (21%) showing <5 mm motion had four-dimensional dose calculations (4DDC) to guide the number of vRSC. The mean deterioration or improvement to the planning target volume covered by 95% of the prescribed dose compared with static three-dimensional plans were: 4DDC no vRSC, –0.6%; 2 vRSC, +0.3%; 4 vRSC, +0.3%; and 8 vRSC, +0.1%. With a median follow-up of 14.9 months (range 2.7–49.0) there were no local recurrences. The 2-year overall survival was 94% and distant progression-free survival was 76%. Acute grade 2–4 toxicity was 11%. During the limited follow-up time, no late toxicities were observed.
The early outcomes of mainly high-risk patients with neuroblastoma treated with PBS-PT were excellent. With a subset of our cohort undergoing PBS-PT with vRSC we have shown that it is logistically feasible and safe. The clinical relevance of vRSC is debatable in anaesthetised children with small pre-PBS-PT motion of <5 mm.
•Pencil beam proton therapy is increasingly used for neuroblastoma.•Early outcomes are excellent with 100% local control.•Volumetric rescanning for motion mitigation in children is safe and feasible.•Interplay dose degradation is minimal in anaesthetised children with <5 mm motion.</description><identifier>ISSN: 0936-6555</identifier><identifier>EISSN: 1433-2981</identifier><identifier>DOI: 10.1016/j.clon.2020.02.002</identifier><identifier>PMID: 32081577</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Child ; Child, Preschool ; children ; Female ; Four-Dimensional Computed Tomography - methods ; Humans ; Infant ; Male ; motion mitigation strategy ; Neuroblastoma ; Neuroblastoma - diagnostic imaging ; Neuroblastoma - pathology ; Neuroblastoma - radiotherapy ; Organ Motion ; pencil beam scanning ; proton therapy ; Proton Therapy - methods ; Radiotherapy Planning, Computer-Assisted - methods ; Radiotherapy Setup Errors - prevention & control ; Relative Biological Effectiveness ; volumetric scanning</subject><ispartof>Clinical oncology (Royal College of Radiologists (Great Britain)), 2020-07, Vol.32 (7), p.467-476</ispartof><rights>2020 The Royal College of Radiologists</rights><rights>Copyright © 2020 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c356t-5e1a595742dbc9d93d4e7fef5f80abe0f73092dd7fd0e94f4d2a79409edfcfcc3</citedby><cites>FETCH-LOGICAL-c356t-5e1a595742dbc9d93d4e7fef5f80abe0f73092dd7fd0e94f4d2a79409edfcfcc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.clon.2020.02.002$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,777,781,3537,27905,27906,45976</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32081577$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lim, P.S.</creatorcontrib><creatorcontrib>Pica, A.</creatorcontrib><creatorcontrib>Hrbacek, J.</creatorcontrib><creatorcontrib>Bachtiary, B.</creatorcontrib><creatorcontrib>Walser, M.</creatorcontrib><creatorcontrib>Lomax, A.J.</creatorcontrib><creatorcontrib>Weber, D.C.</creatorcontrib><title>Pencil Beam Scanning Proton Therapy for Paediatric Neuroblastoma with Motion Mitigation Strategy for Moving Target Volumes</title><title>Clinical oncology (Royal College of Radiologists (Great Britain))</title><addtitle>Clin Oncol (R Coll Radiol)</addtitle><description>More efforts are required to minimise late radiation side-effects for paediatric patients. Pencil beam scanning proton beam therapy (PBS-PT) allows increased sparing of normal tissues while maintaining conformality, but is prone to dose degradation from interplay effects due to respiratory motion. We report our clinical experience of motion mitigation with volumetric rescanning (vRSC) and outcomes of children with neuroblastoma.
Nineteen patients with high-risk (n = 16) and intermediate-risk (n = 3) neuroblastoma received PBS-PT. The median age at PBS-PT was 3.5 years (range 1.2–8.6) and the median PBS-PT dose was 21 Gy (relative biological effectiveness). Most children (89%) were treated under general anaesthesia. Seven patients (37%) underwent four-dimensional computed tomography for motion assessment and were treated with vRSC for motion mitigation.
The mean result of maximum organ motion was 2.7 mm (cranial–caudal), 1.2 mm (left–right), 1.0 mm (anterior–posterior). Four anaesthetised children (21%) showing <5 mm motion had four-dimensional dose calculations (4DDC) to guide the number of vRSC. The mean deterioration or improvement to the planning target volume covered by 95% of the prescribed dose compared with static three-dimensional plans were: 4DDC no vRSC, –0.6%; 2 vRSC, +0.3%; 4 vRSC, +0.3%; and 8 vRSC, +0.1%. With a median follow-up of 14.9 months (range 2.7–49.0) there were no local recurrences. The 2-year overall survival was 94% and distant progression-free survival was 76%. Acute grade 2–4 toxicity was 11%. During the limited follow-up time, no late toxicities were observed.
The early outcomes of mainly high-risk patients with neuroblastoma treated with PBS-PT were excellent. With a subset of our cohort undergoing PBS-PT with vRSC we have shown that it is logistically feasible and safe. The clinical relevance of vRSC is debatable in anaesthetised children with small pre-PBS-PT motion of <5 mm.
•Pencil beam proton therapy is increasingly used for neuroblastoma.•Early outcomes are excellent with 100% local control.•Volumetric rescanning for motion mitigation in children is safe and feasible.•Interplay dose degradation is minimal in anaesthetised children with <5 mm motion.</description><subject>Child</subject><subject>Child, Preschool</subject><subject>children</subject><subject>Female</subject><subject>Four-Dimensional Computed Tomography - methods</subject><subject>Humans</subject><subject>Infant</subject><subject>Male</subject><subject>motion mitigation strategy</subject><subject>Neuroblastoma</subject><subject>Neuroblastoma - diagnostic imaging</subject><subject>Neuroblastoma - pathology</subject><subject>Neuroblastoma - radiotherapy</subject><subject>Organ Motion</subject><subject>pencil beam scanning</subject><subject>proton therapy</subject><subject>Proton Therapy - methods</subject><subject>Radiotherapy Planning, Computer-Assisted - methods</subject><subject>Radiotherapy Setup Errors - prevention & control</subject><subject>Relative Biological Effectiveness</subject><subject>volumetric scanning</subject><issn>0936-6555</issn><issn>1433-2981</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kM1uEzEURi0EoqHwAiyQl2xm8G9mLLGBqtBKDURqYGs59nXqaGYcbE9ReXocUliy8l2c80k-CL2mpKWELt_tWzvEqWWEkZawlhD2BC2o4LxhqqdP0YIovmyWUsoz9CLnPalE36vn6Iwz0lPZdQv0aw2TDQP-CGbEt9ZMU5h2eJ1iiRPe3EEyhwfsY8JrAy6YkoLFX2BOcTuYXOJo8M9Q7vAqllCFVShhZ_6ctyWZAruTvIr3x9mNSTso-Hsc5hHyS_TMmyHDq8f3HH37dLm5uGpuvn6-vvhw01gul6WRQI1UshPMba1yijsBnQcvfU_MFojvOFHMuc47Akp44ZjplCAKnLfeWn6O3p52Dyn-mCEXPYZsYRjMBHHOmglKuOilYBVlJ9SmmHMCrw8pjCY9aEr0sbne62NzfWyuCdO1aJXePO7P2xHcP-Vv5Aq8PwFQf3kfIOlsQ81egyawRbsY_rf_G2Z2la4</recordid><startdate>202007</startdate><enddate>202007</enddate><creator>Lim, P.S.</creator><creator>Pica, A.</creator><creator>Hrbacek, J.</creator><creator>Bachtiary, B.</creator><creator>Walser, M.</creator><creator>Lomax, A.J.</creator><creator>Weber, D.C.</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202007</creationdate><title>Pencil Beam Scanning Proton Therapy for Paediatric Neuroblastoma with Motion Mitigation Strategy for Moving Target Volumes</title><author>Lim, P.S. ; Pica, A. ; Hrbacek, J. ; Bachtiary, B. ; Walser, M. ; Lomax, A.J. ; Weber, D.C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c356t-5e1a595742dbc9d93d4e7fef5f80abe0f73092dd7fd0e94f4d2a79409edfcfcc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Child</topic><topic>Child, Preschool</topic><topic>children</topic><topic>Female</topic><topic>Four-Dimensional Computed Tomography - methods</topic><topic>Humans</topic><topic>Infant</topic><topic>Male</topic><topic>motion mitigation strategy</topic><topic>Neuroblastoma</topic><topic>Neuroblastoma - diagnostic imaging</topic><topic>Neuroblastoma - pathology</topic><topic>Neuroblastoma - radiotherapy</topic><topic>Organ Motion</topic><topic>pencil beam scanning</topic><topic>proton therapy</topic><topic>Proton Therapy - methods</topic><topic>Radiotherapy Planning, Computer-Assisted - methods</topic><topic>Radiotherapy Setup Errors - prevention & control</topic><topic>Relative Biological Effectiveness</topic><topic>volumetric scanning</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lim, P.S.</creatorcontrib><creatorcontrib>Pica, A.</creatorcontrib><creatorcontrib>Hrbacek, J.</creatorcontrib><creatorcontrib>Bachtiary, B.</creatorcontrib><creatorcontrib>Walser, M.</creatorcontrib><creatorcontrib>Lomax, A.J.</creatorcontrib><creatorcontrib>Weber, D.C.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical oncology (Royal College of Radiologists (Great Britain))</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lim, P.S.</au><au>Pica, A.</au><au>Hrbacek, J.</au><au>Bachtiary, B.</au><au>Walser, M.</au><au>Lomax, A.J.</au><au>Weber, D.C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pencil Beam Scanning Proton Therapy for Paediatric Neuroblastoma with Motion Mitigation Strategy for Moving Target Volumes</atitle><jtitle>Clinical oncology (Royal College of Radiologists (Great Britain))</jtitle><addtitle>Clin Oncol (R Coll Radiol)</addtitle><date>2020-07</date><risdate>2020</risdate><volume>32</volume><issue>7</issue><spage>467</spage><epage>476</epage><pages>467-476</pages><issn>0936-6555</issn><eissn>1433-2981</eissn><abstract>More efforts are required to minimise late radiation side-effects for paediatric patients. Pencil beam scanning proton beam therapy (PBS-PT) allows increased sparing of normal tissues while maintaining conformality, but is prone to dose degradation from interplay effects due to respiratory motion. We report our clinical experience of motion mitigation with volumetric rescanning (vRSC) and outcomes of children with neuroblastoma.
Nineteen patients with high-risk (n = 16) and intermediate-risk (n = 3) neuroblastoma received PBS-PT. The median age at PBS-PT was 3.5 years (range 1.2–8.6) and the median PBS-PT dose was 21 Gy (relative biological effectiveness). Most children (89%) were treated under general anaesthesia. Seven patients (37%) underwent four-dimensional computed tomography for motion assessment and were treated with vRSC for motion mitigation.
The mean result of maximum organ motion was 2.7 mm (cranial–caudal), 1.2 mm (left–right), 1.0 mm (anterior–posterior). Four anaesthetised children (21%) showing <5 mm motion had four-dimensional dose calculations (4DDC) to guide the number of vRSC. The mean deterioration or improvement to the planning target volume covered by 95% of the prescribed dose compared with static three-dimensional plans were: 4DDC no vRSC, –0.6%; 2 vRSC, +0.3%; 4 vRSC, +0.3%; and 8 vRSC, +0.1%. With a median follow-up of 14.9 months (range 2.7–49.0) there were no local recurrences. The 2-year overall survival was 94% and distant progression-free survival was 76%. Acute grade 2–4 toxicity was 11%. During the limited follow-up time, no late toxicities were observed.
The early outcomes of mainly high-risk patients with neuroblastoma treated with PBS-PT were excellent. With a subset of our cohort undergoing PBS-PT with vRSC we have shown that it is logistically feasible and safe. The clinical relevance of vRSC is debatable in anaesthetised children with small pre-PBS-PT motion of <5 mm.
•Pencil beam proton therapy is increasingly used for neuroblastoma.•Early outcomes are excellent with 100% local control.•Volumetric rescanning for motion mitigation in children is safe and feasible.•Interplay dose degradation is minimal in anaesthetised children with <5 mm motion.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>32081577</pmid><doi>10.1016/j.clon.2020.02.002</doi><tpages>10</tpages></addata></record> |
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| ispartof | Clinical oncology (Royal College of Radiologists (Great Britain)), 2020-07, Vol.32 (7), p.467-476 |
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| source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
| subjects | Child Child, Preschool children Female Four-Dimensional Computed Tomography - methods Humans Infant Male motion mitigation strategy Neuroblastoma Neuroblastoma - diagnostic imaging Neuroblastoma - pathology Neuroblastoma - radiotherapy Organ Motion pencil beam scanning proton therapy Proton Therapy - methods Radiotherapy Planning, Computer-Assisted - methods Radiotherapy Setup Errors - prevention & control Relative Biological Effectiveness volumetric scanning |
| title | Pencil Beam Scanning Proton Therapy for Paediatric Neuroblastoma with Motion Mitigation Strategy for Moving Target Volumes |
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