Sacral-Nerve-Sparing Planning Strategy in Pelvic Sarcomas/Chordomas Treated with Carbon-Ion Radiotherapy
To minimize radiation-induced lumbosacral neuropathy (RILSN), we employed sacral-nerve-sparing optimized carbon-ion therapy strategy (SNSo-CIRT) in treating 35 patients with pelvic sarcomas/chordomas. Plans were optimized using Local Effect Model-I (LEM-I), prescribed D (median dose to HD-PTV) = 73....
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| Veröffentlicht in: | Cancers 2024-04, Vol.16 (7), p.1284 |
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| creator | Nachankar, Ankita Schafasand, Mansure Hug, Eugen Martino, Giovanna Góra, Joanna Carlino, Antonio Stock, Markus Fossati, Piero |
| description | To minimize radiation-induced lumbosacral neuropathy (RILSN), we employed sacral-nerve-sparing optimized carbon-ion therapy strategy (SNSo-CIRT) in treating 35 patients with pelvic sarcomas/chordomas. Plans were optimized using Local Effect Model-I (LEM-I), prescribed D
(median dose to HD-PTV) = 73.6 (70.4-76.8) Gy (RBE)/16 fractions. Sacral nerves were contoured between L5-S3 levels. D
to 5% of sacral nerves-to-spare (outside HD-CTV) (D
) were restricted to |
| doi_str_mv | 10.3390/cancers16071284 |
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(median dose to HD-PTV) = 73.6 (70.4-76.8) Gy (RBE)/16 fractions. Sacral nerves were contoured between L5-S3 levels. D
to 5% of sacral nerves-to-spare (outside HD-CTV) (D
) were restricted to <69 Gy (RBE). The median follow-up was 25 months (range of 2-53). Three patients (9%) developed late RILSN (≥G3) after an average period of 8 months post-CIRT. The RILSN-free survival at 2 years was 91% (CI, 81-100). With SNSo-CIRT, D
for sacral nerves-to-spare = 66.9 ± 1.9 Gy (RBE), maintaining D
to 98% of HD-CTV (D
) = 70 ± 3.6 Gy (RBE). Two-year OS and LC were 100% and 93% (CI, 84-100), respectively. LETd and D
with modified-microdosimetric kinetic model (mMKM) were recomputed retrospectively. D
and D
were similar, but D
-filtered-LETd was higher in sacral nerves-to-spare in patients with RILSN than those without. At D
cutoff = 64 Gy (RBE), 2-year RILSN-free survival was 100% in patients with <12% of sacral nerves-to-spare voxels receiving LETd > 55 keV/µm than 75% (CI, 54-100) in those with ≥12% of voxels (
< 0.05). D
-filtered-LETd holds promise for the SNSo-CIRT strategy but requires longer follow-up for validation.</description><identifier>ISSN: 2072-6694</identifier><identifier>EISSN: 2072-6694</identifier><identifier>DOI: 10.3390/cancers16071284</identifier><identifier>PMID: 38610962</identifier><language>eng</language><publisher>Switzerland: MDPI AG</publisher><subject>Carbon ; Chemotherapy ; Denosumab ; Diabetes ; Ethics ; Hypoxia ; Medical imaging ; Medical prognosis ; Morbidity ; Nerves ; Neuropathy ; Patients ; Planning ; Radiation therapy ; Radiotherapy ; Sacrum ; Sarcoma ; Sciatic nerve ; Surgery ; Survival ; Toxicity ; Tumors</subject><ispartof>Cancers, 2024-04, Vol.16 (7), p.1284</ispartof><rights>COPYRIGHT 2024 MDPI AG</rights><rights>2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c387t-e94ae6e37554d5fc66aebe3955825ce7263adb52e14be74552fe608e159623523</cites><orcidid>0000-0001-7510-7759 ; 0000-0002-3742-8794 ; 0000-0003-4935-2990</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38610962$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nachankar, Ankita</creatorcontrib><creatorcontrib>Schafasand, Mansure</creatorcontrib><creatorcontrib>Hug, Eugen</creatorcontrib><creatorcontrib>Martino, Giovanna</creatorcontrib><creatorcontrib>Góra, Joanna</creatorcontrib><creatorcontrib>Carlino, Antonio</creatorcontrib><creatorcontrib>Stock, Markus</creatorcontrib><creatorcontrib>Fossati, Piero</creatorcontrib><title>Sacral-Nerve-Sparing Planning Strategy in Pelvic Sarcomas/Chordomas Treated with Carbon-Ion Radiotherapy</title><title>Cancers</title><addtitle>Cancers (Basel)</addtitle><description>To minimize radiation-induced lumbosacral neuropathy (RILSN), we employed sacral-nerve-sparing optimized carbon-ion therapy strategy (SNSo-CIRT) in treating 35 patients with pelvic sarcomas/chordomas. Plans were optimized using Local Effect Model-I (LEM-I), prescribed D
(median dose to HD-PTV) = 73.6 (70.4-76.8) Gy (RBE)/16 fractions. Sacral nerves were contoured between L5-S3 levels. D
to 5% of sacral nerves-to-spare (outside HD-CTV) (D
) were restricted to <69 Gy (RBE). The median follow-up was 25 months (range of 2-53). Three patients (9%) developed late RILSN (≥G3) after an average period of 8 months post-CIRT. The RILSN-free survival at 2 years was 91% (CI, 81-100). With SNSo-CIRT, D
for sacral nerves-to-spare = 66.9 ± 1.9 Gy (RBE), maintaining D
to 98% of HD-CTV (D
) = 70 ± 3.6 Gy (RBE). Two-year OS and LC were 100% and 93% (CI, 84-100), respectively. LETd and D
with modified-microdosimetric kinetic model (mMKM) were recomputed retrospectively. D
and D
were similar, but D
-filtered-LETd was higher in sacral nerves-to-spare in patients with RILSN than those without. At D
cutoff = 64 Gy (RBE), 2-year RILSN-free survival was 100% in patients with <12% of sacral nerves-to-spare voxels receiving LETd > 55 keV/µm than 75% (CI, 54-100) in those with ≥12% of voxels (
< 0.05). D
-filtered-LETd holds promise for the SNSo-CIRT strategy but requires longer follow-up for validation.</description><subject>Carbon</subject><subject>Chemotherapy</subject><subject>Denosumab</subject><subject>Diabetes</subject><subject>Ethics</subject><subject>Hypoxia</subject><subject>Medical imaging</subject><subject>Medical prognosis</subject><subject>Morbidity</subject><subject>Nerves</subject><subject>Neuropathy</subject><subject>Patients</subject><subject>Planning</subject><subject>Radiation therapy</subject><subject>Radiotherapy</subject><subject>Sacrum</subject><subject>Sarcoma</subject><subject>Sciatic nerve</subject><subject>Surgery</subject><subject>Survival</subject><subject>Toxicity</subject><subject>Tumors</subject><issn>2072-6694</issn><issn>2072-6694</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNptkc1P3DAQxa0KVBBw7q2K1AuXsP52ckQr2iKhgrr0HE2cya5RYi92lmr_-zqCohZhH_xk_d54xo-QT4xeCFHThQVvMSamqWG8kh_IMaeGl1rX8uAffUTOUnqgeQnBjDYfyZGoNKO15sdkswIbYSh_YHzCcrWF6Py6uBvA-1mspggTrveF88UdDk_OFiuINoyQFstNiN2sivuImeqK327aFEuIbfDldfDFT-hcmDYYYbs_JYc9DAnPXs4T8uvr1f3ye3lz--16eXlTWlGZqcRaAmoURinZqd5qDdiiqJWquLJouBbQtYojky0aqRTvUdMKmcrjCMXFCTl_rruN4XGHaWpGlywOeSIMu9QIKiopqaxpRr-8QR_CLvrc3UyZzIn83Cu1hgEb5_uQ_8TORZtLU1PKjNR1pi7eofLucHQ2eOxdvv_PsHg22BhSitg32-hGiPuG0WaOt3kTb3Z8fml3147YvfJ_wxR_AJbjn2M</recordid><startdate>20240401</startdate><enddate>20240401</enddate><creator>Nachankar, Ankita</creator><creator>Schafasand, Mansure</creator><creator>Hug, Eugen</creator><creator>Martino, Giovanna</creator><creator>Góra, Joanna</creator><creator>Carlino, Antonio</creator><creator>Stock, Markus</creator><creator>Fossati, Piero</creator><general>MDPI AG</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7TO</scope><scope>7XB</scope><scope>8FE</scope><scope>8FH</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>HCIFZ</scope><scope>LK8</scope><scope>M2O</scope><scope>M7P</scope><scope>MBDVC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7510-7759</orcidid><orcidid>https://orcid.org/0000-0002-3742-8794</orcidid><orcidid>https://orcid.org/0000-0003-4935-2990</orcidid></search><sort><creationdate>20240401</creationdate><title>Sacral-Nerve-Sparing Planning Strategy in Pelvic Sarcomas/Chordomas Treated with Carbon-Ion Radiotherapy</title><author>Nachankar, Ankita ; Schafasand, Mansure ; Hug, Eugen ; Martino, Giovanna ; Góra, Joanna ; Carlino, Antonio ; Stock, Markus ; Fossati, Piero</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c387t-e94ae6e37554d5fc66aebe3955825ce7263adb52e14be74552fe608e159623523</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Carbon</topic><topic>Chemotherapy</topic><topic>Denosumab</topic><topic>Diabetes</topic><topic>Ethics</topic><topic>Hypoxia</topic><topic>Medical imaging</topic><topic>Medical prognosis</topic><topic>Morbidity</topic><topic>Nerves</topic><topic>Neuropathy</topic><topic>Patients</topic><topic>Planning</topic><topic>Radiation therapy</topic><topic>Radiotherapy</topic><topic>Sacrum</topic><topic>Sarcoma</topic><topic>Sciatic nerve</topic><topic>Surgery</topic><topic>Survival</topic><topic>Toxicity</topic><topic>Tumors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nachankar, Ankita</creatorcontrib><creatorcontrib>Schafasand, Mansure</creatorcontrib><creatorcontrib>Hug, Eugen</creatorcontrib><creatorcontrib>Martino, Giovanna</creatorcontrib><creatorcontrib>Góra, Joanna</creatorcontrib><creatorcontrib>Carlino, Antonio</creatorcontrib><creatorcontrib>Stock, Markus</creatorcontrib><creatorcontrib>Fossati, Piero</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Immunology Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection (ProQuest)</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Biological Science Collection</collection><collection>Research Library</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Cancers</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nachankar, Ankita</au><au>Schafasand, Mansure</au><au>Hug, Eugen</au><au>Martino, Giovanna</au><au>Góra, Joanna</au><au>Carlino, Antonio</au><au>Stock, Markus</au><au>Fossati, Piero</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Sacral-Nerve-Sparing Planning Strategy in Pelvic Sarcomas/Chordomas Treated with Carbon-Ion Radiotherapy</atitle><jtitle>Cancers</jtitle><addtitle>Cancers (Basel)</addtitle><date>2024-04-01</date><risdate>2024</risdate><volume>16</volume><issue>7</issue><spage>1284</spage><pages>1284-</pages><issn>2072-6694</issn><eissn>2072-6694</eissn><abstract>To minimize radiation-induced lumbosacral neuropathy (RILSN), we employed sacral-nerve-sparing optimized carbon-ion therapy strategy (SNSo-CIRT) in treating 35 patients with pelvic sarcomas/chordomas. Plans were optimized using Local Effect Model-I (LEM-I), prescribed D
(median dose to HD-PTV) = 73.6 (70.4-76.8) Gy (RBE)/16 fractions. Sacral nerves were contoured between L5-S3 levels. D
to 5% of sacral nerves-to-spare (outside HD-CTV) (D
) were restricted to <69 Gy (RBE). The median follow-up was 25 months (range of 2-53). Three patients (9%) developed late RILSN (≥G3) after an average period of 8 months post-CIRT. The RILSN-free survival at 2 years was 91% (CI, 81-100). With SNSo-CIRT, D
for sacral nerves-to-spare = 66.9 ± 1.9 Gy (RBE), maintaining D
to 98% of HD-CTV (D
) = 70 ± 3.6 Gy (RBE). Two-year OS and LC were 100% and 93% (CI, 84-100), respectively. LETd and D
with modified-microdosimetric kinetic model (mMKM) were recomputed retrospectively. D
and D
were similar, but D
-filtered-LETd was higher in sacral nerves-to-spare in patients with RILSN than those without. At D
cutoff = 64 Gy (RBE), 2-year RILSN-free survival was 100% in patients with <12% of sacral nerves-to-spare voxels receiving LETd > 55 keV/µm than 75% (CI, 54-100) in those with ≥12% of voxels (
< 0.05). D
-filtered-LETd holds promise for the SNSo-CIRT strategy but requires longer follow-up for validation.</abstract><cop>Switzerland</cop><pub>MDPI AG</pub><pmid>38610962</pmid><doi>10.3390/cancers16071284</doi><orcidid>https://orcid.org/0000-0001-7510-7759</orcidid><orcidid>https://orcid.org/0000-0002-3742-8794</orcidid><orcidid>https://orcid.org/0000-0003-4935-2990</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Carbon Chemotherapy Denosumab Diabetes Ethics Hypoxia Medical imaging Medical prognosis Morbidity Nerves Neuropathy Patients Planning Radiation therapy Radiotherapy Sacrum Sarcoma Sciatic nerve Surgery Survival Toxicity Tumors |
| title | Sacral-Nerve-Sparing Planning Strategy in Pelvic Sarcomas/Chordomas Treated with Carbon-Ion Radiotherapy |
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