Pencil Beam Scanning Proton Therapy for Paediatric Neuroblastoma with Motion Mitigation Strategy for Moving Target Volumes |
| |
| Affiliation: | 1. Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland;2. University College London Hospitals, London, UK;3. ETH, Department of Physics, Zürich, Switzerland;4. University Hospital of Zürich, Zürich, Switzerland;1. Oxford University Hospital NHS Foundation Trust, Oxford, UK;2. Cardiff University, Centre for Trials Research, Cardiff, UK;3. Guy''s and St Thomas'' NHS Foundation Trust, London, UK;4. Christie NHS Foundation Trust, Manchester, UK;5. Leeds Teaching Hospitals NHS Trust, Leeds, UK;7. Royal Marsden NHS Foundation Trust, London, UK;11. Royal Devon and Exeter NHS Foundation Trust, Exeter, UK;12. NHS Highland, Inverness, UK;8. Royal Berkshire Hospital, Reading, UK;9. NIHR Oxford Biomedical Research Centre, Oxford, UK;1. Division of Radiation Oncology, IEO, European Institute of Oncology, IRCCS, Milano, Italy;2. Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy;3. Radiotherapy Unit, ASST Ospedale Niguarda, Milano, Italy;4. Radiation Oncology Center, Ospedale Manzoni, Lecco, Italy;5. Radiation Oncology Center, Ospedale Papa Giovanni XXIII, Bergamo, Italy;7. Radiation Oncology Center, Ospedale C. Poma, Mantova, Italy;11. Radiation Oncology Center, Ospedale di Circolo e Fondazione Macchi, ASST dei Sette Laghi, Varese, Italy;12. Department of Radiation Oncology, Policlinico S. Gerardo and University of Milan "Bicocca", Milano, Italy;8. Radiation Oncology Center, Istituto Clinico S. Anna, Brescia, Italy;9. Radiation Oncology Center, Centro Diagnostico Italiano (CDI), Milano, Italy;71. Radiation Oncology Center, Fondazione Poliambulanza, Brescia, Italy;112. Radiation Oncology Center, Ospedale, Busto Arsizio, Italy;123. Division of Radiation Oncology, Ospedale di Treviglio, Caravaggio di Treviglio, Italy;84. Radiation Oncology Center, S. Pio X-Humanitas, Milano, Italy;95. Radiation Oncology Center, IRCCS Ospedale Multimedica, Sesto San Giovanni/Castellanza, Italy;77. Division of Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy;1111. Radiotherapy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy;1212. Radiation Oncology Department, Fondazione IRCCS Policlinico San Matteo and University of Pavia, Pavia, Italy;88. Radiation Oncology Center, Policlinico, Monza, Italy;99. Radiation Oncology Center, Istituti Ospedalieri Bergamaschi, Ponte S. Pietro-Zingonia, Italy;771. Radiation Oncology Center, Istituti Clinici di Pavia e Vigevano, Vigevano, Italy;11112. Radiation Oncology Center, National Center of Oncological Hadrontherapy, CNAO, Pavia, Italy;12123. Radiation Oncology Department, Esine and University of Brescia, Esine, Italy;884. Radiation Oncology Center, Istituto Clinico Sant''Ambrogio, Milano, Italy;995. Radiation Oncology Center, Ospedale Sant’Anna, ASST Lariana, Como, Italy;777. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy;111111. Radiation Oncology Center, Ospedale, Sondrio, Italy;121212. Radiation Oncology Center, Ospedale, Cremona, Italy;888. Ospedale di Casalpusterlengo, Azienda Ospedaliera della Provincia di Lodi, Casalpusterlengo, Italy;999. Unit of Radiotherapy, Cliniche Gavezzeni SPA, Bergamo, Italy;1. CRUK Clinical Trials Unit, University of Glasgow, Glasgow, UK;2. Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK;3. Weston Park Cancer Centre, Sheffield, UK;4. Brighton & Sussex Medical Schools, Brighton, UK;5. National Institute for Health Research, Leeds, UK;7. The Institute of Cancer Research, London, UK;11. University of Cambridge, Cambridge, UK;12. Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia;1. Gamma Knife Center Tilburg, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands;2. Department of Radiology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands;3. Department of Pulmonary Diseases, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands;4. Netherlands Cancer Registry, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands;5. Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands;7. Department of Pulmonary Medicine, Amphia Hospital, Breda, the Netherlands;1. The Christie NHS Foundation Trust, Manchester, UK;2. The University of Manchester, Manchester, UK;3. Addenbrooke''s Hospital, Cambridge, UK;4. Bristol Cancer Institute, UHB NHS Foundation Trust, Bristol, UK;5. Norfolk and Norwich University Hospital, Norwich, UK;1. Department of Clinical Oncology, Leeds Cancer Centre, St James''s Institute of Oncology, Leeds, UK;2. Department of Radiology, Wirral University Teaching Hospital NHS Foundation Trust, Wirral, UK;3. Department of Clinical Oncology, The Clatterbridge Cancer Centre, Wirral, UK |
| |
| Abstract: | ![]()
AimsMore 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.Materials and methodsNineteen 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.ResultsThe 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.ConclusionsThe 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. |
| |
| Keywords: | Neuroblastoma children proton therapy pencil beam scanning volumetric scanning motion mitigation strategy |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
