Maarten Lambrecht1, Daniëlle B P Eekers2, Claire Alapetite3, Neil G Burnet4, Valentin Calugaru5, Ida E M Coremans6, Piero Fossati7, Morten Høyer8, Johannes A Langendijk9, Alejandra Méndez Romero10, Frank Paulsen11, Ana Perpar7, Laurette Renard12, Dirk de Ruysscher2, Beate Timmermann13, Pavel Vitek14, Damien C Weber15, Hiske L van der Weide9, Gillian A Whitfield16, Ruud Wiggenraad17, Erik Roelofs18, Petra Witt Nyström19, Esther G C Troost20. 1. Department of Radiotherapy-Oncology, Leuven Kanker Instituut, UZ Gasthuisberg, Belgium; Particle Therapy Interuniversitary Center Leuven (PartICLe), Belgium. Electronic address: maarten.lambrecht@uzleuven.be. 2. Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, The Netherlands; Proton Therapy Department South-East Netherlands (ZON-PTC), Maastricht, The Netherlands. 3. Institut Curie, Radiation Oncology Department, Paris & Proton Center, Orsay, France. 4. University of Cambridge Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, United Kingdom. 5. Institut Curie, Radiation Oncology Department, Paris & Proton Center, Orsay, France; Institute Curie, Centre de Protonthérapie d'Orsay, France. 6. Leiden University Medical Centre, Department of Radiotherapy, The Netherlands; Holland Proton Therapy Centre, Delft, The Netherlands. 7. EBG MedAustron GmbH, Wiener Neustadt, Austria. 8. Danish Centre for Particle Therapy, Aarhus, Denmark. 9. Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands. 10. Holland Proton Therapy Centre, Delft, The Netherlands; Erasmus Medical Centre, Rotterdam, The Netherlands. 11. Department of Radiation Oncology, Eberhard-Carls-Universität Tübingen, Germany. 12. Service de Radiothérapie Oncologique Cliniques universitaires St Luc, Brussels, Belgium. 13. Clinic for Particle Therapy, University Hospital Essen, West German Cancer Center (WTZ), Germany; West German Proton Therapy Center Essen (WPE), Germany; German Cancer Consortium (DKTK), Partner Site Essen, Germany. 14. Proton Therapy Center Czech, Prague, Czech Republic. 15. Paul Scherrer Institut Med. Center for Proton Therapy, Switzerland. 16. The University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, United Kingdom; The Children's Brain Tumour Research Network, University of Manchester, Royal Manchester Children's Hospital, United Kingdom. 17. Haaglanden Medisch Centrum, Department of Radiotherapy, Leidschendam, The Netherlands. 18. Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, The Netherlands. 19. The Skandion Clinic, Uppsala, Sweden; Danish Centre for Particle Therapy, Aarhus, Denmark. 20. Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Germany; OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany; National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany.
Abstract
PURPOSE: For unbiased comparison of different radiation modalities and techniques, consensus on delineation of radiation sensitive organs at risk (OARs) and on their dose constraints is warranted. Following the publication of a digital, online atlas for OAR delineation in neuro-oncology by the same group, we assessed the brain OAR-dose constraints in a follow-up study. METHODS: We performed a comprehensive search to identify the current papers on OAR dose constraints for normofractionated photon and particle therapy in PubMed, Ovid Medline, Cochrane Library, Embase and Web of Science. Moreover, the included articles' reference lists were cross-checked for potential studies that met the inclusion criteria. Consensus was reached among 20 radiation oncology experts in the field of neuro-oncology. RESULTS: For the OARs published in the neuro-oncology literature, we summarized the available literature and recommended dose constraints associated with certain levels of normal tissue complication probability (NTCP) according to the recent ICRU recommendations. For those OARs with lacking or insufficient NTCP data, a proposal for effective and efficient data collection is given. CONCLUSION: The use of the European Particle Therapy Network-consensus OAR dose constraints summarized in this article is recommended for the model-based approach comparing photon and proton beam irradiation as well as for prospective clinical trials including novel radiation techniques and/or modalities.
PURPOSE: For unbiased comparison of different radiation modalities and techniques, consensus on delineation of radiation sensitive organs at risk (OARs) and on their dose constraints is warranted. Following the publication of a digital, online atlas for OAR delineation in neuro-oncology by the same group, we assessed the brain OAR-dose constraints in a follow-up study. METHODS: We performed a comprehensive search to identify the current papers on OAR dose constraints for normofractionated photon and particle therapy in PubMed, Ovid Medline, Cochrane Library, Embase and Web of Science. Moreover, the included articles' reference lists were cross-checked for potential studies that met the inclusion criteria. Consensus was reached among 20 radiation oncology experts in the field of neuro-oncology. RESULTS: For the OARs published in the neuro-oncology literature, we summarized the available literature and recommended dose constraints associated with certain levels of normal tissue complication probability (NTCP) according to the recent ICRU recommendations. For those OARs with lacking or insufficient NTCP data, a proposal for effective and efficient data collection is given. CONCLUSION: The use of the European Particle Therapy Network-consensus OAR dose constraints summarized in this article is recommended for the model-based approach comparing photon and proton beam irradiation as well as for prospective clinical trials including novel radiation techniques and/or modalities.
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