Majid Mohiuddin1,2, Connor Lynch1, Mingcheng Gao1, William Hartsell1,2. 1. Northwestern Medicine Chicago Proton Center 4455 Weaver Pkwy, Warrenville, IL 60555. 2. Radiation Oncology Consultants, Ltd. 700 Commerce Drive, Suite 500, Oak Brook, IL 60523.
Abstract
OBJECTIVE: Approximately 70 patients with large and bulky tumors refractory to prior treatments were treated with photon spatially fractionated GRID radiation (SFGRT). We identified 10 additional patients who clinically needed GRID but could not be treated with photons due to adjacent critical organs. We developed a proton SFGRT technique, and we report treatment of these 10 patients. METHODS: Subject data were reviewed for clinical results and dosimetric data. 50% of the patients were metastatic at the time of treatment and five had previous photon radiation to the local site but not via GRID. They were treated with 15-20 cobalt Gray equivalent using a single proton GRID field with an average beamlet count of 22.6 (range 7-51). 80% received an average adjuvant radiation dose to the GRID region of 40.8Gy (range 13.7-63.8Gy). Four received subsequent systemic therapy. RESULTS: The median follow-up time was 5.9 months (1.1-18.9). At last follow-up, seven patients were alive and three had died. Two patients who had died from metastatic disease had local shrinkage of tumor. Of those alive, four had complete or partial response, two had partial response but later progressed, and one had no response. For all patients, the tumor regression/local symptom improvement rate was 80%. 50% had acute side-effects of grade1/2 only and all were well-tolerated. CONCLUSION: In circumstances where patients cannot receive photon GRID, proton SFGRT is clinically feasible and effective, with a similar side-effect profile. ADVANCES IN KNOWLEDGE: Proton GRID should be considered as a treatment option earlier in the disease course for patients who cannot be treated by photon GRID.
OBJECTIVE: Approximately 70 patients with large and bulky tumors refractory to prior treatments were treated with photon spatially fractionated GRID radiation (SFGRT). We identified 10 additional patients who clinically needed GRID but could not be treated with photons due to adjacent critical organs. We developed a proton SFGRT technique, and we report treatment of these 10 patients. METHODS: Subject data were reviewed for clinical results and dosimetric data. 50% of the patients were metastatic at the time of treatment and five had previous photon radiation to the local site but not via GRID. They were treated with 15-20 cobalt Gray equivalent using a single proton GRID field with an average beamlet count of 22.6 (range 7-51). 80% received an average adjuvant radiation dose to the GRID region of 40.8Gy (range 13.7-63.8Gy). Four received subsequent systemic therapy. RESULTS: The median follow-up time was 5.9 months (1.1-18.9). At last follow-up, seven patients were alive and three had died. Two patients who had died from metastatic disease had local shrinkage of tumor. Of those alive, four had complete or partial response, two had partial response but later progressed, and one had no response. For all patients, the tumor regression/local symptom improvement rate was 80%. 50% had acute side-effects of grade1/2 only and all were well-tolerated. CONCLUSION: In circumstances where patients cannot receive photon GRID, proton SFGRT is clinically feasible and effective, with a similar side-effect profile. ADVANCES IN KNOWLEDGE: Proton GRID should be considered as a treatment option earlier in the disease course for patients who cannot be treated by photon GRID.
Authors: Geoffrey Neuner; Majid M Mohiuddin; Noam Vander Walde; Olga Goloubeva; Jonathan Ha; Cedric X Yu; William F Regine Journal: Int J Radiat Oncol Biol Phys Date: 2011-04-29 Impact factor: 7.038
Authors: M Mohiuddin; M Fujita; W F Regine; A S Megooni; G S Ibbott; M M Ahmed Journal: Int J Radiat Oncol Biol Phys Date: 1999-10-01 Impact factor: 7.038
Authors: Lauren S L Price; Judith N Rivera; Andrew J Madden; Leah B Herity; Joseph A Piscitelli; Savannah Mageau; Charlene M Santos; Jose R Roques; Bentley Midkiff; Nana N Feinberg; David Darr; Sha X Chang; William C Zamboni Journal: Ther Adv Med Oncol Date: 2021-10-29 Impact factor: 8.168