Andrzej Niemierko1, Jan Schuemann2, Maximilian Niyazi3, Drosoula Giantsoudi2, Genevieve Maquilan2, Helen A Shih2, Harald Paganetti2. 1. Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. Electronic address: aniemierko@mgh.harvard.edu. 2. Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. 3. Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium, partner site Munich, Heidelberg, Germany; German Cancer Research Center, Heidelberg, Germany.
Abstract
PURPOSE: To investigate if radiographic imaging changes defined as necrosis correlate with regions in the brain with elevated linear energy transfer (LET) for proton radiation therapy treatments with partial brain involvement in central nervous system and patients with head and neck cancer. METHODS AND MATERIALS: Fifty patients with head and neck, skull base, or intracranial tumors who underwent proton therapy between 2004 to 2016 with a minimum prescription dose of 59.4 Gy (relative biological effectiveness) and with magnetic resonance imaging changes indicative of brain necrosis after radiation therapy were retrospectively reviewed. Each treatment plan was recalculated using Monte Carlo simulations to provide accurate dose distributions as well as 3-dimensional distributions of LET. To assess the effect of LET on radiographic imaging changes several voxel-based analyses were performed. RESULTS: In this patient cohort, LET adjusted for dose was not found to be associated with risk of brain necrosis. CONCLUSIONS: A voxel-based analysis of brain necrosis as an endpoint is difficult owing to uncertainties in the origin of necrosis, timing of imaging, variability in patient specific radiosensitivity, and the simultaneous effect of dose and LET. Even though it is expected that the LET and thus relative biological effectiveness increases at the end of range, effects in patients might be small compared with interpatient variability of radiosensitivity and might be obscured by other confounding factors.
PURPOSE: To investigate if radiographic imaging changes defined as necrosis correlate with regions in the brain with elevated linear energy transfer (LET) for proton radiation therapy treatments with partial brain involvement in central nervous system and patients with head and neck cancer. METHODS AND MATERIALS: Fifty patients with head and neck, skull base, or intracranial tumors who underwent proton therapy between 2004 to 2016 with a minimum prescription dose of 59.4 Gy (relative biological effectiveness) and with magnetic resonance imaging changes indicative of brain necrosis after radiation therapy were retrospectively reviewed. Each treatment plan was recalculated using Monte Carlo simulations to provide accurate dose distributions as well as 3-dimensional distributions of LET. To assess the effect of LET on radiographic imaging changes several voxel-based analyses were performed. RESULTS: In this patient cohort, LET adjusted for dose was not found to be associated with risk of brain necrosis. CONCLUSIONS: A voxel-based analysis of brain necrosis as an endpoint is difficult owing to uncertainties in the origin of necrosis, timing of imaging, variability in patient specific radiosensitivity, and the simultaneous effect of dose and LET. Even though it is expected that the LET and thus relative biological effectiveness increases at the end of range, effects in patients might be small compared with interpatient variability of radiosensitivity and might be obscured by other confounding factors.
Authors: Cara M Frame; Yu Chen; Jonathan Gagnon; Y Yuan; Tianjun Ma; Anatoly Dritschilo; Dalong Pang Journal: Front Oncol Date: 2022-08-05 Impact factor: 5.738
Authors: Harald Paganetti; Chris Beltran; Stefan Both; Lei Dong; Jacob Flanz; Keith Furutani; Clemens Grassberger; David R Grosshans; Antje-Christin Knopf; Johannes A Langendijk; Hakan Nystrom; Katia Parodi; Bas W Raaymakers; Christian Richter; Gabriel O Sawakuchi; Marco Schippers; Simona F Shaitelman; B K Kevin Teo; Jan Unkelbach; Patrick Wohlfahrt; Tony Lomax Journal: Phys Med Biol Date: 2021-02-26 Impact factor: 4.174