Jérôme Doyen1, Marie-Pierre Sunyach2, Fabien Almairac3, Véronique Bourg4, Arash O Naghavi5, Gwenaëlle Duhil de Bénazé6, Audrey Claren7, Laetitia Padovani8, Karen Benezery7, Georges Noël9, Jean-Michel Hannoun-Lévi1, Ferran Guedea10, Jordi Giralt11, Marie Vidal7, Guillaume Baudin12, Lucas Opitz13, Line Claude2, Pierre-Yves Bondiau7. 1. Université Côte d'Azur, Department of Radiation Oncology, Centre Antoine-Lacassagne, Fédération Claude Lalanne, Nice, France. 2. Department of Radiotherapy, Léon Bérard Cancer Center, Lyon, France. 3. Department of Neurosurgery, Centre Hospitalier Universitaire, University Côte d'Azur, Nice, France. 4. Department of Neurology, Centre Hospitalier Universitaire, University Côte d'Azur, Nice, France. 5. Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States. 6. Department of Pediatric Oncology, Centre Hospitalier Universitaire, University Côte d'Azur, Nice, France. 7. Department of Radiation Oncology, Centre Antoine-Lacassagne, Nice, France. 8. Oncology Radiotherapy Department, CRCM Inserm, UMR1068, CNRS UMR7258, AMU UM105, Genome Instability and Carcinogenesis, Assistance Publique des Hôpitaux de Marseille, Aix-Marseille University, Marseille, France. 9. Department of Radiation Oncology, Institut de cancérologie Strasbourg Europe (Icans), Strasbourg, France. 10. Radiation Oncology Department, Institut Català d'Oncologia (ICO) and University of Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, Spain. 11. Hospital Vall d'Hebron, Vall d'Hebron Institute of Oncology, Barcelona, Spain. 12. Department of Radiology, Centre Antoine-Lacassagne, Nice, France. 13. Department of Anesthesiology, Centre Antoine-Lacassagne, Nice, France.
Abstract
BACKGROUND: The conventional dose rate of radiation therapy is 0.01-0.05 Gy per second. According to preclinical studies, an increased dose rate may offer similar anti-tumoral effect while dramatically improving normal tissue protection. This study aims at evaluating the early toxicities for patients irradiated with high dose rate pulsed proton therapy (PT). MATERIALS AND METHODS: A single institution retrospective chart review was performed for patients treated with high dose rate (10 Gy per second) pulsed proton therapy, from September 2016 to April 2020. This included both benign and malignant tumors with ≥3 months follow-up, evaluated for acute (≤2 months) and subacute (>2 months) toxicity after the completion of PT. RESULTS: There were 127 patients identified, with a median follow up of 14.8 months (3-42.9 months). The median age was 55 years (1.6-89). The cohort most commonly consisted of benign disease (55.1%), cranial targets (95.1%), and were treated with surgery prior to PT (56.7%). There was a median total PT dose of 56 Gy (30-74 Gy), dose per fraction of 2 Gy (1-3 Gy), and CTV size of 47.6 ml (5.6-2,106.1 ml). Maximum acute grade ≥2 toxicity were observed in 49 (38.6%) patients, of which 8 (6.3%) experienced grade 3 toxicity. No acute grade 4 or 5 toxicity was observed. Maximum subacute grade 2, 3, and 4 toxicity were discovered in 25 (19.7%), 12 (9.4%), and 1 (0.8%) patient(s), respectively. CONCLUSION: In this cohort, utilizing high dose rate proton therapy (10 Gy per second) did not result in a major decrease in acute and subacute toxicity. Longer follow-up and comparative studies with conventional dose rate are required to evaluate whether this approach offers a toxicity benefit.
BACKGROUND: The conventional dose rate of radiation therapy is 0.01-0.05 Gy per second. According to preclinical studies, an increased dose rate may offer similar anti-tumoral effect while dramatically improving normal tissue protection. This study aims at evaluating the early toxicities for patients irradiated with high dose rate pulsed proton therapy (PT). MATERIALS AND METHODS: A single institution retrospective chart review was performed for patients treated with high dose rate (10 Gy per second) pulsed proton therapy, from September 2016 to April 2020. This included both benign and malignant tumors with ≥3 months follow-up, evaluated for acute (≤2 months) and subacute (>2 months) toxicity after the completion of PT. RESULTS: There were 127 patients identified, with a median follow up of 14.8 months (3-42.9 months). The median age was 55 years (1.6-89). The cohort most commonly consisted of benign disease (55.1%), cranial targets (95.1%), and were treated with surgery prior to PT (56.7%). There was a median total PT dose of 56 Gy (30-74 Gy), dose per fraction of 2 Gy (1-3 Gy), and CTV size of 47.6 ml (5.6-2,106.1 ml). Maximum acute grade ≥2 toxicity were observed in 49 (38.6%) patients, of which 8 (6.3%) experienced grade 3 toxicity. No acute grade 4 or 5 toxicity was observed. Maximum subacute grade 2, 3, and 4 toxicity were discovered in 25 (19.7%), 12 (9.4%), and 1 (0.8%) patient(s), respectively. CONCLUSION: In this cohort, utilizing high dose rate proton therapy (10 Gy per second) did not result in a major decrease in acute and subacute toxicity. Longer follow-up and comparative studies with conventional dose rate are required to evaluate whether this approach offers a toxicity benefit.
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