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Pierre Blanchard - One of the best experts on this subject based on the ideXlab platform.

  • comparing intensity modulated proton Therapy with intensity modulated Photon Therapy for oropharyngeal cancer the journey from clinical trial concept to activation
    Seminars in Radiation Oncology, 2018
    Co-Authors: Steven J Frank, Adam S Garden, Pierre Blanchard, David I Rosenthal, Jack J Lee, Erich M Sturgis, Merrill S Kies, Mitchell Machtay, Bhadrasain Vikram, Brandon G Gunn
    Abstract:

    Intensity-modulated proton Therapy minimizes the incidental irradiation of normal tissues in patients with head and neck cancer relative to intensity-modulated Photon (x-ray) Therapy and has been associated with lesser treatment-related toxicity and improved quality of life. A phase II/III randomized trial sponsored by the US National Cancer Institute is currently underway to compare deintensification treatment strategies with intensity-modulated proton Therapy vs intensity-modulated Photon (x-ray) Therapy for patients with advanced-stage oropharyngeal tumors. After significant input from numerous stakeholders, the phase III portion of the randomized trial was redesigned as a noninferiority trial with progression-free survival as the primary endpoint. The process by which that redesign took place is described here.

  • intensity modulated proton Therapy versus intensity modulated Photon radiation Therapy for oropharyngeal cancer first comparative results of patient reported outcomes
    International Journal of Radiation Oncology Biology Physics, 2016
    Co-Authors: Pierre Blanchard, Brandon G Gunn, Mike Hernandez, Jack J Lee, Terence T Sio, Huei Kai Lin, Qiuling Shi, Charles S Cleeland, Nikhil G Thaker
    Abstract:

    Purpose We hypothesized that patients with oropharyngeal cancer treated with intensity modulated proton Therapy (IMPT) would have lower symptom burdens, as measured by patient-reported outcome (PRO) surveys, than patients treated with intensity modulated Photon Therapy (IMRT). Methods and Materials Patients were treated for oropharyngeal cancer from 2006 to 2015 through prospective registries with concurrent chemoTherapy and IMPT or chemoTherapy and IMRT and completed the MD Anderson Symptom Inventory for Head and Neck Cancer (MDASI-HN) module at various times before treatment (baseline), during treatment (acute phase), within the first 3 months after treatment (subacute phase), and afterward (chronic phase). Individual symptoms and the top 5 and top 11 most severe symptoms were summarized and compared between the radiation Therapy modalities. Results PRO data were collected and analyzed from 35 patients treated with chemoTherapy and IMPT and from 46 treated with chemoTherapy and IMRT. The baseline symptom burdens were similar between both groups. The overall top 5 symptoms were food taste problems (mean score 4.91 on a 0-10 scale), dry mouth (4.49), swallowing/chewing difficulties (4.26), lack of appetite (4.08), and fatigue (4.00). Among the top 11 symptoms, changes in taste and appetite during the subacute and chronic phases favored IMPT (all P P =.013). Conclusions According to the MDASI-HN, symptom burden was lower among the IMPT patients than among the IMRT patients during the subacute recovery phase after treatment. A prospective randomized clinical trial is underway to define the value of IMPT for the management of head and neck tumors.

  • intensity modulated proton beam Therapy impt versus intensity modulated Photon Therapy imrt for patients with oropharynx cancer a case matched analysis
    Radiotherapy and Oncology, 2016
    Co-Authors: Adam S Garden, William H Morrison, Pierre Blanchard, Brandon G Gunn, David I Rosenthal, Mike Hernandez, Joseph Crutison, Jack Lee, David C Fuller
    Abstract:

    Abstract Background Owing to its physical properties, intensity-modulated proton Therapy (IMPT) used for patients with oropharyngeal carcinoma has the ability to reduce the dose to organs at risk compared to intensity-modulated radioTherapy (IMRT) while maintaining adequate tumor coverage. Our aim was to compare the clinical outcomes of these two treatment modalities. Methods We performed a 1:2 matching of IMPT to IMRT patients. Our study cohort consisted of IMPT patients from a prospective quality of life study and consecutive IMRT patients treated at a single institution during the period 2010–2014. Patients were matched on unilateral/bilateral treatment, disease site, human papillomavirus status, T and N status, smoking status, and receipt of concomitant chemoTherapy. Survival analyzes were performed using a Cox model and binary toxicity endpoints using a logistic regression analysis. Results Fifty IMPT and 100 IMRT patients were included. The median follow-up time was 32months. There were no imbalances in patient/tumor characteristics except for age (mean age 56.8years for IMRT patients and 61.1years for IMPT patients, p -value=0.010). Statistically significant differences were not observed in overall survival (hazard ratio (HR)=0.55; 95% confidence interval (CI): 0.12–2.50, p -value=0.44) or in progression-free survival (HR=1.02; 95% CI: 0.41–2.54; p -value=0.96). The age-adjusted odds ratio (OR) for the presence of a gastrostomy (G)-tube during treatment for IMPT vs IMRT were OR=0.53; 95% CI: 0.24–1.15; p -value=0.11 and OR=0.43; 95% CI: 0.16–1.17; p -value=0.10 at 3months after treatment. When considering the pre-planned composite endpoint of grade 3 weight loss or G-tube presence, the ORs were OR=0.44; 95% CI: 0.19–1.0; p -value=0.05 at 3months after treatment and OR=0.23; 95% CI: 0.07–0.73; p -value=0.01 at 1year after treatment. Conclusion Our results suggest that IMPT is associated with reduced rates of feeding tube dependency and severe weight loss without jeopardizing outcome. Prospective multicenter randomized trials are needed to validate such findings.

  • head and neck radioTherapyintensity modulated proton beam Therapy impt versus intensity modulated Photon Therapy imrt for patients with oropharynx cancer a case matched analysis
    Radiotherapy and Oncology, 2016
    Co-Authors: Pierre Blanchard, Adam S Garden, William H Morrison, Brandon G Gunn, David I Rosenthal, Mike Hernandez, Joseph Crutison, Jack Lee, David C Fuller, Abdallah S R Mohamed
    Abstract:

    Background Owing to its physical properties, intensity-modulated proton Therapy (IMPT) used for patients with oropharyngeal carcinoma has the ability to reduce the dose to organs at risk compared to intensity-modulated radioTherapy (IMRT) while maintaining adequate tumor coverage. Our aim was to compare the clinical outcomes of these two treatment modalities.

Brandon G Gunn - One of the best experts on this subject based on the ideXlab platform.

  • comparing intensity modulated proton Therapy with intensity modulated Photon Therapy for oropharyngeal cancer the journey from clinical trial concept to activation
    Seminars in Radiation Oncology, 2018
    Co-Authors: Steven J Frank, Adam S Garden, Pierre Blanchard, David I Rosenthal, Jack J Lee, Erich M Sturgis, Merrill S Kies, Mitchell Machtay, Bhadrasain Vikram, Brandon G Gunn
    Abstract:

    Intensity-modulated proton Therapy minimizes the incidental irradiation of normal tissues in patients with head and neck cancer relative to intensity-modulated Photon (x-ray) Therapy and has been associated with lesser treatment-related toxicity and improved quality of life. A phase II/III randomized trial sponsored by the US National Cancer Institute is currently underway to compare deintensification treatment strategies with intensity-modulated proton Therapy vs intensity-modulated Photon (x-ray) Therapy for patients with advanced-stage oropharyngeal tumors. After significant input from numerous stakeholders, the phase III portion of the randomized trial was redesigned as a noninferiority trial with progression-free survival as the primary endpoint. The process by which that redesign took place is described here.

  • intensity modulated proton Therapy versus intensity modulated Photon radiation Therapy for oropharyngeal cancer first comparative results of patient reported outcomes
    International Journal of Radiation Oncology Biology Physics, 2016
    Co-Authors: Pierre Blanchard, Brandon G Gunn, Mike Hernandez, Jack J Lee, Terence T Sio, Huei Kai Lin, Qiuling Shi, Charles S Cleeland, Nikhil G Thaker
    Abstract:

    Purpose We hypothesized that patients with oropharyngeal cancer treated with intensity modulated proton Therapy (IMPT) would have lower symptom burdens, as measured by patient-reported outcome (PRO) surveys, than patients treated with intensity modulated Photon Therapy (IMRT). Methods and Materials Patients were treated for oropharyngeal cancer from 2006 to 2015 through prospective registries with concurrent chemoTherapy and IMPT or chemoTherapy and IMRT and completed the MD Anderson Symptom Inventory for Head and Neck Cancer (MDASI-HN) module at various times before treatment (baseline), during treatment (acute phase), within the first 3 months after treatment (subacute phase), and afterward (chronic phase). Individual symptoms and the top 5 and top 11 most severe symptoms were summarized and compared between the radiation Therapy modalities. Results PRO data were collected and analyzed from 35 patients treated with chemoTherapy and IMPT and from 46 treated with chemoTherapy and IMRT. The baseline symptom burdens were similar between both groups. The overall top 5 symptoms were food taste problems (mean score 4.91 on a 0-10 scale), dry mouth (4.49), swallowing/chewing difficulties (4.26), lack of appetite (4.08), and fatigue (4.00). Among the top 11 symptoms, changes in taste and appetite during the subacute and chronic phases favored IMPT (all P P =.013). Conclusions According to the MDASI-HN, symptom burden was lower among the IMPT patients than among the IMRT patients during the subacute recovery phase after treatment. A prospective randomized clinical trial is underway to define the value of IMPT for the management of head and neck tumors.

  • intensity modulated proton beam Therapy impt versus intensity modulated Photon Therapy imrt for patients with oropharynx cancer a case matched analysis
    Radiotherapy and Oncology, 2016
    Co-Authors: Adam S Garden, William H Morrison, Pierre Blanchard, Brandon G Gunn, David I Rosenthal, Mike Hernandez, Joseph Crutison, Jack Lee, David C Fuller
    Abstract:

    Abstract Background Owing to its physical properties, intensity-modulated proton Therapy (IMPT) used for patients with oropharyngeal carcinoma has the ability to reduce the dose to organs at risk compared to intensity-modulated radioTherapy (IMRT) while maintaining adequate tumor coverage. Our aim was to compare the clinical outcomes of these two treatment modalities. Methods We performed a 1:2 matching of IMPT to IMRT patients. Our study cohort consisted of IMPT patients from a prospective quality of life study and consecutive IMRT patients treated at a single institution during the period 2010–2014. Patients were matched on unilateral/bilateral treatment, disease site, human papillomavirus status, T and N status, smoking status, and receipt of concomitant chemoTherapy. Survival analyzes were performed using a Cox model and binary toxicity endpoints using a logistic regression analysis. Results Fifty IMPT and 100 IMRT patients were included. The median follow-up time was 32months. There were no imbalances in patient/tumor characteristics except for age (mean age 56.8years for IMRT patients and 61.1years for IMPT patients, p -value=0.010). Statistically significant differences were not observed in overall survival (hazard ratio (HR)=0.55; 95% confidence interval (CI): 0.12–2.50, p -value=0.44) or in progression-free survival (HR=1.02; 95% CI: 0.41–2.54; p -value=0.96). The age-adjusted odds ratio (OR) for the presence of a gastrostomy (G)-tube during treatment for IMPT vs IMRT were OR=0.53; 95% CI: 0.24–1.15; p -value=0.11 and OR=0.43; 95% CI: 0.16–1.17; p -value=0.10 at 3months after treatment. When considering the pre-planned composite endpoint of grade 3 weight loss or G-tube presence, the ORs were OR=0.44; 95% CI: 0.19–1.0; p -value=0.05 at 3months after treatment and OR=0.23; 95% CI: 0.07–0.73; p -value=0.01 at 1year after treatment. Conclusion Our results suggest that IMPT is associated with reduced rates of feeding tube dependency and severe weight loss without jeopardizing outcome. Prospective multicenter randomized trials are needed to validate such findings.

  • head and neck radioTherapyintensity modulated proton beam Therapy impt versus intensity modulated Photon Therapy imrt for patients with oropharynx cancer a case matched analysis
    Radiotherapy and Oncology, 2016
    Co-Authors: Pierre Blanchard, Adam S Garden, William H Morrison, Brandon G Gunn, David I Rosenthal, Mike Hernandez, Joseph Crutison, Jack Lee, David C Fuller, Abdallah S R Mohamed
    Abstract:

    Background Owing to its physical properties, intensity-modulated proton Therapy (IMPT) used for patients with oropharyngeal carcinoma has the ability to reduce the dose to organs at risk compared to intensity-modulated radioTherapy (IMRT) while maintaining adequate tumor coverage. Our aim was to compare the clinical outcomes of these two treatment modalities.

  • proton Therapy reduces treatment related toxicities for patients with nasopharyngeal cancer a case match control study of intensity modulated proton Therapy and intensity modulated Photon Therapy
    International Journal of Particle Therapy, 2015
    Co-Authors: Emma B Holliday, Adam S Garden, William H Morrison, Brandon G Gunn, David I Rosenthal, David C Fuller, Jack Phan, Beth M Beadle, Xiarong R Zhu, Xiaodong Zhang
    Abstract:

    Abstract Purpose: The physical properties of proton Therapy allow for decreased dose delivery to nontarget structures. The purpose of this study was to determine if this translates into a clinical benefit by comparing acute and chronic morbidity between patients with nasopharyngeal carcinoma who are treated with intensity-modulated proton Therapy (IMPT) and those treated with intensity-modulated radiation Therapy (IMRT). Materials and Methods: Patients receiving IMPT for nasopharyngeal cancer from 2011-13 were matched in a 2:1 IMPT to IMRT ratio. Matching criteria were, in order, T-stage, N-stage, radiation dose, chemoTherapy type, World Health Organization classification, sex, and age. Results: Ten patients treated with IMPT and 20 matched patients treated with IMRT were included. By the end of treatment, 2 IMPT-treated patients (20%) and 13 IMRT-treated patients (65%) required gastrostomy tube (GT) insertion (P = .020). Patients receiving IMPT had significantly lower mean doses to the oral cavity, brain...

Adam S Garden - One of the best experts on this subject based on the ideXlab platform.

  • work outcomes after intensity modulated proton Therapy impt versus intensity modulated Photon Therapy imrt for oropharyngeal cancer
    International journal of particle therapy, 2021
    Co-Authors: Grace L Smith, Matthew S Ning, Diemkhanh Nguyen, Paul M Busse, Robert L Foote, Adam S Garden, G B Gunn, Clifton D Fuller, William H Morrison, Gregory M Chronowski
    Abstract:

    Purpose We compared work outcomes in patients with oropharyngeal cancer (OPC), randomized to intensity-modulated proton (IMPT) versus intensity-modulated Photon Therapy (IMRT) for chemoradiation Therapy (CRT). Patients and Methods In 147 patients with stage II-IVB squamous cell OPC participating in patient-reported outcomes assessments, a prespecified secondary aim of a randomized phase II/III trial of IMPT (n = 69) versus IMRT (n = 78), we compared absenteeism, presenteeism (i.e., the extent to which an employee is not fully functional at work), and work productivity losses. We used the work productivity and activity impairment questionnaire at baseline (pre-CRT), at the end of CRT, and at 6 months, 1 year, and 2 years. A one-sided Cochran-Armitage test was used to analyze within-arm temporal trends, and a χ2 test was used to compare between-arm differences. Among working patients, at each follow-up point, a 1-sided Wilcoxon rank-sum test was used to compare work-productivity scores. Results Patient characteristics in IMPT versus IMRT arms were similar. In the IMPT arm, within-arm analysis demonstrated that an increasing proportion of patients resumed working after IMPT, from 60% (40 of 67) pre-CRT and 71% (30 of 42) at 1 year to 78% (18 of 23) at 2 years (P = 0.025). In the IMRT arm, the proportion remained stable, with 57% (43 of 76) pre-CRT, 54% (21 of 39) at 1 year, and 52% (13 of 25) working at 2 years (P = 0.47). By 2 years after CRT, the between-arm difference between patients who had IMPT and those who had IMRT trended toward significance (P = 0.06). Regardless of treatment arm, among working patients, the most severe work impairments occurred from treatment initiation to the end of CRT, with significant recovery from absenteeism, presenteeism, and productivity impairments by the 2-year follow-up (P < 0.001 for all). Higher magnitudes of recovery from absenteeism (at 1 year, P = 0.05; and at 2 years, P = 0.04) and composite work impairment scores (at 1 year, P = 0.04; and at 2 years, P = 0.04) were seen in patients treated with IMPT versus those treated with IMRT. Conclusion In patients with OPC receiving curative CRT, patients randomized to IMPT demonstrated increasing work and productivity recovery trends. Studies are needed to identify mechanisms underlying head and neck CRT treatment causing work disability and impairment.

  • activity based costing of intensity modulated proton versus Photon Therapy for oropharyngeal cancer
    International journal of particle therapy, 2021
    Co-Authors: Nikhil G Thaker, Grace L Smith, Matthew S Ning, Adam S Garden, David Boycefappiano, Dario Pasalic, Alexis B Guzman, Emma B Holliday, James R Incalcaterra, Simona F Shaitelman
    Abstract:

    Purpose In value-based health care delivery, radiation oncologists need to compare empiric costs of care delivery with advanced technologies, such as intensity-modulated proton Therapy (IMPT) and intensity-modulated radiation Therapy (IMRT). We used time-driven activity-based costing (TDABC) to compare the costs of delivering IMPT and IMRT in a case-matched pilot study of patients with newly diagnosed oropharyngeal (OPC) cancer. Materials and Methods We used clinicopathologic factors to match 25 patients with OPC who received IMPT in 2011-12 with 25 patients with OPC treated with IMRT in 2000-09. Process maps were created for each multidisciplinary clinical activity (including chemoTherapy and ancillary services) from initial consultation through 1 month of follow-up. Resource costs and times were determined for each activity. Each patient-specific activity was linked with a process map and TDABC over the full cycle of care. All calculated costs were normalized to the lowest-cost IMRT patient. Results TDABC costs for IMRT were 1.00 to 3.33 times that of the lowest-cost IMRT patient (mean ± SD: 1.65 ± 0.56), while costs for IMPT were 1.88 to 4.32 times that of the lowest-cost IMRT patient (2.58 ± 0.39) (P < .05). Although single-fraction costs were 2.79 times higher for IMPT than for IMRT (owing to higher equipment costs), average full cycle cost of IMPT was 1.53 times higher than IMRT, suggesting that the initial cost increase is partly mitigated by reductions in costs for other, non-RT supportive health care services. Conclusions In this matched sample, although IMPT was on average more costly than IMRT primarily owing to higher equipment costs, a subset of IMRT patients had similar costs to IMPT patients, owing to greater use of supportive care resources. Multidimensional patient outcomes and TDABC provide vital methodology for defining the value of radiation Therapy modalities.

  • comparing intensity modulated proton Therapy with intensity modulated Photon Therapy for oropharyngeal cancer the journey from clinical trial concept to activation
    Seminars in Radiation Oncology, 2018
    Co-Authors: Steven J Frank, Adam S Garden, Pierre Blanchard, David I Rosenthal, Jack J Lee, Erich M Sturgis, Merrill S Kies, Mitchell Machtay, Bhadrasain Vikram, Brandon G Gunn
    Abstract:

    Intensity-modulated proton Therapy minimizes the incidental irradiation of normal tissues in patients with head and neck cancer relative to intensity-modulated Photon (x-ray) Therapy and has been associated with lesser treatment-related toxicity and improved quality of life. A phase II/III randomized trial sponsored by the US National Cancer Institute is currently underway to compare deintensification treatment strategies with intensity-modulated proton Therapy vs intensity-modulated Photon (x-ray) Therapy for patients with advanced-stage oropharyngeal tumors. After significant input from numerous stakeholders, the phase III portion of the randomized trial was redesigned as a noninferiority trial with progression-free survival as the primary endpoint. The process by which that redesign took place is described here.

  • intensity modulated proton beam Therapy impt versus intensity modulated Photon Therapy imrt for patients with oropharynx cancer a case matched analysis
    Radiotherapy and Oncology, 2016
    Co-Authors: Adam S Garden, William H Morrison, Pierre Blanchard, Brandon G Gunn, David I Rosenthal, Mike Hernandez, Joseph Crutison, Jack Lee, David C Fuller
    Abstract:

    Abstract Background Owing to its physical properties, intensity-modulated proton Therapy (IMPT) used for patients with oropharyngeal carcinoma has the ability to reduce the dose to organs at risk compared to intensity-modulated radioTherapy (IMRT) while maintaining adequate tumor coverage. Our aim was to compare the clinical outcomes of these two treatment modalities. Methods We performed a 1:2 matching of IMPT to IMRT patients. Our study cohort consisted of IMPT patients from a prospective quality of life study and consecutive IMRT patients treated at a single institution during the period 2010–2014. Patients were matched on unilateral/bilateral treatment, disease site, human papillomavirus status, T and N status, smoking status, and receipt of concomitant chemoTherapy. Survival analyzes were performed using a Cox model and binary toxicity endpoints using a logistic regression analysis. Results Fifty IMPT and 100 IMRT patients were included. The median follow-up time was 32months. There were no imbalances in patient/tumor characteristics except for age (mean age 56.8years for IMRT patients and 61.1years for IMPT patients, p -value=0.010). Statistically significant differences were not observed in overall survival (hazard ratio (HR)=0.55; 95% confidence interval (CI): 0.12–2.50, p -value=0.44) or in progression-free survival (HR=1.02; 95% CI: 0.41–2.54; p -value=0.96). The age-adjusted odds ratio (OR) for the presence of a gastrostomy (G)-tube during treatment for IMPT vs IMRT were OR=0.53; 95% CI: 0.24–1.15; p -value=0.11 and OR=0.43; 95% CI: 0.16–1.17; p -value=0.10 at 3months after treatment. When considering the pre-planned composite endpoint of grade 3 weight loss or G-tube presence, the ORs were OR=0.44; 95% CI: 0.19–1.0; p -value=0.05 at 3months after treatment and OR=0.23; 95% CI: 0.07–0.73; p -value=0.01 at 1year after treatment. Conclusion Our results suggest that IMPT is associated with reduced rates of feeding tube dependency and severe weight loss without jeopardizing outcome. Prospective multicenter randomized trials are needed to validate such findings.

  • head and neck radioTherapyintensity modulated proton beam Therapy impt versus intensity modulated Photon Therapy imrt for patients with oropharynx cancer a case matched analysis
    Radiotherapy and Oncology, 2016
    Co-Authors: Pierre Blanchard, Adam S Garden, William H Morrison, Brandon G Gunn, David I Rosenthal, Mike Hernandez, Joseph Crutison, Jack Lee, David C Fuller, Abdallah S R Mohamed
    Abstract:

    Background Owing to its physical properties, intensity-modulated proton Therapy (IMPT) used for patients with oropharyngeal carcinoma has the ability to reduce the dose to organs at risk compared to intensity-modulated radioTherapy (IMRT) while maintaining adequate tumor coverage. Our aim was to compare the clinical outcomes of these two treatment modalities.

Charles B Simone - One of the best experts on this subject based on the ideXlab platform.

  • a novel prospective study assessing the combination of photodynamic Therapy and proton radiation Therapy safety and outcomes when treating malignant pleural mesothelioma
    Photochemistry and Photobiology, 2019
    Co-Authors: Stephanie R Rice, Keith A Cengel, Theresa M Busch, Michele M Kim, Sally Mcnulty, Andrea Dimofte, Timothy C Zhu, Charles B Simone
    Abstract:

    Malignant pleural mesothelioma remains difficult to treat, with high failure rates despite optimal Therapy. We present a novel prospective trial combining proton Therapy (PT) and photodynamic Therapy (PDT) and the largest-ever mesothelioma PT experience (n = 10). PDT photosensitizers included porfimer sodium (2 mg·kg-1 ; 24 h drug-light interval) or 2-[1-hexyloxyethyl]-2-devinyl pyropheophorbide-a (HPPH) (4 mg·m-2 ;48 h) with wavelengths of 630 nm to 60J·cm-2 and 665 nm to 15-45J·cm-2 , respectively. With a median age of 69 years, patients were predominantly male (90%) with epithelioid histology (100%) and stage III-IV disease (100%). PT was delivered to a median of 55.0 CGE/1.8-2.0 CGE (range 50-75 CGE) adjuvantly (n = 8) or as salvage Therapy (n = 2) following extended pleurectomy/decortication (ePD)/PDT. Two-year local control was 90%, with distant and regional failure rates of 50% and 30%, respectively. All patients received chemoTherapy, and four received immunoTherapy. Surgical complications included atrial fibrillation (n = 3), pneumonia (n = 2), and deep vein thrombosis (n = 2). Median survival from PT completion was 19.5 months (30.3 months from diagnosis), and 1- and 2-year survival rates were 58% and 29%. No patient experienced CTCAEv4 grade ≥2 acute or late toxicity. Our prolonged survival in very advanced-stage patients compares favorably to survival for PT without PDT and Photon Therapy with PDT, suggesting possible spatial or systemic cooperativity and immune effect.

  • Advances in proton Therapy in lung cancer
    SAGE Publishing, 2018
    Co-Authors: Melissa A.l. Vyfhuis, Nasarachi Onyeuku, Tejan Diwanji, Sina Mossahebi, Neha P. Amin, Shahed N. Badiyan, Pranshu Mohindra, Charles B Simone
    Abstract:

    Lung cancer remains the leading cause of cancer deaths in the United States (US) and worldwide. Radiation Therapy is a mainstay in the treatment of locally advanced non-small cell lung cancer (NSCLC) and serves as an excellent alternative for early stage patients who are medically inoperable or who decline surgery. Proton Therapy has been shown to offer a significant dosimetric advantage in NSCLC patients over Photon Therapy, with a decrease in dose to vital organs at risk (OARs) including the heart, lungs and esophagus. This in turn, can lead to a decrease in acute and late toxicities in a population already predisposed to lung and cardiac injury. Here, we present a review on proton treatment techniques, studies, clinical outcomes and toxicities associated with treating both early stage and locally advanced NSCLC

  • consensus statement on proton Therapy in early stage and locally advanced non small cell lung cancer
    International Journal of Radiation Oncology Biology Physics, 2016
    Co-Authors: Joe Y Chang, Steven E Schild, Dirk De Ruysscher, Charles B Simone, Steven J Feigenberg, Salma K Jabbour, Ramesh Rengan, Atif J Khan, Noah C Choi, Jeffrey D Bradley
    Abstract:

    Radiation dose escalation has been shown to improve local control and survival in patients with non-small cell lung cancer in some studies, but randomized data have not supported this premise, possibly owing to adverse effects. Because of the physical characteristics of the Bragg peak, proton Therapy (PT) delivers minimal exit dose distal to the target volume, resulting in better sparing of normal tissues in comparison to Photon-based radiation Therapy. This is particularly important for lung cancer given the proximity of the lung, heart, esophagus, major airways, large blood vessels, and spinal cord. However, PT is associated with more uncertainty because of the finite range of the proton beam and motion for thoracic cancers. PT is more costly than traditional Photon Therapy but may reduce side effects and toxicity-related hospitalization, which has its own associated cost. The cost of PT is decreasing over time because of reduced prices for the building, machine, maintenance, and overhead, as well as newer, shorter treatment programs. PT is improving rapidly as more research is performed particularly with the implementation of 4-dimensional computed tomography-based motion management and intensity modulated PT. Given these controversies, there is much debate in the oncology community about which patients with lung cancer benefit significantly from PT. The Particle Therapy Co-operative Group (PTCOG) Thoracic Subcommittee task group intends to address the issues of PT indications, advantages and limitations, cost-effectiveness, technology improvement, clinical trials, and future research directions. This consensus report can be used to guide clinical practice and indications for PT, insurance approval, and clinical or translational research directions.

  • cost comparativeness of proton versus Photon Therapy
    Chinese clinical oncology, 2016
    Co-Authors: Vivek Verma, Chirag Shah, Jeanclaude M Rwigema, Timothy D Solberg, X Zhu, Charles B Simone
    Abstract:

    Proton beam radioTherapy (PBT) offers great promise in the treatment of a wide variety of cancers owing to the sharp drop-off in radiation dose at a defined point, known as the Bragg peak, beyond which there is no appreciable dose. However, it is also well-understood that PBT is associated with large economic costs, including both capital investment and operating costs. From a medical as well as societal perspective, therefore, it is important to be aware of the economic implications of new technologies such as PBT, and to evaluate the cost effectiveness based on different clinical and treatment scenarios. This review examines PBT from a health economics perspective, evaluating both the design and results of costeffectiveness (CE) studies that have been performed previously. We further examine several salient variables that can affect CE of PBT, including patient, tumor, treatment, and logistical factors. We discuss the implication of technological advances on PBT delivery, and its impact on overall healthcare delivery costs. Additionally, we evaluate the status of economic analyses for PBT and discuss the role of ongoing and future CE studies in better defining the economic role of PBT as part of modern cancer Therapy.

  • predicted rates of secondary malignancies from proton versus Photon radiation Therapy for stage i seminoma
    International Journal of Radiation Oncology Biology Physics, 2012
    Co-Authors: Justin E Bekelman, Charles B Simone, Kevin Kramer, W Omeara, Arnaud Belard, James Mcdonough, John Oconnell
    Abstract:

    Purpose Photon radioTherapy has been the standard adjuvant treatment for stage I seminoma. Single-dose carboplatin Therapy and observation have emerged as alternative options due to concerns for acute toxicities and secondary malignancies from radiation. In this institutional review board-approved study, we compared Photon and proton radioTherapy for stage I seminoma and the predicted rates of excess secondary malignancies for both treatment modalities. Methods and Material Computed tomography images from 10 consecutive patients with stage I seminoma were used to quantify dosimetric differences between Photon and proton therapies. Structures reported to be at increased risk for secondary malignancies and in-field critical structures were contoured. Reported models of organ-specific radiation-induced cancer incidence rates based on organ equivalent dose were used to determine the excess absolute risk of secondary malignancies. Calculated values were compared with tumor registry reports of excess secondary malignancies among testicular cancer survivors. Results Photon and proton plans provided comparable target volume coverage. Proton plans delivered significantly lower mean doses to all examined normal tissues, except for the kidneys. The greatest absolute reduction in mean dose was observed for the stomach (119 cGy for proton plans vs. 768 cGy for Photon plans; p Conclusions For patients with stage I seminoma, proton radiation Therapy reduced the predicted secondary cancer risk compared with Photon Therapy. We predict a reduction of one additional secondary cancer for every 50 patients with a life expectancy of 40 years from the time of radiation treatment with protons instead of Photons. Proton radiation Therapy also allowed significant sparing of most critical structures examined and warrants further study for patients with seminoma, to decrease radiation-induced toxicity.

Phillip J Taddei - One of the best experts on this subject based on the ideXlab platform.

  • inter institutional comparison of personalized risk assessments for second malignant neoplasms for a 13 year old girl receiving proton versus Photon craniospinal irradiation
    Cancers, 2015
    Co-Authors: Rui Zhang, Phillip J Taddei, Anita Mahajan, Nabil Khater, Fady B Geara, Wassim Jalbout, A Perezandujar
    Abstract:

    Children receiving radioTherapy face the probability of a subsequent malignant neoplasm (SMN). In some cases, the predicted SMN risk can be reduced by proton Therapy. The purpose of this study was to apply the most comprehensive dose assessment methods to estimate the reduction in SMN risk after proton Therapy vs. Photon Therapy for a 13-year-old girl requiring craniospinal irradiation (CSI). We reconstructed the equivalent dose throughout the patient’s body from therapeutic and stray radiation and applied SMN incidence and mortality risk models for each modality. Excluding skin cancer, the risk of incidence after proton CSI was a third of that of Photon CSI. The predicted absolute SMN risks were high. For Photon CSI, the SMN incidence rates greater than 10% were for thyroid, non-melanoma skin, lung, colon, stomach, and other solid cancers, and for proton CSI they were non-melanoma skin, lung, and other solid cancers. In each setting, lung cancer accounted for half the risk of mortality. In conclusion, the predicted SMN risk for a 13-year-old girl undergoing proton CSI was reduced vs. Photon CSI. This study demonstrates the feasibility of inter-institutional whole-body dose and risk assessments and also serves as a model for including risk estimation in personalized cancer care.

  • comparison of risk of radiogenic second cancer following Photon and proton craniospinal irradiation for a pediatric medulloblastoma patient
    Physics in Medicine and Biology, 2013
    Co-Authors: Rui Zhang, Phillip J Taddei, A Giebeler, Rebecca Maureen Howell, Anita Mahajan, Wayne D Newhauser
    Abstract:

    Pediatric patients who received radiation Therapy are at risk of developing side effects such as radiogenic second cancer. We compared proton and Photon therapies in terms of the predicted risk of second cancers for a 4 year old medulloblastoma patient receiving craniospinal irradiation (CSI). Two CSI treatment plans with 23.4 Gy or Gy (RBE) prescribed dose were computed: a three-field 6 MV Photon Therapy plan and a four-field proton Therapy plan. The primary doses for both plans were determined using a commercial treatment planning system. Stray radiation doses for proton Therapy were determined from Monte Carlo simulations, and stray radiation doses for Photon Therapy were determined from measured data. Dose–risk models based on the Biological Effects of Ionization Radiation VII report were used to estimate the risk of second cancer in eight tissues/organs. Baseline predictions of the relative risk for each organ were always less for proton CSI than for Photon CSI at all attained ages. The total lifetime attributable risk of the incidence of second cancer considered after proton CSI was much lower than that after Photon CSI, and the ratio of lifetime risk was 0.18. Uncertainty analysis revealed that the qualitative findings of this study were insensitive to any plausible changes of dose–risk models and mean radiation weighting factor for neutrons. Proton Therapy confers lower predicted risk of second cancer than Photon Therapy for the pediatric medulloblastoma patient.

  • mo g brc 01 comparison of the risk of second malignant neoplasm in a developed country versus a developing country for a 13 year old girl receiving craniospinal irradiation
    Medical Physics, 2011
    Co-Authors: Rui Zhang, Phillip J Taddei, Nabil Khater, Fady B Geara, Wassim Jalbout, D Mirkovic, Rebecca M Howell
    Abstract:

    Purpose: Childhood cancer is a global health problem that affects nations of every socioeconomic status. The incidence of treatment‐induced second malignant neoplasms (SMNs) for these children is high and will increase with years of follow up. Advanced radioTherapy techniques may reduce the risk of SMN, but these techniques are not available in developing countries. The purpose of this study was to compare the predicted SMN risk for a 13‐ year‐old girl who received craniospinal irradiation (CSI) in a developed country versus that if she had been treated in a developing country. Methods: Treatment plans were created for the girl on the basis of the standards of care in each country, comprised of 4 proton fields in the developed country and 4 6‐MV Photon fields in the developing country. Mean organ equivalent dose, HT, values from primary radiation fields were calculated using commercial treatment planning systems in the clinics of the respective countries while HT from stray radiation were determined based on Monte Carlo simulations in the case of proton Therapy and on thermoluminescent dosimeter measurements in an anthropomorphic phantom in the case of Photon Therapy. An organ‐, age‐, and sex‐specific risk model was applied to predict the risk of SMN incidence for each standard of care. Results: The predicted risk of SMN incidence was almost a factor of two higher for the standard of care of a developing country using Photons versus that of a developed country using protons. The absolute risks were predominated by second thyroid, lung, and other solid cancers. Conclusion: Our findings suggest that SMN incidence of children undergoing CSI in developing countries may be improved if they are treated with advanced radioTherapy techniques currently available only in developed countries.