Systematic reviewSystematic assessment of clinical outcomes and toxicities of proton radiotherapy for reirradiation
Section snippets
Materials and methods
This systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [16]. Eligibility criteria included published work in English evaluating proton RT for neoplasms that have undergone an initial course of RT, with reRT being performed in the setting of recurrent disease or second primary tumor in the initial RT field. Relevant endpoints to be considered for each disease site were any types of adverse events and/or complications,
Ocular
Table 1 illustrates details regarding PBT reRT for ocular, adult central nervous system (CNS), and pediatric CNS neoplasms. In an evaluation of re-PBT for 31 patients with recurrent uveal melanoma at Harvard University [17], the median time to reRT was 36 months, and nearly all patients were re-treated with a full dose of 70 Gray-equivalent (GyE). Most patients had initially received 70 GyE. At 5 years, the rate of local recurrence (LR) was 31%, with a 5-year eye retention rate of 55%. Of the
Discussion
This is the first systematic review to date comprehensively assessing the safety and efficacy of PBT for re-irradiation, a high-risk circumstance for which advanced technologies such as PBT may have substantial utility. Literature to date, while encouraging, is limited, and reporting of further experiences and correlations with toxicities and outcomes is needed.
Among the diverse constellation of CNS malignancies, PBT displays appropriate safety profiles in the reRT setting. Although outcomes of
Conflicts of interest
All authors declare that conflicts of interest do not exist.
Funding
There were no funding sources for this work.
Ethics
This work did not involve patients.
References (57)
- et al.
Risk of a second malignant neoplasm after cancer in childhood treated with radiotherapy: correlation with the integral dose restricted to the irradiated fields
Int J Radiat Oncol Biol Phys
(2008) - et al.
Predicted rates of secondary malignancies from proton versus photon radiation therapy for stage I seminoma
Int J Radiat Oncol Biol Phys.
(2012) - et al.
Clinical outcomes and toxicity of proton radiotherapy for breast cancer
Clin Breast Cancer
(2016) - et al.
Improving outcomes for esophageal cancer using proton beam therapy
Int J Radiat Oncol Biol Phys
(2016) - et al.
Prospective study of proton beam radiation therapy for adjuvant and definitive treatment of thymoma and thymic carcinoma: early response and toxicity assessment
Radiother Oncol
(2016) - et al.
First clinical report of proton beam therapy for postoperative radiotherapy for non-small-cell lung cancer
Clin Lung Cancer
(2017) - et al.
Proton beam radiotherapy as part of comprehensive regional nodal irradiation for locally advanced breast cancer
Radiother Oncol
(2017) - et al.
PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement
Int J Surg
(2010) - et al.
Conservation treatment of the eye: Conformal proton reirradiation for recurrent uveal melanoma
Int J Radiat Oncol Biol Phys
(2006) - et al.
Proton therapy for reirradiation of progressive or recurrent chordoma
Int J Radiat Oncol Biol Phys
(2013)
Reirradiation with proton therapy for recurrent gliomas
Int J Particle Ther
Use of proton therapy for re-irradiation in pediatric intracranial ependymoma
Radiother Oncol
Reirradiation of recurrent pediatric brain tumors after initial proton therapy
Int J Particle Ther
Proton beam reirradiation for recurrent head and neck cancer: multi-institutional report on feasibility and early outcomes
Int J Radiat Oncol Biol Phys
Reirradiation of head and neck cancers with proton therapy: outcomes and analyses
Int J Radiat Oncol Biol Phys
Reirradiation of recurrent and second primary head and neck cancer with proton therapy
Int J Radiat Oncol Biol Phys
Feasibility of proton beam therapy for reirradiation of locoregionally recurrent non-small cell lung cancer
Radiother Oncol
Multi-institutional prospective study of reirradiation with proton beam radiotherapy for locoregionally recurrent non-small cell lung cancer
J Thorac Oncol
A prospective study of proton beam reirradiation for esophageal cancer
Int J Radiat Oncol Biol Phys
Proton reirradiation of recurrent rectal cancer: dosimetric comparison, toxicities, and preliminary outcomes
Int J Particle Ther
Analysis of repeated proton beam therapy for patients with hepatocellular carcinoma
Radiother Oncol
Consensus statement on proton therapy in early-stage and locally advanced non-small cell lung cancer
Int J Radiat Oncol Biol Phys
Intensity-modulated proton therapy for elective nodal irradiation and involved-field radiation in the definitive treatment of locally advanced non-small-cell lung cancer: a dosimetric study
Clin Lung Cancer
Pembrolizumab versus docetaxel for previously treated, PD-L1-positive, advanced non-small- cell lung cancer (KEYNOTE-010): a randomised controlled trial
Lancet
Salvage re-irradiation for recurrent head and neck cancer
Int J Radiat Oncol Biol Phys
First clinical investigation of cone bone computed tomography and deformable registration for adaptive proton therapy of lung cancer
Int J Radiat Oncol Biol Phys
Comparison of intensity-modulated radiotherapy, adaptive radiotherapy, proton radiotherapy, and adaptive proton radiotherapy for treatment of locally advanced head and neck cancer
Radiother Oncol
Benefit of particle therapy in re-irradiation of head and neck patients. Results of a multicentric in silico ROCOCO trial
Radiother Oncol
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