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Cancers
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Proton Therapy for CNS Tumors
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Proton Therapy for CNS Tumors

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (31 December 2022) | Viewed by 10392

Special Issue Editors

Prof. Dr. Beate Timmermann

E-Mail Website
Guest Editor
Department of Particle Therapy, West German Proton Therapy Centre Essen (WPE), University Hospital Essen, German Cancer Consortium (DKTK), 45122 Essen, Germany
Interests: radiation oncology; proton beam therapy; CNS tumors; sarcomas; pediatric malignancies; quality assurance in radiotherapy; late effects and quality of life
Dr. Julie A. Bradley

E-Mail Website
Guest Editor
Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
Interests: radiation oncology; proton beam therapy; pediatric malignancies; breast cancer; late effects

Special Issue Information

Dear Colleagues, 

Radiotherapy is an important and highly effective part of modern multimodality management of CNS tumors. However, radiotherapy is known to cause a broad range of adverse effects, potentially having a significant negative impact on quality of life. Thus, strategies that mitigate late effects are needed. With regard to radiotherapy, techniques are attractive when able to better protect normal tissue and critical organs of risk. Due to its particular physical characteristics, Proton therapy (PT) can achieve high dose conformality to the target volume while sparing normal tissue. Important technological advances have managed to make PT more robust and deliverable to a huge variety of tumor entities. PT is often preferred in tumors sites in the vicinity of particularly vulnerable tissue and in tumors requiring high radiation doses. Therefore, CNS and base of skull tumors of the CNS are the predominant diagnoses in the majority of proton facilities and clinical evidence is increasing.

This Special Issue on proton therapy for CNS tumors will highlight the role of PT in CNS tumors, covering various clinical, physical, and biological aspects.

Prof. Dr. Beate Timmermann
Dr. Julie A. Bradley
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • proton therapy
  • CNS
  • brain tumors
  • outcome
  • late effects
  • quality of life

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Published Papers (4 papers)

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Research

20 pages, 7029 KiB  
Article
Proton Beam Therapy for Pediatric Tumors of the Central Nervous System—Experiences of Clinical Outcome and Feasibility from the KiProReg Study
by Sarah Peters, Sabine Frisch, Annika Stock, Julien Merta, Christian Bäumer, Christoph Blase, Eicke Schuermann, Stephan Tippelt, Brigitte Bison, Michael Frühwald, Stefan Rutkowski, Gudrun Fleischhack and Beate Timmermann
Cancers 2022, 14(23), 5863; https://doi.org/10.3390/cancers14235863 - 28 Nov 2022
Cited by 3 | Viewed by 2062
Abstract
As radiotherapy is an important part of the treatment in a variety of pediatric tumors of the central nervous system (CNS), proton beam therapy (PBT) plays an evolving role due to its potential benefits attributable to the unique dose distribution, with the possibility [...] Read more.
As radiotherapy is an important part of the treatment in a variety of pediatric tumors of the central nervous system (CNS), proton beam therapy (PBT) plays an evolving role due to its potential benefits attributable to the unique dose distribution, with the possibility to deliver high doses to the target volume while sparing surrounding tissue. Children receiving PBT for an intracranial tumor between August 2013 and October 2017 were enrolled in the prospective registry study KiProReg. Patient’s clinical data including treatment, outcome, and follow-up were analyzed using descriptive statistics, Kaplan–Meier, and Cox regression analysis. Adverse events were scored according to the Common Terminology Criteria for Adverse Events (CTCAE) 4.0 before, during, and after PBT. Written reports of follow-up imaging were screened for newly emerged evidence of imaging changes, according to a list of predefined keywords for the first 14 months after PBT. Two hundred and ninety-four patients were enrolled in this study. The 3-year overall survival of the whole cohort was 82.7%, 3-year progression-free survival was 67.3%, and 3-year local control was 79.5%. Seventeen patients developed grade 3 adverse events of the CNS during long-term follow-up (new adverse event n = 7; deterioration n = 10). Two patients developed vision loss (CTCAE 4°). This analysis demonstrates good general outcomes after PBT. Full article
(This article belongs to the Special Issue Proton Therapy for CNS Tumors)
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11 pages, 1290 KiB  
Article
Hearing Loss in Cancer Patients with Skull Base Tumors Undergoing Pencil Beam Scanning Proton Therapy: A Retrospective Cohort Study
by Barbara Bachtiary, Dorothe Veraguth, Nicolaas Roos, Flurin Pfiffner, Dominic Leiser, Alessia Pica, Marc Walser, Stefanie von Felten and Damien C. Weber
Cancers 2022, 14(16), 3853; https://doi.org/10.3390/cancers14163853 - 9 Aug 2022
Cited by 2 | Viewed by 1650
Abstract
To assess the incidence and severity of changes in hearing threshold in patients undergoing high-dose pencil-beam-scanning proton therapy (PBS-PT). This retrospective cohort study included fifty-one patients (median 50 years (range, 13–68)) treated with PBS-PT for skull base tumors. No chemotherapy was delivered. Pure [...] Read more.
To assess the incidence and severity of changes in hearing threshold in patients undergoing high-dose pencil-beam-scanning proton therapy (PBS-PT). This retrospective cohort study included fifty-one patients (median 50 years (range, 13–68)) treated with PBS-PT for skull base tumors. No chemotherapy was delivered. Pure tone averages (PTAs)were determined before (baseline) and after PBS-PT as the average hearing thresholds at frequencies of 0.5, 1, 2, and 4 kHz. Hearing changes were calculated as PTA differences between pre-and post-PBS-PT. A linear mixed-effects model was used to assess the relationship between the PTA at the follow-up and the baseline, the cochlea radiation dose intensity, the increased age, and the years after PBS-PT. Included patients were treated for chordoma (n = 24), chondrosarcoma (n = 9), head and neck tumors (n = 9), or meningioma (n = 3), with a mean tumor dose of 71.1 Gy (RBE) (range, 52.0–77.8), and a mean dose of 37 Gy (RBE) (range, 0.0–72.7) was delivered to the cochleas. The median time to the first follow-up was 11 months (IQR, 5.5–33.7). The PTA increased from a median of 15 dB (IQR 10.0–25) at the baseline to 23.8 (IQR 11.3–46.3) at the first follow-up. In the linear mixed-effect model, the baseline PTA (estimate 0.80, 95%CI 0.64 to 0.96, p ≤ 0.001), patient’s age (0.30, 0.03 to 0.57, p = 0.029), follow-up time (2.07, 0.92 to 3.23, p ≤ 0.001), and mean cochlear dose in Gy (RBE) (0.34, 0.21 to 0.46, p ≤ 0.001) were all significantly associated with an increase in PTA at follow-up. The applied cochlear dose and baseline PTA, age, and time after treatment were significantly associated with hearing loss after proton therapy. Full article
(This article belongs to the Special Issue Proton Therapy for CNS Tumors)
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18 pages, 1004 KiB  
Article
Toxicity and Clinical Results after Proton Therapy for Pediatric Medulloblastoma: A Multi-Centric Retrospective Study
by Alessandro Ruggi, Fraia Melchionda, Iacopo Sardi, Rossana Pavone, Linda Meneghello, Lidija Kitanovski, Lorna Zadravec Zaletel, Paolo Farace, Mino Zucchelli, Mirko Scagnet, Francesco Toni, Roberto Righetto, Marco Cianchetti, Arcangelo Prete, Daniela Greto, Silvia Cammelli, Alessio Giuseppe Morganti and Barbara Rombi
Cancers 2022, 14(11), 2747; https://doi.org/10.3390/cancers14112747 - 1 Jun 2022
Cited by 8 | Viewed by 2679
Abstract
Medulloblastoma is the most common malignant brain tumor in children. Even if current treatment dramatically improves the prognosis, survivors often develop long-term treatment-related sequelae. The current radiotherapy standard for medulloblastoma is craniospinal irradiation with a boost to the primary tumor site and to [...] Read more.
Medulloblastoma is the most common malignant brain tumor in children. Even if current treatment dramatically improves the prognosis, survivors often develop long-term treatment-related sequelae. The current radiotherapy standard for medulloblastoma is craniospinal irradiation with a boost to the primary tumor site and to any metastatic sites. Proton therapy (PT) has similar efficacy compared to traditional photon-based radiotherapy but might achieve lower toxicity rates. We report on our multi-centric experience with 43 children with medulloblastoma (median age at diagnosis 8.7 years, IQR 6.6, M/F 23/20; 26 high-risk, 14 standard-risk, 3 ex-infant), who received active scanning PT between 2015 and 2021, with a focus on PT-related acute-subacute toxicity, as well as some preliminary data on late toxicity. Most acute toxicities were mild and manageable with supportive therapy. Hematological toxicity was limited, even among HR patients who underwent hematopoietic stem-cell transplantation before PT. Preliminary data on late sequelae were also encouraging, although a longer follow-up is needed. Full article
(This article belongs to the Special Issue Proton Therapy for CNS Tumors)
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17 pages, 1872 KiB  
Article
Outcome after Radiotherapy for Vestibular Schwannomas (VS)—Differences in Tumor Control, Symptoms and Quality of Life after Radiotherapy with Photon versus Proton Therapy
by Maike Küchler, Rami A. El Shafie, Sebastian Adeberg, Klaus Herfarth, Laila König, Kristin Lang, Juliane Hörner-Rieber, Peter Karl Plinkert, Wolfgang Wick, Felix Sahm, Simon David Sprengel, Jürgen Debus and Denise Bernhardt
Cancers 2022, 14(8), 1916; https://doi.org/10.3390/cancers14081916 - 10 Apr 2022
Cited by 6 | Viewed by 2941
Abstract
Background: To evaluate differences in local tumor control (LC), symptoms and quality of life (QOL) of 261 patients with VS after stereotactic radiosurgery/hypofractionated stereotactic radiotherapy (SRS/HFSRT) vs. fractionated radiotherapy (FRT) vs. fractionated proton therapy (FPT) were studied. Methods: For SRS/HFSRT (n = [...] Read more.
Background: To evaluate differences in local tumor control (LC), symptoms and quality of life (QOL) of 261 patients with VS after stereotactic radiosurgery/hypofractionated stereotactic radiotherapy (SRS/HFSRT) vs. fractionated radiotherapy (FRT) vs. fractionated proton therapy (FPT) were studied. Methods: For SRS/HFSRT (n = 149), the median fraction dose applied was 12 Gy. For FRT (n = 87) and FPT (n = 25), the median cumulative doses applied were 57.6 Gy and 54 Gy (RBE), respectively. FRT and FPT used single median doses of 1.8 Gy/Gy (RBE). Median follow-up was 38 months. We investigated dosimetry for organs at risk and analyzed toxicity and QOL by sending out a questionnaire. Results: LC was 99.5% at 12 months after RT with no statistical difference between treatment groups (p = 0.19). LC was significantly lower in NF2 patients (p = 0.004) and in patients with higher tumor extension grade (p = 0.039). The hearing preservation rate was 97% at 12 months after RT with no statistical difference between treatment groups (p = 0.31). Facial and trigeminal nerve affection after RT occurred as mild symptoms with highest toxicity rate in FPT patients. Conclusion: SRS/HFSRT, FRT and FPT for VS show similar overall clinical and functional outcomes. Cranial nerve impairment rates vary, potentially due to selection bias with larger VS in the FRT and FPT group. Full article
(This article belongs to the Special Issue Proton Therapy for CNS Tumors)
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