News | Proton Therapy | March 24, 2017

Proton Therapy Offers New Treatment Possibility for Recurrent Lung Cancer

Advanced form of image-guided radiation therapy is an option for patients who previously had none

proton therapy, recurrent lung cancer, clinical study, IMPT, 2017 Multidisciplinary Thoracic Cancers Symposium

March 24, 2017 — A new study offers hope for patients with recurrent lung cancer, who historically have been considered ineligible for curative treatment. In the largest analysis to date of re-irradiation using intensity-modulated proton therapy (IMPT) for lung and other thoracic tumors, more than three-fourths of patients were free from local recurrence at one year following retreatment, and fewer than one in ten patients experienced severe side effects. The study was presented at the 2017 Multidisciplinary Thoracic Cancers Symposium, March 14-16 in San Diego.

Lung cancer causes more deaths in the United States than any other type of cancer, due in part to its aggressive nature and likelihood of recurrence. Historically, recurrences have been challenging to treat, because many of these patients are not candidates for surgery. Moreover, concerns about cumulative radiation doses to essential organs near thoracic tumors (e.g., heart, lungs, esophagus) may limit the use of curative radiation therapy (RT) for patients who received thoracic RT in the past. Accordingly, patients whose lung cancer recurs are generally offered only palliative options to manage pain and other symptoms.

Proton therapy, an advanced type of RT, allows radiation oncologists to spare critical normal tissues while delivering escalated, curative doses of radiation to nearby tumors. In particular, IMPT is able to exactly target a tumor, even if the tumor wraps around a critical normal tissue structure, such as a lung.

“Treating patients who have already received a prior course of thoracic radiation is a common clinical scenario, and it is particularly challenging to subsequently provide strong enough radiation doses to eliminate the new tumor without causing significant harm to normal tissues,” said Jennifer Ho, M.D., lead author of the study and a resident in radiation oncology at the University of Texas MD Anderson Cancer Center in Houston. “Our study is the first to show that IMPT can be safe and effective for these patients — and that it offers these patients a chance for lasting cancer control without adding significant toxicity.”

Researchers retrospectively examined the records of 27 patients who received reirradiation for thoracic tumors using the IMPT technique through prospective clinical trials at a single institution between 2011 and 2016. Twenty-two patients (81%) had non-small cell lung cancer (NSCLC). All patients had previously received curative thoracic RT.

Time to reirradiation ranged from 0.1 months to 212 months, with a median of 29.5 months. The median radiation dose was 66 Gray (Gy), with a range of 43.2 to 84 Gy, and it was delivered in 2 Gy fractions. The median follow-up for all patients in the study was 11.2 months.

The median overall survival (OS) for patients in this study was 18 months following IMPT re-irradiation. At one year following retreatment, the majority of patients were free from local and regional relapse (freedom from local failure = 78 percent; local-regional relapse = 61 percent). Just over half of the patients were free from disease progression (progression-free survival, PFS = 51 percent), and the one-year OS rate was 54 percent. Four of the patients (15 percent) experienced a local recurrence within one year of retreatment.

Patients who were prescribed a higher dose of IMPT re-irradiation were even less likely to experience recurrence or progression. At one-year follow-up, patients who received IMPT re-irradiation doses at or above the population median were twice as likely to be free from local failure (100 percent vs. 49 percent, p = 0.01) and nearly four times as likely to be free from local-regional failure (84 percent vs. 23 percent, p = 0.035). The one-year PFS rate was five times higher for these patients, as well (76 percent vs. 14 percent, p = 0.05). Several disease characteristics, namely higher T stage at diagnosis, squamous histology and higher recurrent tumor volume, were associated with worse OS rates.

Reirradiation with IMPT was well-tolerated among the patients. Only two patients (7 percent) experienced moderate to severe long-term lung toxicity (i.e., grade 3 or higher side effects). There were no severe long-term esophageal side effects nor any life-threatening toxicities among these patients.

“Historically, 20 to 30 percent of patients have experienced moderate or severe side effects, and even fatal side effects, following reirradiation. We knew that IMPT would allow us to generate much more precise radiation treatment plans that spared normal tissue, but we weren’t sure if this would translate into excellent clinical outcomes,” said Joe Y. Chang, M.D., senior author of the study and a professor of radiation oncology at MD Anderson. “Our findings demonstrate that the use of IMPT resulted in better local control and survival, with very minimal toxicity, compared to other radiation types, suggesting that IMPT is the optimal treatment modality for re-treatment of thoracic cancers.”

For more information: www.thoracicsymposium.org

Related Content

Technology becomes a state-of-the-art tool when it gets exposed to a structure that constantly tests it and allows it to evolve.

Technology becomes a state-of-the-art tool when it gets exposed to a structure that constantly tests it and allows it to evolve. Getty Images

Feature | Oncology Information Management Systems (OIMS) | May 27, 2020 | By Reshu Gupta
In the history of medicine, researchers have found cures for many diseases, but cancer has been elusive.
Miami Cancer Institute’s Proton Therapy Center is the first in South Florida and the region’s top destination for this leading-edge treatment. Proton therapy is an advanced form of radiation therapy that uses pencil beam scanning (PBS) technology.

Miami Cancer Institute’s Proton Therapy Center is the first in South Florida and the region’s top destination for this leading-edge treatment. Proton therapy is an advanced form of radiation therapy that uses pencil beam scanning (PBS) technology.

Feature | Proton Therapy | May 27, 2020 | By Minesh Mehta, M.D.
Radiation therapy has advanced significantly in the last few decades as a result of a continued technological revolut
The Philips Lumify point-of-care ultrasound (POCUS) system assessing a patient in the emergency room combined with telehealth to enable real-time collaboration with other physicians.

The Philips Lumify point-of-care ultrasound (POCUS) system assessing a patient in the emergency room combined with telehealth to enable real-time collaboration with other physicians.

News | Coronavirus (COVID-19) | May 26, 2020
May 26, 2020  — Philips Healthcare recently received 510(k) clearance from the U.S.
a Schematic of the system. The entire solid tumour is illuminated from four sides by a four-arm fibre bundle. A cylindrically focused linear array is designed to detect optoacoustic signals from the tumour. In vivo imaging is performed in conical scanning geometry by controlling the rotation and translation stages. The sensing part of the transducer array and the tumour are submerged in water to provide acoustic coupling. b Maximum intensity projections of the optoacoustic reconstruction of a phantom of pol

a Schematic of the system. The entire solid tumour is illuminated from four sides by a four-arm fibre bundle. A cylindrically focused linear array is designed to detect optoacoustic signals from the tumour. In vivo imaging is performed in conical scanning geometry by controlling the rotation and translation stages. The sensing part of the transducer array and the tumour are submerged in water to provide acoustic coupling. b Maximum intensity projections of the optoacoustic reconstruction of a phantom of polyethylene microspheres (diameter, 20 μm) dispersed in agar. The inset shows a zoomed-in view of the region boxed with a yellow dashed line. In addition, the yellow boxes are signal profiles along the xy and z axes across the microsphere centre, as well as the corresponding full width at half-maximum values. c Normalized absorption spectra of Hb, HbO2 and gold nanoparticles (AuNPs). The spectrum for the AuNPs was obtained using a USB4000 spectrometer (Ocean Optics, Dunedin, FL, USA), while the spectra for Hb and HbO2 were taken from http://omlc.org/spectra/haemoglobin/index.html. The vertical dashed lines indicate the five wavelengths used to stimulate the three absorbers: 710, 750, 780, 810 and 850 nm. Optoacoustic signals were filtered into a low-frequency band (red) and high-frequency band (green), which were used to reconstruct separate images.

News | Breast Imaging | May 26, 2020
May 26, 2020 — Breast cancer is the most common cancer in women.
A new technique developed by researchers at UC Davis offers a significant advance in using magnetic resonance imaging to pick out even very small tumors from normal tissue. The team created a probe that generates two magnetic resonance signals that suppress each other until they reach the target, at which point they both increase contrast between the tumor and surrounding tissue

A new technique developed by researchers at UC Davis offers a significant advance in using magnetic resonance imaging to pick out even very small tumors from normal tissue. The team created a probe that generates two magnetic resonance signals that suppress each other until they reach the target, at which point they both increase contrast between the tumor and surrounding tissue. Image courtesy of Xiandoing Xue, UC Davis

News | Magnetic Resonance Imaging (MRI) | May 26, 2020
May 26, 2020 — Researchers at the University of California, Davis offers a...
Researchers from Tokyo Metropolitan University have surveyed the amount of gadolinium found in river water in Tokyo. Gadolinium is contained in contrast agents given to patients undergoing medical magnetic resonance imaging (MRI) scans, and it has been shown in labs to become toxic when exposed to ultraviolet rays. The researchers found significantly elevated levels, particularly near water treatment plants, highlighting the need for new public policy and removal technologies as MRI become even more commonp

Samples were taken along rivers around Tokyo. Measurements of rare earth element quantities indicate a clearly elevated amount of gadolinium compared to that in natural shale. Graphics courtesy of Tokyo Metropolitan University

News | Magnetic Resonance Imaging (MRI) | May 26, 2020
May 26, 2020 — Researchers from Tokyo Metropolitan...
Remote reading of imaging studies on home picture archiving and communication systems (PACS) workstations can contribute to social distancing, protect vulnerable radiologists and others in the hospital, and ensure seamless interpretation capabilities in emergency scenarios, according to an open-access article published ahead-of-print by the American Journal of Roentgenology (AJR).

Srini Tridandapani, M.D., Ph.D.

News | PACS | May 21, 2020
May 21, 2020 — 
The global radiation therapy market is expected to reach $10.11 billion in 2024, witnessing growth at a CAGR of 3.38%, over the period 2020-2024.
News | Proton Therapy | May 20, 2020
May 20, 2020 — ResearchAndMarkets.com has released its latest report, the ...
Examples of chest CT images of COVID-19 (+) patients and visualization of features correlated to COVID-19 positivity. For each pair of images, the left image is a CT image showing the segmented lung used as input for the CNN (convolutional neural network algorithm) model trained on CT images only, and the right image shows the heatmap of pixels that the CNN model classified as having SARS-CoV-2 infection (red indicates higher probability). (a) A 51-year-old female with fever and history of exposure to SARS-

Figure 1: Examples of chest CT images of COVID-19 (+) patients and visualization of features correlated to COVID-19 positivity. For each pair of images, the left image is a CT image showing the segmented lung used as input for the CNN (convolutional neural network algorithm) model trained on CT images only, and the right image shows the heatmap of pixels that the CNN model classified as having SARS-CoV-2 infection (red indicates higher probability). (a) A 51-year-old female with fever and history of exposure to SARS-CoV-2. The CNN model identified abnormal features in the right lower lobe (white color), whereas the two radiologists labeled this CT as negative. (b) A 52-year-old female who had a history of exposure to SARS-CoV-2 and presented with fever and productive cough. Bilateral peripheral ground-glass opacities (arrows) were labeled by the radiologists, and the CNN model predicted positivity based on features in matching areas. (c) A 72-year-old female with exposure history to the animal market in Wuhan presented with fever and productive cough. The segmented CT image shows ground-glass opacity in the anterior aspect of the right lung (arrow), whereas the CNN model labeled this CT as negative. (d) A 59-year-old female with cough and exposure history. The segmented CT image shows no evidence of pneumonia, and the CNN model also labeled this CT as negative.  

News | Coronavirus (COVID-19) | May 19, 2020
May 19, 2020 — Mount Sinai researchers are the first in the country to use...