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May 2022Volume 2, Issue 1, Pages 1–11
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Opportunities and Advances in the use of Proton Radiotherapy for Management of Central Nervous System and Base of Skull Tumors

Bansi Savla
x
Bansi Savla
, MD
,
Gregory Alexander
x
Gregory Alexander
, MD
,
Ariel E. Pollock
x
Ariel E. Pollock
, MD
,
Justin Cohen
x
Justin Cohen
, MD
,
Mark V. Mishra
x
Mark V. Mishra
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Correspondence

  • Corresponding author.
, MD∗,'Correspondence information about the author MD Mark V. Mishra
x
Mark V. Mishra
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Correspondence

  • Corresponding author.
Department of Radiation Oncology, University of Maryland School of Medicine, College Park, MD, USA
Opportunities and Advances in the use of Proton Radiotherapy for Management of Central Nervous System and Base of Skull Tumors
DOI: https://doi.org/10.1016/j.yao.2022.01.001

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Figures

Fig. 1

Protons are charged particles that lose energy continuously as they penetrate the body. As it slows, its rate of energy loss increases. Right before it stops, the rate of energy loss peaks, and this is known as the Bragg-Peak. Because of this there is virtually no exit dose and a reduction in integral dose.

Fig. 2

IMPT and VMAT comparative plans for left frontal anaplastic oligodendroglioma WHO III IDH mutant 1p19q co-deleted s/p GTR. Patient received 5940 cGy at 180 cGy/fx. Comparative proton and photon plan is shown.

Fig. 3

IMPT and VMAT comparative plans for left temporal GBM after prior LGG s/p resection and 54 Gy with photon RT. Patient received reirradiation with PBT to 5400 cGy at 180 cGy/fx. Comparative proton and photon plan with prior dose to OARS and cumulative doses is shown.

Fig. 4

IMPT and VMAT comparative plans for skull-based meningioma s/p CyberKnife. Patient received 5060 cGy of reirradiation at 110 cGy/fx. Comparative proton and photon plan is shown.

Fig. 5

IMPT and VMAT comparative plans for clival chordoma s/p tumor debulking. Patient received 6970 cGy at 170 cGy/fx. Comparative proton and photon plan is shown.

Fig. 6

IMPT and VMAT comparative plans for vestibular schwannoma s/p tumor debulking. Patient received 4680 cGy at 180 cGy/fx. Comparative proton and photon plan is shown.

First page of article

Advances in managing central nervous system (CNS) malignancies have led to improved survival outcomes and therefore an increased need to reduce the risk of treatment-related toxicities. Precise dose delivery through advanced radiation techniques can spare toxicity to critical structures while maintaining adequate target coverage. This review discusses potential clinical applications of proton beam therapy for treatment of tumors of the central nervous system and to review the emerging clinical data supporting use of proton beam therapy and ongoing clinical trial efforts.

Keywords:

Proton, Radiotherapy, CNS, Bragg-peak, PBT, Brain tumors, Pencil beam

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May 2022Volume 2, Issue 1, Pages 1–11