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@ARTICLE{Blumenfeld:303499,
      author       = {P. Blumenfeld and A. Pryanichnikov$^*$ and Y. Hillman and
                      E. Wajnryt and A. Berger and S. Winograd and M. Wygoda and
                      A. Salhab and M. Fang and J. Feldman and A. Popovtzer},
      title        = {{P}rospective clinical trial of upright image-guided proton
                      therapy for locally recurrent head and neck and brain
                      malignancies.},
      journal      = {Radiotherapy and oncology},
      volume       = {211},
      issn         = {0167-8140},
      address      = {Amsterdam [u.a.]},
      publisher    = {Elsevier Science},
      reportid     = {DKFZ-2025-01690},
      pages        = {111097},
      year         = {2025},
      note         = {#EA:E041# / Volume 211, October 2025, 111097},
      abstract     = {The advent of commercially available vertical CT systems
                      has renewed interest in gantry-less proton therapy (PT), in
                      which patients are treated in an upright position using a
                      fixed beamline and robotic positioning. This study evaluates
                      the feasibility, safety, and preliminary efficacy of novel
                      gantry-less image-guided adaptive PT (IGAPT) for recurrent
                      head and neck (HN) and brain malignancies.A planned interim
                      analysis was performed on 20 adult patients with recurrent
                      HN (80 $\%)$ and brain (20 $\%)$ cancers, median age 62
                      years, with Eastern Cooperative Oncology Group (ECOG)
                      performance status ≤2. Patients underwent upright and
                      supine imaging and simulation, followed by treatment
                      planning comparing upright PT to conventional supine
                      intensity-modulated radiotherapy (IMRT). Dosimetric analyses
                      focused on organ-at-risk (OAR) sparing and target coverage.
                      Toxicities were assessed prospectively every three months
                      using the Common Terminology Criteria for Adverse Events
                      (CTCAE).Gantry-less PT demonstrated significant dosimetric
                      advantages over photon IMRT, including reduced doses to
                      critical OARs including brainstem (6 Gy(RBE) vs. 19.1 Gy; p
                      < 0.001) and spinal cord (12.5 Gy(RBE) vs. 18.3 Gy; p <
                      0.006). At 3-month follow-up (n = 14), a complete response
                      was observed in 64.3 $\%$ of evaluable patients and a
                      partial response in 21.4 $\%.$ Most toxicities were
                      mild-to-moderate (grades 1-2), primarily dermatitis (55
                      $\%),$ fatigue (45 $\%),$ and mucositis (31.3 $\%).$ Grade 3
                      toxicities occurred in four patients (20 $\%).$ There were
                      no device-related deaths.This first clinical evaluation of a
                      novel gantry-less IGAPT system confirms its feasibility,
                      safety, and promising efficacy for recurrent HN and brain
                      cancer, with superior dosimetry and high local control
                      rates. Its cost-effective design may improve global access
                      to the IGAPT.},
      keywords     = {Adaptive radiotherapy (Other) / Image guidance (Other) /
                      Proton therapy (Other) / Radiotherapy (Other) / Upright CT
                      (Other) / Upright treatments (Other)},
      cin          = {E041},
      ddc          = {610},
      cid          = {I:(DE-He78)E041-20160331},
      pnm          = {315 - Bildgebung und Radioonkologie (POF4-315)},
      pid          = {G:(DE-HGF)POF4-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:40803484},
      doi          = {10.1016/j.radonc.2025.111097},
      url          = {https://inrepo02.dkfz.de/record/303499},
}