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| Home > Publications database > Prospective clinical trial of upright image-guided proton therapy for locally recurrent head and neck and brain malignancies. > print |
| 001 | 303499 | ||
| 005 | 20250829132522.0 | ||
| 024 | 7 | _ | |a 10.1016/j.radonc.2025.111097 |2 doi |
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| 037 | _ | _ | |a DKFZ-2025-01690 |
| 041 | _ | _ | |a English |
| 082 | _ | _ | |a 610 |
| 100 | 1 | _ | |a Blumenfeld, Philip |b 0 |
| 245 | _ | _ | |a Prospective clinical trial of upright image-guided proton therapy for locally recurrent head and neck and brain malignancies. |
| 260 | _ | _ | |a Amsterdam [u.a.] |c 2025 |b Elsevier Science |
| 336 | 7 | _ | |a article |2 DRIVER |
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| 336 | 7 | _ | |a Journal Article |0 0 |2 EndNote |
| 500 | _ | _ | |a #EA:E041# / Volume 211, October 2025, 111097 |
| 520 | _ | _ | |a 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. |
| 536 | _ | _ | |a 315 - Bildgebung und Radioonkologie (POF4-315) |0 G:(DE-HGF)POF4-315 |c POF4-315 |f POF IV |x 0 |
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| 650 | _ | 7 | |a Adaptive radiotherapy |2 Other |
| 650 | _ | 7 | |a Image guidance |2 Other |
| 650 | _ | 7 | |a Proton therapy |2 Other |
| 650 | _ | 7 | |a Radiotherapy |2 Other |
| 650 | _ | 7 | |a Upright CT |2 Other |
| 650 | _ | 7 | |a Upright treatments |2 Other |
| 700 | 1 | _ | |a Pryanichnikov, Alexander |0 P:(DE-He78)0704701d58e3a0d5f45fbd1018d5aa77 |b 1 |e First author |u dkfz |
| 700 | 1 | _ | |a Hillman, Yair |b 2 |
| 700 | 1 | _ | |a Wajnryt, Ella |b 3 |
| 700 | 1 | _ | |a Berger, Aviad |b 4 |
| 700 | 1 | _ | |a Winograd, Shimshon |b 5 |
| 700 | 1 | _ | |a Wygoda, Marc |b 6 |
| 700 | 1 | _ | |a Salhab, Ayman |b 7 |
| 700 | 1 | _ | |a Fang, Marcel |b 8 |
| 700 | 1 | _ | |a Feldman, Jon |b 9 |
| 700 | 1 | _ | |a Popovtzer, Aron |b 10 |
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