Treatment of a first patient with FLASH-radiotherapy.

Aged Drug Resistance, Neoplasm Humans Lymphoma, T-Cell, Cutaneous / radiotherapy Male Organ Sparing Treatments / methods Radiotherapy / methods Radiotherapy Dosage Skin Neoplasms / radiotherapy Treatment Outcome
Clinical translation Differential effect FLASH-RT Normal tissue protection

Journal

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
ISSN: 1879-0887
Titre abrégé: Radiother Oncol
Pays: Ireland
ID NLM: 8407192

Informations de publication

Date de publication:
10 2019
Historique:
received: 01 04 2019
revised: 12 06 2019
accepted: 14 06 2019
pubmed: 16 7 2019
medline: 21 4 2020
entrez: 16 7 2019
Statut: ppublish

Résumé

When compared to conventional radiotherapy (RT) in pre-clinical studies, FLASH-RT was shown to reproducibly spare normal tissues, while preserving the anti-tumor activity. This marked increase of the differential effect between normal tissues and tumors prompted its clinical translation. In this context, we present here the treatment of a first patient with FLASH-RT. A 75-year-old patient presented with a multiresistant CD30+ T-cell cutaneous lymphoma disseminated throughout the whole skin surface. Localized skin RT has been previously used over 110 times for various ulcerative and/or painful cutaneous lesions progressing despite systemic treatments. However, the tolerance of these RT was generally poor, and it was hypothesized that FLASH-RT could offer an equivalent tumor control probability, while being less toxic for the skin. This treatment was given to a 3.5-cm diameter skin tumor with a 5.6-MeV linac specifically designed for FLASH-RT. The prescribed dose to the PTV was 15 Gy, in 90 ms. Redundant dosimetric measurements were performed with GafChromic films and alanine, to check the consistency between the prescribed and the delivered doses. At 3 weeks, i.e. at the peak of the reactions, a grade 1 epithelitis (CTCAE v 5.0) along with a transient grade 1 oedema (CTCAE v5.0) in soft tissues surrounding the tumor were observed. Clinical examination was consistent with the optical coherence tomography showing no decrease of the thickness of the epidermis and no disruption at the basal membrane with limited increase of the vascularization. In parallel, the tumor response was rapid, complete, and durable with a short follow-up of 5 months. These observations, both on normal skin and on the tumor, were promising and prompt to further clinical evaluation of FLASH-RT. This first FLASH-RT treatment was feasible and safe with a favorable outcome both on normal skin and the tumor.

Sections du résumé

BACKGROUND
When compared to conventional radiotherapy (RT) in pre-clinical studies, FLASH-RT was shown to reproducibly spare normal tissues, while preserving the anti-tumor activity. This marked increase of the differential effect between normal tissues and tumors prompted its clinical translation. In this context, we present here the treatment of a first patient with FLASH-RT.
MATERIAL & METHODS
A 75-year-old patient presented with a multiresistant CD30+ T-cell cutaneous lymphoma disseminated throughout the whole skin surface. Localized skin RT has been previously used over 110 times for various ulcerative and/or painful cutaneous lesions progressing despite systemic treatments. However, the tolerance of these RT was generally poor, and it was hypothesized that FLASH-RT could offer an equivalent tumor control probability, while being less toxic for the skin. This treatment was given to a 3.5-cm diameter skin tumor with a 5.6-MeV linac specifically designed for FLASH-RT. The prescribed dose to the PTV was 15 Gy, in 90 ms. Redundant dosimetric measurements were performed with GafChromic films and alanine, to check the consistency between the prescribed and the delivered doses.
RESULTS
At 3 weeks, i.e. at the peak of the reactions, a grade 1 epithelitis (CTCAE v 5.0) along with a transient grade 1 oedema (CTCAE v5.0) in soft tissues surrounding the tumor were observed. Clinical examination was consistent with the optical coherence tomography showing no decrease of the thickness of the epidermis and no disruption at the basal membrane with limited increase of the vascularization. In parallel, the tumor response was rapid, complete, and durable with a short follow-up of 5 months. These observations, both on normal skin and on the tumor, were promising and prompt to further clinical evaluation of FLASH-RT.
CONCLUSION
This first FLASH-RT treatment was feasible and safe with a favorable outcome both on normal skin and the tumor.

Identifiants

DOI: 10.1016/j.radonc.2019.06.019 PMID: 31303340
pubmed: 31303340
pii: S0167-8140(19)32959-7
doi: 10.1016/j.radonc.2019.06.019
pii:
doi:

Types de publication

Case Reports Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

18-22

Commentaires et corrections

Type : CommentIn

Informations de copyright

Copyright © 2019. Published by Elsevier B.V.

Auteurs

Jean Bourhis (J)

Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, Switzerland; Radiation Oncology Laboratory, Department of Radiation Oncology. Lausanne University Hospital and University of Lausanne, Switzerland. Electronic address: jean.bourhis@chuv.ch.

Wendy Jeanneret Sozzi (WJ)

Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, Switzerland.

Patrik Gonçalves Jorge (PG)

Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, Switzerland; Radiation Oncology Laboratory, Department of Radiation Oncology. Lausanne University Hospital and University of Lausanne, Switzerland; Institute of Radiation Physics, Lausanne University Hospital and University of Lausanne, Switzerland.

Olivier Gaide (O)

Department of Dermatology, Lausanne University Hospital and University of Lausanne, Switzerland.

Claude Bailat (C)

Institute of Radiation Physics, Lausanne University Hospital and University of Lausanne, Switzerland.

Fréderic Duclos (F)

Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, Switzerland.

David Patin (D)

Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, Switzerland.

Mahmut Ozsahin (M)

Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, Switzerland.

François Bochud (F)

Institute of Radiation Physics, Lausanne University Hospital and University of Lausanne, Switzerland.

Jean-François Germond (JF)

Institute of Radiation Physics, Lausanne University Hospital and University of Lausanne, Switzerland.

Raphaël Moeckli (R)

Institute of Radiation Physics, Lausanne University Hospital and University of Lausanne, Switzerland.

Marie-Catherine Vozenin (MC)

Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, Switzerland; Radiation Oncology Laboratory, Department of Radiation Oncology. Lausanne University Hospital and University of Lausanne, Switzerland.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Treatment of a first patient with FLASH-radiotherapy.
questionsmedicales.fr › Phénomènes physiologiques › Phénomènes pharmacologiques et toxicologiques › Phénomènes pharmacologiques › Résistance aux substances › Résistance aux médicaments antinéoplasiques › Treatment of a first patient with FLASH-radiotherapy.
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Treatment of a first patient with FLASH-radiotherapy.
questionsmedicales.fr › Maladies du système immunitaire › Syndromes immunoprolifératifs › Syndromes lymphoprolifératifs › Lymphomes › Lymphome malin non hodgkinien › Lymphome T › Lymphome T cutané › Treatment of a first patient with FLASH-radiotherapy.
questionsmedicales.fr › Thérapeutique › Traitements préservant les organes › Treatment of a first patient with FLASH-radiotherapy.
questionsmedicales.fr › Thérapeutique › Radiothérapie › Treatment of a first patient with FLASH-radiotherapy.
questionsmedicales.fr › Thérapeutique › Radiothérapie › Dosimétrie en radiothérapie › Treatment of a first patient with FLASH-radiotherapy.
questionsmedicales.fr › Maladies de la peau et du tissu conjonctif › Maladies de la peau › Tumeurs cutanées › Treatment of a first patient with FLASH-radiotherapy.
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Treatment of a first patient with FLASH-radiotherapy.