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Accelerated fast neutron therapy: a pilot study.

D J Husband1, R D Errington, S Myint

  • 1Mersey Regional Centre for Radiotherapy and Oncology, Clatterbridge Hospital, Bebington, Wirral, UK.

The British Journal of Radiology
|August 1, 1992
PubMed
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Accelerated fractionation of fast neutron therapy did not improve the therapeutic ratio. This approach resulted in excessive late normal tissue damage, limiting its clinical use for advanced tumors.

Area of Science:

  • Radiation Oncology
  • Medical Physics

Background:

  • Fast neutron therapy's clinical use is hindered by significant late normal tissue damage.
  • Accelerated fractionation strategies aim to improve the therapeutic ratio by enhancing acute responses without increasing late effects.

Purpose of the Study:

  • To evaluate the efficacy and toxicity of accelerated fractionation for fast neutron therapy in patients with locally advanced tumors.
  • To determine if accelerated fractionation improves the therapeutic ratio compared to conventional fractionation.

Main Methods:

  • A pilot study involving 23 patients with 27 tumor sites treated with 6 or 12 fractions of 62 MeV (p-Be) neutrons over 12 days.
  • Dose adjustments were made based on site-specific tolerance, with reductions of 12% (18 Gy) for skin/oral mucosa and 15% for pelvic sites.

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  • Toxicity and response rates were assessed using established criteria.

    • Main Results:

    • Acceptable early reactions were observed with dose reductions, but 46% incidence of late EORTC/RTOG grade 4 toxicity occurred.
    • Overall response rate was 76%, with a complete response rate of 16%.
    • Locally advanced breast cancer showed a lower complete response rate (9%) compared to conventional schedules.

    Conclusions:

    • Accelerated fractionation of fast neutron therapy did not enhance the therapeutic ratio due to excessive late normal tissue toxicity.
    • Late normal tissue damage remains a dose-limiting factor, suggesting this approach is not superior to conventional fractionation.