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Feasibility issues
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The purpose of this study is to determine if Proton Therapy can provide effective and safe treatment for Malignant Peripheral Nerve Sheath Tumors of the spine and Neurofibromas of the spine.
Proton therapy may provide the benefits of local control or palliation, while reducing the risk associated with photon radiation, by delivering therapeutic doses to a well-defined target area with significant reduction in the integral dose. A dosimetry comparison of protons and photons at the University of Florida Proton Therapy Institute confirmed the feasibility of proton irradiation of these tumors with less exposure of normal tissue to radiation than expected with photon techniques. This reduced radiation exposure to uninvolved normal tissues is expected to decrease the risk of radiation-induced second malignancies and neoplasms.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Proton Radiation for MPNST | Experimental | Proton radiation 30 cobalt gray equivalent(CGE)at 6 CGE per fraction |
|
| Proton Radiation for neurofibromas | Experimental | Proton radiation 25 cobalt gray equivalent(CGE) at 5 CGE per fraction |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Proton Radiation for MPNST | Radiation | 30 CGE at 6 CGE/Fx |
| |
| Measure | Description | Time Frame |
|---|---|---|
| Local Control | 7 years after completion of RT |
| Measure | Description | Time Frame |
|---|---|---|
| Progression or palliation of pain, numbness, or weakness | At 3, 6, 12, 24 and 60 months after RT | |
| Number of adverse events | At 3, 6, 12, 24, 60 months and 15 years after RT | |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Randal H Henderson, MD | University of Florida | Principal Investigator |
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| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 19523356 | Background | Hottinger AF, Khakoo Y. Neuro-oncology of Neurofibromatosis Type 1. Curr Treat Options Neurol. 2009 Jul;11(4):306-14. doi: 10.1007/s11940-009-0034-4. | |
| 9128932 | Background | Friedman JM, Birch PH. Type 1 neurofibromatosis: a descriptive analysis of the disorder in 1,728 patients. Am J Med Genet. 1997 May 16;70(2):138-43. doi: 10.1002/(sici)1096-8628(19970516)70:23.0.co;2-u. |
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| ID | Term |
|---|---|
| D018317 | Nerve Sheath Neoplasms |
| D009455 | Neurofibroma |
| D013120 | Spinal Cord Neoplasms |
| D018319 | Neurofibrosarcoma |
| ID | Term |
|---|---|
| D009380 | Neoplasms, Nerve Tissue |
| D009370 | Neoplasms by Histologic Type |
| D009369 | Neoplasms |
| D010524 | Peripheral Nervous System Neoplasms |
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| ID | Term |
|---|---|
| D025542 | Neurofibromin 1 |
| ID | Term |
|---|---|
| D020703 | ras GTPase-Activating Proteins |
| D020690 | GTPase-Activating Proteins |
| D020555 | GTP-Binding Protein Regulators |
| D047908 | Intracellular Signaling Peptides and Proteins |
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| Proton Radiation for neurofibromas |
| Radiation |
25 CGE at 5 CGE/Fx |
|
| Quality of Life |
| 3, 6, 12, 24 and 60 months after RT |
| Rate of malignant transformation within the high-dose volume | 15 years after RT |
| Rate of second malignant primaries outside of high dose volume, but located in tissues exposed to radiation within the beam path | 15 years after RT |
| 9659085 | Background | Cnossen MH, de Goede-Bolder A, van den Broek KM, Waasdorp CM, Oranje AP, Stroink H, Simonsz HJ, van den Ouweland AM, Halley DJ, Niermeijer MF. A prospective 10 year follow up study of patients with neurofibromatosis type 1. Arch Dis Child. 1998 May;78(5):408-12. doi: 10.1136/adc.78.5.408. |
| 18559970 | Background | Mautner VF, Asuagbor FA, Dombi E, Funsterer C, Kluwe L, Wenzel R, Widemann BC, Friedman JM. Assessment of benign tumor burden by whole-body MRI in patients with neurofibromatosis 1. Neuro Oncol. 2008 Aug;10(4):593-8. doi: 10.1215/15228517-2008-011. Epub 2008 Jun 17. |
| 7897516 | Background | Seppala MT, Haltia MJ, Sankila RJ, Jaaskelainen JE, Heiskanen O. Long-term outcome after removal of spinal neurofibroma. J Neurosurg. 1995 Apr;82(4):572-7. doi: 10.3171/jns.1995.82.4.0572. |
| 10525761 | Background | Thakkar SD, Feigen U, Mautner VF. Spinal tumours in neurofibromatosis type 1: an MRI study of frequency, multiplicity and variety. Neuroradiology. 1999 Sep;41(9):625-9. doi: 10.1007/s002340050814. |
| 16818170 | Background | Tonsgard JH. Clinical manifestations and management of neurofibromatosis type 1. Semin Pediatr Neurol. 2006 Mar;13(1):2-7. doi: 10.1016/j.spen.2006.01.005. |
| 9403645 | Background | Needle MN, Cnaan A, Dattilo J, Chatten J, Phillips PC, Shochat S, Sutton LN, Vaughan SN, Zackai EH, Zhao H, Molloy PT. Prognostic signs in the surgical management of plexiform neurofibroma: the Children's Hospital of Philadelphia experience, 1974-1994. J Pediatr. 1997 Nov;131(5):678-82. doi: 10.1016/s0022-3476(97)70092-1. |
| 3082508 | Background | Ducatman BS, Scheithauer BW, Piepgras DG, Reiman HM, Ilstrup DM. Malignant peripheral nerve sheath tumors. A clinicopathologic study of 120 cases. Cancer. 1986 May 15;57(10):2006-21. doi: 10.1002/1097-0142(19860515)57:103.0.co;2-6. |
| 12011145 | Background | Evans DG, Baser ME, McGaughran J, Sharif S, Howard E, Moran A. Malignant peripheral nerve sheath tumours in neurofibromatosis 1. J Med Genet. 2002 May;39(5):311-4. doi: 10.1136/jmg.39.5.311. |
| 11894862 | Background | Ferner RE, Gutmann DH. International consensus statement on malignant peripheral nerve sheath tumors in neurofibromatosis. Cancer Res. 2002 Mar 1;62(5):1573-7. |
| 16226708 | Background | Chao RC, Pyzel U, Fridlyand J, Kuo YM, Teel L, Haaga J, Borowsky A, Horvai A, Kogan SC, Bonifas J, Huey B, Jacks TE, Albertson DG, Shannon KM. Therapy-induced malignant neoplasms in Nf1 mutant mice. Cancer Cell. 2005 Oct;8(4):337-48. doi: 10.1016/j.ccr.2005.08.011. |
| 7947106 | Background | Stiller CA, Chessells JM, Fitchett M. Neurofibromatosis and childhood leukaemia/lymphoma: a population-based UKCCSG study. Br J Cancer. 1994 Nov;70(5):969-72. doi: 10.1038/bjc.1994.431. |
| 2511319 | Background | Huson SM, Compston DA, Harper PS. A genetic study of von Recklinghausen neurofibromatosis in south east Wales. II. Guidelines for genetic counselling. J Med Genet. 1989 Nov;26(11):712-21. doi: 10.1136/jmg.26.11.712. |
| 16735710 | Background | Sharif S, Ferner R, Birch JM, Gillespie JE, Gattamaneni HR, Baser ME, Evans DG. Second primary tumors in neurofibromatosis 1 patients treated for optic glioma: substantial risks after radiotherapy. J Clin Oncol. 2006 Jun 1;24(16):2570-5. doi: 10.1200/JCO.2005.03.8349. |
| 10048435 | Background | Papageorgio C, Seiter K, Feldman EJ. Therapy-related myelodysplastic syndrome in adults with neurofibromatosis. Leuk Lymphoma. 1999 Feb;32(5-6):605-8. doi: 10.3109/10428199909058420. |
| 18496194 | Background | Gerszten PC, Burton SA, Ozhasoglu C, McCue KJ, Quinn AE. Radiosurgery for benign intradural spinal tumors. Neurosurgery. 2008 Apr;62(4):887-95; discussion 895-6. doi: 10.1227/01.neu.0000318174.28461.fc. |
| 19927062 | Background | Karabatsou K, Kiehl TR, Wilson DM, Hendler A, Guha A. Potential role of 18fluorodeoxyglucose-positron emission tomography/computed tomography in differentiating benign neurofibroma from malignant peripheral nerve sheath tumor associated with neurofibromatosis 1. Neurosurgery. 2009 Oct;65(4 Suppl):A160-70. doi: 10.1227/01.NEU.0000337597.18599.D3. |
| 17932395 | Background | Ferner RE, Golding JF, Smith M, Calonje E, Jan W, Sanjayanathan V, O'Doherty M. [18F]2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG PET) as a diagnostic tool for neurofibromatosis 1 (NF1) associated malignant peripheral nerve sheath tumours (MPNSTs): a long-term clinical study. Ann Oncol. 2008 Feb;19(2):390-4. doi: 10.1093/annonc/mdm450. Epub 2007 Oct 11. |
| 19142634 | Background | Warbey VS, Ferner RE, Dunn JT, Calonje E, O'Doherty MJ. [18F]FDG PET/CT in the diagnosis of malignant peripheral nerve sheath tumours in neurofibromatosis type-1. Eur J Nucl Med Mol Imaging. 2009 May;36(5):751-7. doi: 10.1007/s00259-008-1038-0. Epub 2009 Jan 14. |
| 18687535 | Background | Wentworth S, Pinn M, Bourland JD, Deguzman AF, Ekstrand K, Ellis TL, Glazier SS, McMullen KP, Munley M, Stieber VW, Tatter SB, Shaw EG. Clinical experience with radiation therapy in the management of neurofibromatosis-associated central nervous system tumors. Int J Radiat Oncol Biol Phys. 2009 Jan 1;73(1):208-13. doi: 10.1016/j.ijrobp.2008.03.073. Epub 2008 Aug 5. |
| 15923807 | Background | Chopra R, Morris CG, Friedman WA, Mendenhall WM. Radiotherapy and radiosurgery for benign neurofibromas. Am J Clin Oncol. 2005 Jun;28(3):317-20. doi: 10.1097/01.coc.0000156923.52181.3d. |
| 17994789 | Background | Sahgal A, Chou D, Ames C, Ma L, Lamborn K, Huang K, Chuang C, Aiken A, Petti P, Weinstein P, Larson D. Image-guided robotic stereotactic body radiotherapy for benign spinal tumors: theUniversity of California San Francisco preliminary experience. Technol Cancer Res Treat. 2007 Dec;6(6):595-604. doi: 10.1177/153303460700600602. |
| 16575331 | Background | Dodd RL, Ryu MR, Kamnerdsupaphon P, Gibbs IC, Chang SD Jr, Adler JR Jr. CyberKnife radiosurgery for benign intradural extramedullary spinal tumors. Neurosurgery. 2006 Apr;58(4):674-85; discussion 674-85. doi: 10.1227/01.NEU.0000204128.84742.8F. |
| Background | Schadev S, Dodd RL, Chang SD, Soltys SG, Adler JR, Luxton G, Choi CYH, Tupper LA, Gibbs IC. Stereotactic Radiosurgery Yields Long-term Control for Benign Intradural, Extramedullary Spine Tumors. Int J Radiat Oncol Biol Phys 2009; 75:101 (Abstract) |
| 12672283 | Background | Korones DN, Padowski J, Factor BA, Constine LS. Do children with optic pathway tumors have an increased frequency of other central nervous system tumors? Neuro Oncol. 2003 Apr;5(2):116-20. doi: 10.1093/neuonc/5.2.116. |
| D009423 | Nervous System Neoplasms |
| D009422 | Nervous System Diseases |
| D010523 | Peripheral Nervous System Diseases |
| D009468 | Neuromuscular Diseases |
| D016543 | Central Nervous System Neoplasms |
| D009371 | Neoplasms by Site |
| D013118 | Spinal Cord Diseases |
| D002493 | Central Nervous System Diseases |
| D005354 | Fibrosarcoma |
| D018218 | Neoplasms, Fibrous Tissue |
| D009372 | Neoplasms, Connective Tissue |
| D018204 | Neoplasms, Connective and Soft Tissue |
| D012509 | Sarcoma |
| D010455 | Peptides |
| D000602 | Amino Acids, Peptides, and Proteins |
| D011506 | Proteins |
| D025521 | Tumor Suppressor Proteins |
| D009363 | Neoplasm Proteins |