ArticleInternational journal of radiation oncology, biology, physics2020
End-of-Range Radiobiological Effect on Rib Fractures in Patients Receiving Proton Therapy for Breast Cancer.
Article in International journal of radiation oncology, biology, physics, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 40 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
40 citing papers in PubMed, 85 citations in OpenAlex.
- Article
- Deep learning for dose-averaged linear energy transfer estimation in pencil-beam scanning and double scattering proton radiotherapy plans with uncertainty-aware external validation.Physics and imaging in radiation oncology · 2026Article
- Poly ADP Ribose Polymerase Inhibitors Potentiate Proton Therapy End-of-Range Effects by Accelerating Replication Forks and Promoting Transcription Conflict.International journal of radiation oncology, biology, physics · 2026Article
- Commissioning of a Monte Carlo-based scanning proton beam for breast cancer: Incorporating LETd calculations and variable RBE models.Journal of applied clinical medical physics · 2026Article
- Relative Biological Effectiveness-Clinical Practice at US Proton Therapy Centers.International journal of particle therapy · 2025Article
- Critical review of patient outcome study in head and neck cancer radiotherapy.Meta-radiology · 2025Article
- LET measurements in proton and helium-ion beams of therapeutic energies using a silicon pixel detector towards a tool for quality assurance.Medical physics · 2025Article
- Dose Constraints in Carbon-Ion Radiation Therapy to Minimize the Risk of Pectoral Myositis.International journal of particle therapy · 2025Article
- Targeting Active Microglia Alleviates Distal Edge of Proton Radiation-induced Neural Damage.Advances in radiation oncology · 2025Article
- Risk factors for radiation-induced rib fractures following proton beam therapy for stage I non-small cell lung cancer: a retrospective study.BMC cancer · 2025Article
- Article
- Enabling clinical use of linear energy transfer in proton therapy for head and neck cancer - A review of implications for treatment planning and adverse events study.Visualized cancer medicine · 2025Article
- Linear approximation of variable relative biological effectiveness models for proton therapy.Physics and imaging in radiation oncology · 2025Article
- NRG Oncology White Paper on the Relative Biological Effectiveness in Proton Therapy.International journal of radiation oncology, biology, physics · 2025Review
- Beyond a constant proton relative biological effectiveness: A survey of clinical and research perspectives among proton institutions in Europe and the United States.Journal of applied clinical medical physics · 2025Article
- Dosimetric comparison of advanced radiation techniques for scalp-sparing in low-grade gliomas.Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] · 2024Article
- Dose Rate Effects from the 1950s through to the Era of FLASH.Radiation research · 2024Review
- Review
- Sacral-Nerve-Sparing Planning Strategy in Pelvic Sarcomas/Chordomas Treated with Carbon-Ion Radiotherapy.Cancers · 2024Article
- Voxel-wise dose rate calculation in clinical pencil beam scanning proton therapy.Physics in medicine and biology · 2024Article
Corrections and comments
- Erratum issued
Authors and funding
9 authors at 2 institutions in 2 countries.
Funding
Abstract
purposeA prospective trial of proton therapy for breast cancer revealed an increased rib fracture rate of 7%, which is higher than the expected rate based on the literature on photon therapies. We aim to evaluate the hypothesis that the increased relative biological effectiveness (RBE) at the distal edge of proton beams is the cause. METHODS AND MATERIALS: We combined the cohort from the prospective clinical trial and a retrospective cohort from a database. Monte Carlo simulations were performed to recalculate the physical dose and dose-averaged linear energy transfer (LETd). The first 10 ribs and fracture areas in patients with fractures were contoured and deformably registered. The LETd-weighted dose was used as a surrogate for biological effectiveness and compared with the conventional fixed RBE of 1.1. Dose to 0.5 cm
resultsThirteen of 203 patients in the cohorts exhibited a total of 25 fractures. The LETd in fractured areas is increased (6.1 ± 2.0 keV/μm, mean ± standard deviation), suggesting possible end-of-range radiobiological effects with increased RBE. The D0.5 of the fractured ribs is 80.3 ± 9.4 Gy
conclusionsThe increased rib fracture rate seen in our trial is probably associated with the increased LETd and RBE at the distal edge of proton beams. This phenomenon warrants further investigation and possible integration of LETd into treatment planning and optimization in proton therapy.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.