Clinical Implementation of Intensity Modulated Proton Therapy in Thoracic Malignancies

Chang, Joe Y.; Li, H.; Zhu, Ronald X.; Liao, Zhongxing; Zhang, Lina; Liu, A.L.; Zhu, Zhengfei; Gomez, Daniel R.; Wu, Richard; Gillin, Michael; Zhang, X.

doi:10.1016/j.ijrobp.2014.05.1836

Cited by 14 publications

(28 citation statements)

References 22 publications

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“…Specific limitations of the design included the inability to select patients with limited tumor motion nor re-plan the IMPT courses adaptively, which may be necessary in select patients; the recently published implementation of IMPT in thoracic cancers both selected patients for limited motion as well as adaptively planned with repeated 4D-CT simulation during treatment. 22,38 With regard to organ motion, previous studies have quantified the amount of expected motion for mediastinal lymph nodes. A study utilizing 4D-CT simulation showed the mean motion for radiologically positive lymph nodes to be 2.6 mm mediolateral, 2.5 mm anterior-posterior, and 5.2 mm superior-inferior, with greater motion in the subcarinal lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

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Intensity-Modulated Proton Therapy for Elective Nodal Irradiation and Involved-Field Radiation in the Definitive Treatment of Locally Advanced Non–Small-Cell Lung Cancer: A Dosimetric Study

Kesarwala

Ning

et al. 2015

Clinical Lung Cancer

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Background Photon involved-field radiation therapy (IFRT), the standard for locally advanced non-small cell lung cancer (LA-NSCLC), results in favorable outcomes without increased isolated nodal failures, perhaps from scattered dose to elective nodal stations. Given the high conformality of intensity-modulated proton therapy (IMPT), proton IFRT could increase nodal failures. We investigated the feasibility of IMPT for elective nodal irradiation (ENI) in LA-NSCLC. Materials and Methods IMPT IFRT plans were generated to the same total dose of 66.6–72 Gy received by 20 LA-NSCLC patients treated with photon IFRT. IMPT ENI plans were generated to 46 CGE to elective nodal (EN) planning treatment volumes (PTV) plus 24 CGE to involved field (IF)-PTVs. Results Proton IFRT and ENI both improved D95 involved field (IF)-PTV coverage by 4% (p<0.01) compared to photon IFRT. All evaluated dosimetric parameters improved significantly with both proton plans. Lung V20 and mean lung dose decreased 18% (p<0.01) and 36% (p<0.01), respectively, with proton IFRT and 11% (p=0.03) and 26% (p<0.01) with ENI. Mean esophagus dose decreased 16% with IFRT and 12% with ENI; heart V25 decreased 63% with both (all p<0.01). Conclusions This study demonstrates the feasibility of IMPT for LA-NSCLC ENI. Potential decreased toxicity indicates IMPT could allow ENI while maintaining a favorable therapeutic ratio compared to photon IFRT.

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Section: Discussionmentioning

confidence: 99%

“…13–15 For NSCLC, several early-phase proton trials showed efficacy and decreased pneumonitis and esophagitis, and the first successful clinical implementation of intensity-modulated proton therapy (IMPT) for thoracic cancers has been recently published. 16–22 …”

Section: Introductionmentioning

confidence: 99%

Intensity-Modulated Proton Therapy for Elective Nodal Irradiation and Involved-Field Radiation in the Definitive Treatment of Locally Advanced Non–Small-Cell Lung Cancer: A Dosimetric Study

Kesarwala

Ning

et al. 2015

Clinical Lung Cancer

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“…Spot scanningy–based intensity modulated proton therapy (IMPT), which has been implemented in selected lung cancer patients, can result in a lower dose to normal tissues such as lung, esophagus, and heart, compared with intensity modulated photon radiation therapy (1, 2). However, respiratory motion–induced dose uncertainty remains a major concern in the IMPT of lung and liver cancers (3, 4).…”

Section: Introductionmentioning

confidence: 99%

Reducing Dose Uncertainty for Spot-Scanning Proton Beam Therapy of Moving Tumors by Optimizing the Spot Delivery Sequence

Zhu

Zhang

2015

International Journal of Radiation Oncology*Biology*Physics

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Purpose To develop and validate a novel delivery strategy for reducing the respiratory motion–induced dose uncertainty of spot-scanning proton therapy. Methods and Materials The spot delivery sequence was optimized to reduce dose uncertainty. The effectiveness of the delivery sequence optimization was evaluated using measurements and patient simulation. One hundred ninety-one 2-dimensional measurements using different delivery sequences of a single-layer uniform pattern were obtained with a detector array on a 1-dimensional moving platform. Intensity modulated proton therapy plans were generated for 10 lung cancer patients, and dose uncertainties for different delivery sequences were evaluated by simulation. Results Without delivery sequence optimization, the maximum absolute dose error can be up to 97.2% in a single measurement, whereas the optimized delivery sequence results in a maximum absolute dose error of ≤11.8%. In patient simulation, the optimized delivery sequence reduces the mean of fractional maximum absolute dose error compared with the regular delivery sequence by 3.3% to 10.6% (32.5-68.0% relative reduction) for different patients. Conclusions Optimizing the delivery sequence can reduce dose uncertainty due to respiratory motion in spot-scanning proton therapy, assuming the 4-dimensional CT is a true representation of the patients’ breathing patterns.

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“…Ainsi, la chimiothérapie n'est parfois pas réalisée. Augmenter la dose par séance par protons est faisable et a permis, lors d'une comparaison rétrospective dans une cohorte de 119 personnes, malgré l'absence de chimiothérapie, d'obtenir une survie identique à celle d'autres patients qui ont reç u une chimioradiothérapie avec des photons [21]. La protonthérapie a a priori comblé le manque de la chimiothérapie mais cela reste à démontrer au cours d'un essai randomisé.…”

Section: Carcinomes Bronchiques Non à Petites Cellulesunclassified

État des lieux et perspectives de la protonthérapie

Doyen

Bondiau

Bénézery

et al. 2015

Cancer/Radiothérapie

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Clinical Implementation of Intensity Modulated Proton Therapy in Thoracic Malignancies

Cited by 14 publications

References 22 publications

Intensity-Modulated Proton Therapy for Elective Nodal Irradiation and Involved-Field Radiation in the Definitive Treatment of Locally Advanced Non–Small-Cell Lung Cancer: A Dosimetric Study

Intensity-Modulated Proton Therapy for Elective Nodal Irradiation and Involved-Field Radiation in the Definitive Treatment of Locally Advanced Non–Small-Cell Lung Cancer: A Dosimetric Study

Reducing Dose Uncertainty for Spot-Scanning Proton Beam Therapy of Moving Tumors by Optimizing the Spot Delivery Sequence

État des lieux et perspectives de la protonthérapie

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