Intensity-Modulated Proton Therapy Versus Helical Tomotherapy in Nasopharynx Cancer: Planning Comparison and NTCP Evaluation

Widesott, L.; Pierelli, A.; Fiorino, Claudio; Dell’Oca, I.; Broggi, S.; Cattaneo, Giovanni Mauro; Muzio, N. Di; Fazio, Ferruccio; Calandrino, R.; Schwarz, Marco

doi:10.1016/j.ijrobp.2008.05.065

Cited by 135 publications

(127 citation statements)

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“…The NTCP model for the larynx did not result in a significant difference between IMPT and HT [14]. www.TheOncologist.com…”

Section: Do Lower Doses To Oars Results In Lower Ntcp Values?mentioning

confidence: 85%

“…Third, most authors only presented average results for all cases [9,13,14,16,18]. It should be noted that the benefit of a new technique in terms of dose distributions in targets and OARs will depend on a number of factors, such as the volume and shape of the target, the position of the target reference to OARs, and the amount of overlap between the PTV and a given OAR.…”

Section: Discussionmentioning

confidence: 99%

“…However, both discussed treatment planning comparison strategies are important to investigate differences between radiotherapy techniques. Furthermore, in general, if no attempts are made to reduce OAR doses as much as possible, the achieved results will not necessarily be the best results that can be achieved with the specific techniques [11,14]. Consequently, the obtained differences in NTCP cannot be used to adequately determine which technique is best to spare a specific OAR (e.g., the larynx structure spared by Widesott et al [14]).…”

Section: Discussionmentioning

confidence: 99%

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The Potential Benefit of Radiotherapy with Protons in Head and Neck Cancer with Respect to Normal Tissue Sparing: A Systematic Review of Literature

et al. 2011

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Purpose. Clinical studies concerning head and neck cancer patients treated with protons reporting on radiation-induced side effects are scarce. Therefore, we reviewed the literature regarding the potential benefits of protons compared with the currently used photons in terms of lower doses to normal tissue and the potential for fewer subsequent radiation-induced side effects, with the main focus on in silico planning comparative (ISPC) studies.Materials and Methods. A literature search was performed by two independent researchers on ISPC studies that included proton-based and photon-based irradiation techniques.Results. Initially, 877 papers were retrieved and 14 relevant and eligible ISPC studies were identified and included in this review. Four studies included paranasal sinus cancer cases, three included nasopharyngeal cancer cases, and seven included oropharyngeal, hypopharyngeal, and/or laryngeal cancer cases. Seven studies compared the most sophisticated photon and proton techniques: intensity-modulated photon therapy versus intensity-modulated proton therapy (IMPT). Four studies compared different proton techniques. All studies showed that protons had a lower normal tissue dose, while keeping similar or better target coverage. Two studies found that these lower doses theoretically translated into a significantly lower incidence of salivary dysfunction.Conclusion. The results of ISPC studies indicate that protons have the potential for a significantly lower normal tissue dose, while keeping similar or better target coverage. Scanned IMPT probably offers the most advantage and will allow for a substantially lower probability of radiation-induced side effects. The results of these ISPC studies should be confirmed in properly designed clinical trials. The Oncologist 2011;16:366 -377

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“…The NTCP model for the larynx did not result in a significant difference between IMPT and HT [14]. www.TheOncologist.com…”

Section: Do Lower Doses To Oars Results In Lower Ntcp Values?mentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Potential Benefit of Radiotherapy with Protons in Head and Neck Cancer with Respect to Normal Tissue Sparing: A Systematic Review of Literature

et al. 2011

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“…The superior homogeneity is highly valuable feature for the treatment of H&N cancers. 1 Improved target dose homogeneity may minimize the toxicity of tissues within the target volume (e.g., base of tongue) which may compromise organ function such as swallowing. Improvement in homogeneity with robust optimization is due to the fact that, if the incorporation of uncertainties reveals hot or cold spots within the target volume, the objective function value (i.e., the plan score) is penalized.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, the improved sparing of the parotid glands, for instance, might avoid severe xerostomia, which could improve patients' quality of life. 1 In general, the improvement in robustness is thought to be at the expense of normal tissue sparing. [6][7][8]18 We believe this has been the result of comparing results of CTV-based robust optimization with CTV-based conventional optimization, i.e., without the incorporation of uncertainties in their CTV-based conventional optimization via a PTV margin.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of robust optimization in intensity‐modulated proton therapy planning for head and neck cancers

et al. 2013

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Purpose: Intensity-modulated proton therapy (IMPT) is highly sensitive to uncertainties in beam range and patient setup. Conventionally, these uncertainties are dealt using geometrically expanded planning target volume (PTV). In this paper, the authors evaluated a robust optimization method that deals with the uncertainties directly during the spot weight optimization to ensure clinical target volume (CTV) coverage without using PTV. The authors compared the two methods for a population of head and neck (H&N) cancer patients. Methods: Two sets of IMPT plans were generated for 14 H&N cases, one being PTV-based conventionally optimized and the other CTV-based robustly optimized. For the PTV-based conventionally optimized plans, the uncertainties are accounted for by expanding CTV to PTV via margins and delivering the prescribed dose to PTV. For the CTV-based robustly optimized plans, spot weight optimization was guided to reduce the discrepancy in doses under extreme setup and range uncertainties directly, while delivering the prescribed dose to CTV rather than PTV. For each of these plans, the authors calculated dose distributions under various uncertainty settings. The root-mean-square dose (RMSD) for each voxel was computed and the area under the RMSD-volume histogram curves (AUC) was used to relatively compare plan robustness. Data derived from the dose volume histogram in the worst-case and nominal doses were used to evaluate the plan optimality. Then the plan evaluation metrics were averaged over the 14 cases and were compared with two-sided paired t tests. Results: CTV-based robust optimization led to more robust (i.e., smaller AUCs) plans for both targets and organs. Under the worst-case scenario and the nominal scenario, CTV-based robustly optimized plans showed better target coverage (i.e., greater D 95% ), improved dose homogeneity (i.e., smaller D 5% − D 95% ), and lower or equivalent dose to organs at risk. Conclusions: CTV-based robust optimization provided significantly more robust dose distributions to targets and organs than PTV-based conventional optimization in H&N using IMPT. Eliminating the use of PTV and planning directly based on CTV provided better or equivalent normal tissue sparing.

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Rare Pediatric Malignancies of the Head And Neck

Herzog

Kupferman²,

Huh

et al. 2012

Textbook of Uncommon Cancer

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Intensity-Modulated Proton Therapy Versus Helical Tomotherapy in Nasopharynx Cancer: Planning Comparison and NTCP Evaluation

Cited by 135 publications

References 37 publications

The Potential Benefit of Radiotherapy with Protons in Head and Neck Cancer with Respect to Normal Tissue Sparing: A Systematic Review of Literature

The Potential Benefit of Radiotherapy with Protons in Head and Neck Cancer with Respect to Normal Tissue Sparing: A Systematic Review of Literature

Effectiveness of robust optimization in intensity‐modulated proton therapy planning for head and neck cancers

Rare Pediatric Malignancies of the Head And Neck

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