Proton Radiation Therapy Offers Reduced Normal Lung and Bone Marrow Exposure for Patients Receiving Dose-Escalated Radiation Therapy for Unresectable Stage III Non-Small-Cell Lung Cancer: A Dosimetric Study

Nichols, R.C.; Huh, Soon; Henderson, Randal H.; Mendenhall, Nancy P.; Flampouri, Stella; Li, Zuofeng; D’Agostino, Harry J.; Cury, James; Pham, Dat; Hoppe, Bradford S.

doi:10.1016/j.cllc.2011.03.027

Cited by 77 publications

(62 citation statements)

References 27 publications

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“…For current IMRT treatment of thoracic malignancies, specific dose constraints of the BM were not followed, as none have been set. Furthermore, Nichols et al 24 have demonstrated that when taken into consideration during pre-treatment planning, proton therapy can help reduce irradiation doses to the BM compared with 3D-CRT or IMRT in thoracic malignancies. BM-sparing IMRT/intensity-modulated proton therapy has the potential advantage of avoiding acute HT (grade $ 3).…”

Section: (Continued)mentioning

confidence: 99%

Dosimetric predictors of acute haematological toxicity in oesophageal cancer patients treated with neoadjuvant chemoradiotherapy

Lee¹,

Lin²,

Sun³

et al. 2016

BJR

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Objective: Haematological toxicity (HT) is common in patients with oesophageal cancer (EC) treated with chemoradiotherapy (CRT). The Quantitative Analysis of Normal Tissue Effects in the Clinic guidelines provide no dose constraints for the bone marrow (BM) to avoid HT. We aimed to determine dosimetric factors associated with HT during CRT for EC. Methods: 41 patients with EC treated with neoadjuvant cisplatin and 5-fluorouracil-based CRT were retrospectively reviewed. Associations between the dose-volume histogram parameters of thoracic bones and blood cell count changes during CRT were assessed using logistic regression analyses. Receiver-operating characteristic curves were used to derive optimal dosimetric planning constraints. V x indicates the total organ volume percentage exceeding a radiation dose of x (Gy). Results: Greater thoracic vertebrae and rib irradiation doses, including mean vertebral dose (MVD), thoracic vertebrae V 5-30 (TVV 5-30 ), mean rib dose and rib V 5-20 , were associated with increased leukopenia (grade $ 3) risk. Additional BM sites (sternum, scapulae and clavicles) did not influence HT. White blood cell and absolute neutrophil count nadirs were associated with increased irradiation doses to the thoracic vertebrae, ribs and sternum. Chemotherapy cycle number was not significantly associated with severe neutropenia or leukopenia. Cut-off values with the highest likelihood of avoiding leukopenia were MVD , 25.9 Gy, TVV 20 , 70% and TVV 10 , 77%. Conclusion: Thoracic bone irradiation dose was significantly associated with HT after adjusting for chemotherapy effects. Efforts to maintain MVD , 25.9 Gy, TVV 10 , 77% and TVV 20 , 70% could reduce HT. Advances in knowledge: This is the first study addressing issues concerning HT in patients with neoadjuvant CRTtreated EC.

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Section: (Continued)mentioning

confidence: 99%

Dosimetric predictors of acute haematological toxicity in oesophageal cancer patients treated with neoadjuvant chemoradiotherapy

Lee¹,

Lin²,

Sun³

et al. 2016

BJR

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“…The lung volume receiving 20 Gy (V 20 ) with PBT (16.8%) was similar to that with IMRT (16.3%), but the mean lung dose with PBT (13.5 Gy) was significantly lower than that for IMRT (16.4 Gy) and 3D conformal radiotherapy (18.9 Gy), and V 5 for protons was less than half the values for both photon modalities. Nichols et al evaluated dose distribution in eight patients with stage III disease, and found that PBT gave about a 30% reduction of normal lung V 20 in all patients [50]. Salama et al investigated pulmonary toxicities in a photon dose escalation study, and found a strong correlation with patients with N3 or V 20 ≥38% [51].…”

Section: Clinical Results Of Pbt For Advanced Nsclcmentioning

confidence: 99%

“…Few studies have compared the dose distribution between proton and photon beams for stage III NSCLC compared with those for early stage NSCLC, however, the advantage of PBT for stage III NSCLC seems to be more significant than that for early NSCLC [49,50]. Roelofs et al investigated if PBT reduces the dose and irradiated volume of normal tissue with dose escalation in 25 patients with stage IA-IIIB disease, including 20 cases of stage IIB-IIIB disease [49].…”

Section: Clinical Results Of Pbt For Advanced Nsclcmentioning

confidence: 99%

The use of proton-beam therapy in the treatment of non-small-cell lung cancer

Oshiro¹,

Sakurai

2013

Expert Review of Medical Devices

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“…Dosimetric studies on NSCLC have demonstrated that proton therapy is superior in terms of sparing uninvolved lung tissue when compared to the 3DCRT and IMRT. [4][5][6][7] Furthermore, few other studies have reported that proton therapy has dosimetric advantages over photon based stereotactic body radiation therapy (SBRT) when a smaller size of lung tumor is involved. [7][8][9][10] However, Zhang et al 11 suggested that IMRT may be better than the passive-scatter proton therapy, especially when a tumor has an irregular shape and involves the mediastinum.…”

Section: Introductionmentioning

confidence: 99%

“…Several authors [4][5][6][7] have performed the treatment planning studies on inoperable NSCLC cases comparing the dosimetric quality of different treatment techniques such as 3-dimensional conformal radiation therapy (3CDRT), intensity modulated radiation therapy (IMRT), and proton therapy. Dosimetric studies on NSCLC have demonstrated that proton therapy is superior in terms of sparing uninvolved lung tissue when compared to the 3DCRT and IMRT.…”

Section: Introductionmentioning

confidence: 99%

Treatment planning study comparing proton therapy, RapidArc and IMRT for a synchronous bilateral lung cancer case

Rana

Pokharel

Zheng

et al. 2014

Int J Cancer Ther Oncol

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Purpose: The main purpose of this study is to perform a treatment planning study on a synchronous bilateral non-small cell lung cancer case using three treatment modalities: uniform scanning proton therapy, RapidArc, and intensity modulated radiation therapy (IMRT). Methods: The maximum intensity projection (MIP) images obtained from the 4 dimensional-computed tomography (4DCT) scans were used for delineation of tumor volumes in the left and right lungs. The average 4D-CT was used for the treatment planning among all three modalities with identical patient contouring and treatment planning goal. A proton therapy plan was generated in XiO treatment planning system (TPS) using 2 fields for each target. For a comparative purpose, IMRT and RapidArc plans were generated in Eclipse TPS. Treatment plans were generated for a total dose of 74 CGE or Gy prescribed to each planning target volume (PTV) (left and right) with 2 CGE or Gy per fraction. In IMRT and RapidArc plans, normalization was done based on PTV coverage values in proton plans. Results: The mean PTV dose deviation from the prescription dose was lower in proton plan (within 3.4%), but higher in IMRT (6.5% to 11.3%) and RapidArc (3.8% to 11.5%) plans. Proton therapy produced lower mean dose to the total lung, heart, and esophagus when compared to IMRT and RapidArc. The relative volume of the total lung receiving 20, 10, and 5 CGE or Gy (V20, V10, and V5, respectively) were lower using proton therapy than using IMRT, with absolute differences of 9.71%, 22.88%, and 39.04%, respectively. The absolute differences in the V20, V10, and V5 between proton and RapidArc plans were 4.84%, 19.16%, and 36.8%, respectively, with proton therapy producing lower dosimetric values. Conclusion: Based on the results presented in this case study, uniform scanning proton therapy has a dosimetric advantage over both IMRT and RapidArc for a synchronous bi-lateral NSCLC, especially for the normal lung tissue, heart, and esophagus sparing. Further studies on a large group of patients with bi-lateral lung cancer are required to validate the dosimetric superiority of proton therapy over the IMRT and RapidArc.

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Proton Radiation Therapy Offers Reduced Normal Lung and Bone Marrow Exposure for Patients Receiving Dose-Escalated Radiation Therapy for Unresectable Stage III Non-Small-Cell Lung Cancer: A Dosimetric Study

Cited by 77 publications

References 27 publications

Dosimetric predictors of acute haematological toxicity in oesophageal cancer patients treated with neoadjuvant chemoradiotherapy

Dosimetric predictors of acute haematological toxicity in oesophageal cancer patients treated with neoadjuvant chemoradiotherapy

The use of proton-beam therapy in the treatment of non-small-cell lung cancer

Treatment planning study comparing proton therapy, RapidArc and IMRT for a synchronous bilateral lung cancer case

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