Scanning proton beam therapy reduces normal tissue exposure in pelvic radiotherapy for anal cancer

Anand, Aman; Bues, Martin; Rule, William G.; Keole, Sameer R.; Beltran, Chris; Yin, Jun; Haddock, Michael G.; Hallemeier, Christopher L.; Miller, Robert C.; Ashman, Jonathan B.

doi:10.1016/j.radonc.2015.10.027

Cited by 29 publications

(16 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Radiation planning and delivery using scanning proton beam therapy offers a reduction in dose to the bone marrow space compared with VMAT. This is similar to the finding by Anand et al, who also demonstrated that scanning proton beam therapy can reduce to dose to bone marrow by .50% compared with IMRT [6].…”

Section: Discussionsupporting

confidence: 90%

See 1 more Smart Citation

Dosimetric Comparison of Intensity-Modulated Proton Therapy and Volumetric-Modulated Arc Therapy in Anal Cancer Patients and the Ability to Spare Bone Marrow

Meier

Mascia

Wolf

et al. 2017

International Journal of Particle Therapy

View full text Add to dashboard Cite

Section: Discussionsupporting

confidence: 90%

“…The IMPT plans were created using a 3-field multi-field optimized split target technique [6]. A posterior field was used to cover the primary tumor and pelvic lymph nodes and a right and left anterior oblique field was used to cover the right and left inguinal lymph nodes (Figures 2 and 3B).…”

Section: Methodsmentioning

confidence: 99%

Dosimetric Comparison of Intensity-Modulated Proton Therapy and Volumetric-Modulated Arc Therapy in Anal Cancer Patients and the Ability to Spare Bone Marrow

Meier

Mascia

Wolf

et al. 2017

International Journal of Particle Therapy

View full text Add to dashboard Cite

“…Chemotherapy was administered as a half dose under the following conditions: (a) white blood cell (WBC) count ,2.0 3 10 9 /l, (b) absolute neutrophil count (ANC) between 1.0 3 10 9 and 1.5 3 10 9 /l or (c) platelet (Plt) count between 5.0 3 10 7 and 7.5 3 10 7 /l. Chemotherapy was omitted under the following conditions: (a) ANC , 1.0 3 10 9 /l, (b) Plt count ,5.0 3 10 7 /l or (c) creatinine clearance ,50 ml min 21 . None of the patients underwent Plt transfusions or granulocyte/monocyte colony-stimulating factor treatments.…”

Section: Methods and Materials Patientsmentioning

confidence: 99%

“…For pelvic malignancies, BM-sparing IMRT/ intensity-modulated proton therapy using specific dose constraints of the BM had theoretic benefit through dosimetric analysis. [19][20][21][22] Desai et al 23 demonstrated that BM-sparing IMRT reduced acute HT in patients with pelvic malignancies. For current IMRT treatment of thoracic malignancies, specific dose constraints of the BM were not followed, as none have been set.…”

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

View full text Add to dashboard Cite

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.

show abstract

“…Intensity modulated radiation therapy techniques (intensity modulated radiation therapy [IMRT] and volumetric modulated arc therapy [VMAT]) can be used in the treatment of these tumor sites for improved pelvic bone marrow sparing. Reduced HT in cervical cancer (12) and reductions in HT for anal cancer (13) treated with IMRT and scanned proton therapy (14) have been reported. These delivery techniques can also be combined with functional imaging to identify active bone marrow regions within the pelvis to guide dose optimization 11 , 15 , 16 .…”

Section: Introductionmentioning

confidence: 97%

Potential of Proton Therapy to Reduce Acute Hematologic Toxicity in Concurrent Chemoradiation Therapy for Esophageal Cancer

Warren

Hurt

Crosby

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

View full text Add to dashboard Cite

PurposeRadiation therapy dose escalation using a simultaneous integrated boost (SIB) is predicted to improve local tumor control in esophageal cancer; however, any increase in acute hematologic toxicity (HT) could limit the predicted improvement in patient outcomes. Proton therapy has been shown to significantly reduce HT in lung cancer patients receiving concurrent chemotherapy. Therefore, we investigated the potential of bone marrow sparing with protons for esophageal tumors.Methods and MaterialsTwenty-one patients with mid-esophageal cancer who had undergone conformal radiation therapy (3D50) were selected. Two surrogates for bone marrow were created by outlining the thoracic bones (bone) and only the body of the thoracic vertebrae (TV) in Eclipse. The percentage of overlap of the TV with the planning treatment volume was recorded for each patient. Additional plans were created retrospectively, including a volumetric modulated arc therapy (VMAT) plan with the same dose as for 3D50; a VMAT SIB plan with a dose prescription of 62.5 Gy to the high-risk subregion within the planning treatment volume; a reoptimized TV-sparing VMAT plan; and a proton therapy plan with the same SIB dose prescription. The bone and TV dose metrics were recorded and compared across all plans and variations with respect to PTV and percentage of overlap for each patient.ResultsThe 3D50 plans showed the highest bone mean dose and TV percentage of volume receiving ≥30 Gy (V30Gy) for each patient. The VMAT plans irradiated a larger bone V10Gy than did the 3D50 plans. The reoptimized VMAT62.5 VT plans showed improved sparing of the TV volume, but only the proton plans showed significant sparing for bone V10Gy and bone mean dose, especially for patients with a larger PTV.ConclusionsThe results of the present study have shown that proton therapy can reduced bone marrow toxicity.

show abstract

Scanning proton beam therapy reduces normal tissue exposure in pelvic radiotherapy for anal cancer

Cited by 29 publications

References 23 publications

Dosimetric Comparison of Intensity-Modulated Proton Therapy and Volumetric-Modulated Arc Therapy in Anal Cancer Patients and the Ability to Spare Bone Marrow

Dosimetric Comparison of Intensity-Modulated Proton Therapy and Volumetric-Modulated Arc Therapy in Anal Cancer Patients and the Ability to Spare Bone Marrow

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

Potential of Proton Therapy to Reduce Acute Hematologic Toxicity in Concurrent Chemoradiation Therapy for Esophageal Cancer

Contact Info

Product

Resources

About