Significant reduction of normal tissue dose by proton radiotherapy compared with three-dimensional conformal or intensity-modulated radiation therapy in Stage I or Stage III non–small-cell lung cancer

Chang, Joe Y.; Zhang, Xiaodong; Wang, Xiaochun; Kang, Young Ae; Riley, B.; Bilton, Stephen; Mohan, Radhe; Komaki, Ritsuko; Cox, James D.

doi:10.1016/j.ijrobp.2006.01.052

Cited by 295 publications

(235 citation statements)

References 30 publications

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“…PBS treatment planning for thoracic tumors can achieve better sparing of organs at risk (OAR) than IMRT techniques 13 , 14 , 15 . Despite the dosimetric advantages of PBS, DS and IMRT remain the methods of choice for treating complex thoracic tumors.…”

Section: Introductionmentioning

confidence: 99%

Beam‐specific planning target volumes incorporating 4D CT for pencil beam scanning proton therapy of thoracic tumors

Lin

Kang

Huang

et al. 2015

J Applied Clin Med Phys

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The purpose of this study is to determine whether organ sparing and target coverage can be simultaneously maintained for pencil beam scanning (PBS) proton therapy treatment of thoracic tumors in the presence of motion, stopping power uncertainties, and patient setup variations. Ten consecutive patients that were previously treated with proton therapy to 66.6/1.8 Gy (RBE) using double scattering (DS) were replanned with PBS. Minimum and maximum intensity images from 4D CT were used to introduce flexible smearing in the determination of the beam specific PTV (BSPTV). Datasets from eight 4D CT phases, using ±3% uncertainty in stopping power and ±3 mm uncertainty in patient setup in each direction, were used to create 8×12×10=960 PBS plans for the evaluation of 10 patients. Plans were normalized to provide identical coverage between DS and PBS. The average lung V20, V5, and mean doses were reduced from 29.0%, 35.0%, and 16.4 Gy with DS to 24.6%, 30.6%, and 14.1 Gy with PBS, respectively. The average heart V30 and V45 were reduced from 10.4% and 7.5% in DS to 8.1% and 5.4% for PBS, respectively. Furthermore, the maximum spinal cord, esophagus, and heart doses were decreased from 37.1 Gy, 71.7 Gy, and 69.2 Gy with DS to 31.3 Gy, 67.9 Gy, and 64.6 Gy with PBS. The conformity index (CI), homogeneity index (HI), and global maximal dose were improved from 3.2, 0.08, 77.4 Gy with DS to 2.8, 0.04, and 72.1 Gy with PBS. All differences are statistically significant, with p‐values <0.05, with the exception of the heart V45 (p=0.146). PBS with BSPTV achieves better organ sparing and improves target coverage using a repainting method for the treatment of thoracic tumors. Incorporating motion‐related uncertainties is essential.PACS number: 87.55.D

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Section: Introductionmentioning

confidence: 99%

Beam‐specific planning target volumes incorporating 4D CT for pencil beam scanning proton therapy of thoracic tumors

Lin

Kang

Huang

et al. 2015

J Applied Clin Med Phys

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“…Each approach should be evaluated in terms of the specific objectives when selecting the best option for a given patient. If the objective is to always minimize ID to normal tissue, protons are emerging as an important option [27][28].…”

Section: Discussionmentioning

confidence: 99%

Modern External Beam Radiotherapy Techniques for Endometrial Cancer

Yang¹,

Wang²

2012

Cancer of the Uterine Endometrium - Advances and Controversies

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“…A 3-dimensional (3D) treatment planning technique is used in DS to design a conformal radiation dose distribution. Individualized compensators, along with apertures, are used to shape the distal edge of the beam and to limit the perimeter of radiation field, respectively [4,5].…”

Section: Introductionmentioning

confidence: 99%

Dosimetric Comparison of Pencil-Beam Scanning and Photon-Based Radiation Therapy as a Boost in Carcinoma of Cervix

Sharma

Hug

Bhushan

et al. 2017

International Journal of Particle Therapy

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Purpose: Brachytherapy is essential for local treatment in cervical carcinoma, but some patients are not suitable for it. Presently, for these patients, the authors prefer a boost by using intensity-modulated radiation therapy (IMRT). The authors evaluated the dosimetric comparison of proton-modulated radiation therapy versus IMRT and volumetric-modulated arc therapy (VMAT) as a boost to know whether protons can replace photons. Patients and Methods: Five patients who received external beam radiation therapy to the pelvis by IMRT were reviewed. Three different plans were made, including pencil beam scanning (PBS), IMRT, and VMAT. The prescribed planning target volume (PTV) was 20 Gy in 4 fractions. The dose to 95% PTV (D 95% ), the conformity index, and the homogeneity index were evaluated for PTV. The D max , D 2cc , and D mean were evaluated for organs at risk along with the integral dose of normal tissue and organs at risk. Results: The PTV coverage was optimal and homogeneous with modulated protons and photons. For PBS, coverage D 95% was 20.01 6 0.02 Gy (IMRT, 20.08 6 0.06 Gy; VMAT, 20.1 6 0.04 Gy). For the organs at risk, D max of the bladder for PBS was 21.05 6 0.05 Gy (IMRT, 20.8 6 0.21 Gy; VMAT, 21.65 6 0.41 Gy) while the D max for the rectum for PBS was 21.04 6 0.03 Gy (IMRT, 20.81 6 0.12 Gy; VMAT, 21.66 6 0.38 Gy). Integral dose to normal tissues in PBS was 14.17 6 2.65 Gy (IMRT, 25.29 6 6.35 Gy; VMAT, 25.24 6 6.24 Gy). Conclusions: Compared with photons, modulated protons provide comparable conformal plans. However, PBS reduces the integral dose to critical structures significantly compared with IMRT and VMAT. Although PBS may be a better alternative for such cases, further research is required to substantiate such findings.

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Significant reduction of normal tissue dose by proton radiotherapy compared with three-dimensional conformal or intensity-modulated radiation therapy in Stage I or Stage III non–small-cell lung cancer

Cited by 295 publications

References 30 publications

Beam‐specific planning target volumes incorporating 4D CT for pencil beam scanning proton therapy of thoracic tumors

Beam‐specific planning target volumes incorporating 4D CT for pencil beam scanning proton therapy of thoracic tumors

Modern External Beam Radiotherapy Techniques for Endometrial Cancer

Dosimetric Comparison of Pencil-Beam Scanning and Photon-Based Radiation Therapy as a Boost in Carcinoma of Cervix

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