Treatment planning comparison of conventional, 3D conformal, and intensity-modulated photon (IMRT) and proton therapy for paranasal sinus carcinoma

Mock, Ulrike; Georg, Dietmar; Bogner, Joachim; Allmendinger, Thomas; Pötter, Richard

doi:10.1016/s0360-3016(03)01452-4

Cited by 180 publications

(104 citation statements)

References 31 publications

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“…Compared with photon IMRT, protons have an even greater capacity to deliver highly conformal dose distributions but with minimal integral doses (29,30). Treatment planning studies have also shown that protons offer an advantage compared with IMRT in some head and neck tumours (31). Technical equipment such as proton facilities is likely to improve the radiotherapy of a large number of diseases in the future (32).…”

Section: Discussionmentioning

confidence: 99%

Can Photon IMRT be improved by combination with mixed electron and photon techniques?

Mu¹,

Olofsson²,

Karlsson³

et al. 2004

Acta Oncologica

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Section: Discussionmentioning

confidence: 99%

Can Photon IMRT be improved by combination with mixed electron and photon techniques?

Mu¹,

Olofsson²,

Karlsson³

et al. 2004

Acta Oncologica

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“…In particular, there are a number of vulnerable organs in this region, including the brain, brain stem and optic nerve, and it is potentially difficult to deliver ≥65 Gy to the tumor using conventional RT methods without inducing severe late complications, such as optic nerve damage and brain necrosis (16,17). To reduce the irradiation dose to organs at risk, intensity-modulated radiation therapy (IMRT) and PBT are often used, and Mock et al (18) reported that PBT reduces the amount of normal tissue exposed to irradiation compared with photon-based treatment, particularly at low-and mid-dose levels. Therefore, 3D-CRT and IMRT treatment planning was performed for the most recently treated case in the present study using the same CT images, in order to compare dose-volume histograms of the normal tissues, including the contralateral optic nerve, chiasm, brain and brain stem; the results are presented in Figs.…”

Section: Discussionmentioning

confidence: 99%

Proton beam therapy for locally advanced and unresectable (T4bN0M0) squamous cell carcinoma of the ethmoid sinus: A report of seven cases and a literature review

Saito¹,

Ishikawa²,

Ohnishi³

et al. 2015

Oncology Letters

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Abstract. The present study reports treatment outcomes of locally advanced and unresectable squamous cell carcinoma of the ethmoid sinus (SCC-ES) following proton beam therapy (PBT). Between January 1997 and December 2012, 7 patients (median age, 63 years) with SCC-ES underwent definitive PBT. All tumors were categorized as T4bN0M0 (2009 UICC tumor-node-metastasis classification) and were treated using conventional fractionation at a median total dose of 72 Gy equivalents (GyE; range,. Imaging diagnosis for the initial treatment effect within 3 months of PBT revealed that a complete response (CR) was achieved in 2 patients and a partial response (PR) in 5 patients. The overall median survival time of the patients was 43 months (range, 12-62 months), and 4 patients survived for ≥3 years. No recurrence was observed in the 2 patients who exhibited an initial CR treatment effect; however, locoregional recurrences occurred in 4/5 patients who exhibited a PR. No grade 3 or severe acute toxicities were observed, but the late toxicities of grade 3 contralateral optic nerve damage and cataracts developed in 1 and 2 patients, respectively. Based on the findings of the present study, intensification of the local treatment effect may be important for yielding favorable treatment outcomes, since no distant metastasis was observed. PBT is therefore a potentially useful treatment tool for unresectable SCC-ES. IntroductionMalignancies of the paranasal cavity are rare, representing ~3% of all head and neck cancers and ≤1% of total malignancies; the combination of surgery, chemotherapy and radiation therapy (RT) has been widely used in patients with the disease (1-3). Among paranasal cavity malignancies, cancer of the ethmoid sinus complex is even rarer, and surgical approaches are usually complicated by a lack of satisfactory surgical clearance and the risk of serious dysfunction of the surrounding normal tissues, including the brain stem and optic nerve (4). Consequently, definitive RT for patients with unresectable squamous cell carcinoma of the ethmoid sinus (SCC-ES) has been performed, but it can be difficult to deliver a curative irradiation dose to the tumor without severe complications, such as visual loss and brain necrosis, among others (5). Thus, there is little information on the efficacy of RT for SCC-ES at present.Proton beam therapy (PBT) offers advantageous physical properties to RT for a variety of cancers. Since proton beams exhibit a spread-out Bragg peak and achieve an improved dose distribution of the target volume using specified beam modulations compared with photon beams (6-10), PBT delivers a large irradiation dose to the tumor using limited numbers of portals while sparing the surrounding normal tissues. Hence, the technique may yield improved disease control with minimum morbidity compared with previous conventional RT (11). A number of previous studies have reported favorable outcomes for patients with head and neck cancers treated with PBT (8-10), but SCC-ES has not been an area of focus, as there is ...

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“…All plans were normalized based on the DVHs to ensure that 95% of the PTV received 100% of the prescribed dose. The dose inhomogeneity (DI) in the PTV was defined as

false(D_{5} - D_{95} false) / D_{mean}

(32) . (Table 1 shows the definitions of

D_{5}, D_{95}

, and

D_{mean}

.…”

Section: Methodsmentioning

confidence: 99%

Forward‐planning intensity‐modulated radiotherapy technique for prostate cancer

Metwaly

Awaad

El-Sayed

et al. 2007

J Applied Clin Med Phys

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In this study, we present an intensity‐modulated radiotherapy technique based on forward planning dose calculations to provide a concave dose distribution to the prostate and seminal vesicles by means of modified dynamic arc therapy (M‐DAT). Dynamic arcs (350 degrees) conforming to the beam's eye view of the prostate and seminal vesicles while shielding the rectum, combined with two lateral oblique conformal fields (15 degrees with respect to laterals) fitting the prostate only, were applied to deliver doses of 78 Gy and 61.23 Gy in 39 fractions to the prostate and seminal vesicles respectively. Dynamic wedges (45 degrees of thick end, anteriorly oriented) were used with conformal beams to adjust the dose homogeneity to the prostate, although in some cases, hard wedges (30 degrees of thick part, inferiorly oriented) were used with arcs to adjust the dose coverage to the seminal vesicles. The M‐DAT was applied to 10 patients in supine and 10 patients in prone positioning to determine the proper patient positioning for optimum protection of the rectum. The M‐DAT was compared with the simplified intensity‐modulated arc therapy (SIMAT) technique, composed of three phases of bilateral dynamic arcs. The mean rectal dose in M‐DAT for prone patients was 22.5±5.1 Gy; in M‐DAT and SIMAT for supine patients, it was 30.2±5.1 Gy and 39.4±6.0 Gy respectively. The doses to 15%, 25%, 35%, and 50% of the rectum volume in M‐DAT for prone patients were 44.5±10.2 Gy, 33.0±8.2 Gy, 25.3±6.4 Gy, and 16.3±5.6 Gy respectively. These values were lower than those in M‐DAT and in SIMAT for supine patients by 7.7%, 18.2%, 22.4%, and 28.5% and by 25.0%, 32.1%, 34.9%, and 41.9% of the prescribed dose (78 Gy) respectively. Ion chamber measurements showed good agreement of the calculated and measured isocentric dose (maximum deviation of 3.5%). Accuracy of the dose distribution calculation was evaluated by film dosimetry using a gamma index, allowing 3% dose variation and 4 mm distance to agreement as the individual acceptance criteria in prostate and seminal vesicle levels alike for all supine and prone patients. We found that fewer than 10% of the pixels in the dose distribution of the calculated area of 10×10−cm failed the acceptance criteria. These pixels were observed mainly in the low‐dose regions, particularly at the level of the seminal vesicles.In conclusion, the single‐phase M‐DAT technique with patients in the prone position was found to provide the intended coverage of the prescribed doses to the prostate and seminal vesicles with improved protection for the rectum. Accordingly, M‐DAT has replaced non‐modulated conformal radiotherapy or SIMAT as the standard treatment for prostate cancer in our department.PACS number: 87.53.Tf

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Treatment planning comparison of conventional, 3D conformal, and intensity-modulated photon (IMRT) and proton therapy for paranasal sinus carcinoma

Cited by 180 publications

References 31 publications

Can Photon IMRT be improved by combination with mixed electron and photon techniques?

Can Photon IMRT be improved by combination with mixed electron and photon techniques?

Proton beam therapy for locally advanced and unresectable (T4bN0M0) squamous cell carcinoma of the ethmoid sinus: A report of seven cases and a literature review

Forward‐planning intensity‐modulated radiotherapy technique for prostate cancer

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