Consensus Statement on Proton Therapy in Early-Stage and Locally Advanced Non–Small Cell Lung Cancer

Chang, Joe Y.; Jabbour, Salma K.; Ruysscher, Dirk De; Schild, Steven E.; Simone, Charles B.; Rengan, Ramesh; Feigenberg, Steven J.; Khan, Atif J.; Choi, Noah C.; Bradley, Jeffrey D.; Zhu, Xiaorong Ronald; Lomax, Anthony; Hoppe, Bradford S.

doi:10.1016/j.ijrobp.2016.01.036

Cited by 124 publications

(98 citation statements)

References 64 publications

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“…But in both techniques, there are opportunities to escalate the tumor dose and, simultaneously, deliver low dose to normal structures. This difference compared with photons is the basis for clinical research and proton application [17]. However, the results from the present study are merely suggestive for the advantages of dose escalation by PBS.…”

Section: Discussionmentioning

confidence: 56%

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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Section: Discussionmentioning

confidence: 56%

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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“…Recently, Chang et al nicely summarized trials underway or recently completed (133). The only randomized data to date were presented at the 2016 meeting of the American Society for Clinical Oncology.…”

Section: Clinical Outcomesmentioning

confidence: 99%

Advances in radiotherapy techniques and delivery for non-small cell lung cancer: benefits of intensity-modulated radiation therapy, proton therapy, and stereotactic body radiation therapy

Diwanji¹,

Mohindra²,

Vyfhuis³

et al. 2017

Transl. Lung Cancer Res.

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Abstract:The 21st century has seen several paradigm shifts in the treatment of non-small cell lung cancer (NSCLC) in early-stage inoperable disease, definitive locally advanced disease, and the postoperative setting.A key driver in improvement of local disease control has been the significant evolution of radiation therapy techniques in the last three decades, allowing for delivery of definitive radiation doses while limiting exposure of normal tissues. For patients with locally-advanced NSCLC, the advent of volumetric imaging techniques has allowed a shift from 2-dimensional approaches to 3-dimensional conformal radiation therapy (3DCRT).The next generation of 3DCRT, intensity-modulated radiation therapy and volumetric-modulated arc therapy (VMAT), have enabled even more conformal radiation delivery. Clinical evidence has shown that this can improve the quality of life for patients undergoing definitive management of lung cancer. In the earlystage setting, conventional fractionation led to poor outcomes. Evaluation of altered dose fractionation with the previously noted technology advances led to advent of stereotactic body radiation therapy (SBRT). This technique has dramatically improved local control and expanded treatment options for inoperable, earlystage patients. The recent development of proton therapy has opened new avenues for improving conformity and the therapeutic ratio. Evolution of newer proton therapy techniques, such as pencil-beam scanning (PBS), could improve tolerability and possibly allow reexamination of dose escalation. These new progresses, along with significant advances in systemic therapies, have improved survival for lung cancer patients across the spectrum of non-metastatic disease. They have also brought to light new challenges and avenues for further research and improvement.

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“…Planning studies comparing proton vs. photon plans for lung cancer treatment demonstrated proton plans score lower number on the mean dose, the V 20 Gy , and the V 5 Gy for normal lung 4, 5. Based on the current clinical guidelines, it would appear that proton would reduce radiation toxicities compared to a matched photon plan 6, 7, 8. More specifically, based on dose volume histogram (DVH) constraints specified in current clinical guidelines, the proton would be superior to its photon peer.…”

Section: Introductionmentioning

confidence: 99%

Using gEUD based plan analysis method to evaluate proton vs. photon plans for lung cancer radiation therapy

Xiao

Zou

Chen

et al. 2018

J Applied Clin Med Phys

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The goal of this study was to exam the efficacy of current DVH based clinical guidelines draw from photon experience for lung cancer radiation therapy on proton therapy. Comparison proton plans and IMRT plans were generated for 10 lung patients treated in our proton facility. A gEUD based plan evaluation method was developed for plan evaluation. This evaluation method used normal lung gEUD(a) curve in which the model parameter “a” was sampled from the literature reported value. For all patients, the proton plans delivered lower normal lung V5 Gy with similar V20 Gy and similar target coverage. Based on current clinical guidelines, proton plans were ranked superior to IMRT plans for all 10 patients. However, the proton and IMRT normal lung gEUD(a) curves crossed for 8 patients within the tested range of “a”, which means there was a possibility that proton plan would be worse than IMRT plan for lung sparing. A concept of deficiency index (DI) was introduced to quantify the probability of proton plans doing worse than IMRT plans. By applying threshold on DI, four patients’ proton plan was ranked inferior to the IMRT plan. Meanwhile if a threshold to the location of curve crossing was applied, 6 patients’ proton plan was ranked inferior to the IMRT plan. The contradictory ranking results between the current clinical guidelines and the gEUD(a) curve analysis demonstrated there is potential pitfalls by applying photon experience directly to the proton world. A comprehensive plan evaluation based on radio‐biological models should be carried out to decide if a lung patient would really be benefit from proton therapy.

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Consensus Statement on Proton Therapy in Early-Stage and Locally Advanced Non–Small Cell Lung Cancer

Cited by 124 publications

References 64 publications

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

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

Advances in radiotherapy techniques and delivery for non-small cell lung cancer: benefits of intensity-modulated radiation therapy, proton therapy, and stereotactic body radiation therapy

Using gEUD based plan analysis method to evaluate proton vs. photon plans for lung cancer radiation therapy

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