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

Meier, Teresa; Mascia, Anthony; Wolf, Eric; Kharofa, Jordan

doi:10.14338/ijpt-17-00017

Cited by 10 publications

(15 citation statements)

References 19 publications

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“… 24 , 25 Multiple dosimetric studies comparing IMPT and IMRT radiation plans for anal cancer show that IMPT reduces low-dose radiation to the bone marrow, bowel, femoral heads, and genitalia, with the authors concluding that this had the potential to reduce gastrointestinal and hematologic toxicities of chemoradiation therapy for anal cancer. 14 , 15 , 16 These are not unreasonable predictions, because the Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC) group summarized prior model-based and clinical data suggesting that greater doses to and volumes of irradiated bowel are associated with more grade 3 or greater gastrointestinal toxicities. 21 Multiple clinical studies have also found that greater doses to and volumes of irradiated bone marrow are associated with hematologic toxicity.…”

Section: Discussionmentioning

confidence: 99%

“…Interest in IMPT for anal cancer has grown with the publication of several dosimetry studies showing that IMPT could reduce radiation dose to several organ systems compared to IMRT. [14][15][16] Wo et al recently published the results of a feasibility trial of IMPT showing comparable toxicity rates to those of RTOG 0529. 12 Based on its anticipated reduction of radiation dose to normal organs, we hypothesized that IMPT would be associated with less acute toxicity compared to IMRT.…”

Section: Introductionmentioning

confidence: 99%

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Multi-institutional Comparison of Intensity Modulated Photon Versus Proton Radiation Therapy in the Management of Squamous Cell Carcinoma of the Anus

Mohiuddin

Jethwa

Grandhi

et al. 2021

Advances in Radiation Oncology

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Multi-institutional Comparison of Intensity Modulated Photon Versus Proton Radiation Therapy in the Management of Squamous Cell Carcinoma of the Anus

Mohiuddin

Jethwa

Grandhi

et al. 2021

Advances in Radiation Oncology

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“…Proton therapy is being investigated as an alternative to intensity-modulated radiation therapy because of its potential to minimize radiation exposure to the transplanted kidney and other organs at risk. Previous dosimetric studies have demonstrated improved organ-at-risk sparing with IMPT, compared with intensity-modulated radiation therapy, that do not sacrifice coverage of the target volumes [19]. Of note, there are 3 on-going clinical trials investigating the use of proton therapy in the treatment of anal cancer in the population at large (NCT03018418, NCT01858025, and NCT03690921).…”

Section: Discussionmentioning

confidence: 99%

“…The radiation dose and fractionation were delivered through a simultaneous integrated boost technique in 28 to 30 fractions, per the Radiation Therapy Oncology Group (RTOG) 0529 schema [18]. The IMPT technique has been previously described [19]. The approach used a 3-field multifield-optimized split-target technique.…”

Section: Case Seriesmentioning

confidence: 99%

Proton Therapy in the Treatment of Anal Cancer in Pelvic Kidney Transplant Recipients: A Case Series

Buchberger

Kreinbrink

Kharofa

2019

International Journal of Particle Therapy

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Purpose: The incidence of anal cancer in patients with kidney transplants has increased. The definitive treatment for anal cancer is chemotherapy and intensity-modulated radiation therapy. In kidney transplant recipients, sparing the pelvic kidney in the process of delivering radiation to the anus can be challenging. Intensity-modulated proton therapy (IMPT) has been proposed as an alternative to intensity-modulated radiation therapy for the treatment of anal cancer in this population, given its increased ability to spare organs-at-risk. Case Series: We present 4 cases of patients with transplanted pelvic kidneys who subsequently developed anal cancer and were treated with IMPT from 2017 to 2019. Conclusion: Use of IMPT appears to be an acceptable option for the treatment of anal cancer in patients with a pelvic kidney.

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“…While preoperative treatment results in long-term disease-free survival, it often displayed high rates of acute toxicity particularly in gastrointestinal, genitourinary and hematologic toxicity. 18 The incidence of clinically significant complications associated with the radiation is approximately 5-20%. 19 Due to irradiation of the pelvis and the rectal region in particular, the gastrointestinal tract becomes vulnerable, resulting in adverse effects most common among them being small bowel obstruction.…”

Section: Introductionmentioning

confidence: 99%

Dosimetric and radiobiological evaluation of four radiation techniques in preoperative rectal cancer radiotherapy

et al. 2020

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Purpose: To compare tumour dose distribution, conformality, homogeneity, normal tissue avoidance, tumour control probability (TCP) and normal tissue complication probability (NTCP) using 3D conformal radiation therapy (3DCRT), 3- and 4-field intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) in patients with locally advanced rectal cancer. Materials and methods: Twenty-four patients staged T1–3N+M0 with locally advanced rectal cancer underwent neoadjuvant chemoradiation therapy. Four different radiotherapy plans were prepared for each patient: 3DCRT, 3- and 4-field IMRT and VMAT are evaluated for target distribution using CI and homogeneity index (HI), normal tissue avoidance using Dmax, V45, V40, V50 and TCP and NTCP using the Lyman–Kutcher–Burman model. Results: VMAT has better HI (HI = 1·32) and 3DCRT exhibited better conformality (CI = 1·05) than the other radiotherapy techniques. With regard to normal tissue avoidance, all radiotherapy plans met the constraints. Dmax in the 3DCRT plans was statistically significant (p = 0·04) for bladder and no significant differences in V40 and V50. In the bowel bag, no significant differences in Dmax for any radiotherapy plan and V40 was lower in 3DCRT than VMAT (p = 0·024). In the case of femoral heads, 3DCRT has a statistically significant lower dose on Dmax than 4-field IMRT (p = 0·00 « 0·05). VMAT has the biggest TCP (80·76%) than the other three radiotherapy plans. With regard to normal tissue complications, probabilities were shown to be very low, of the order of 10-14 and 10-41 for bowel bag and femoral heads respectively. Conclusions: It can be concluded that 3DCRT plan improves conformity and decreases radiation sparing in the organ at risks, but the VMAT plan exhibits better homogeneity and greater TCP.

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

Cited by 10 publications

References 19 publications

Multi-institutional Comparison of Intensity Modulated Photon Versus Proton Radiation Therapy in the Management of Squamous Cell Carcinoma of the Anus

Multi-institutional Comparison of Intensity Modulated Photon Versus Proton Radiation Therapy in the Management of Squamous Cell Carcinoma of the Anus

Proton Therapy in the Treatment of Anal Cancer in Pelvic Kidney Transplant Recipients: A Case Series

Dosimetric and radiobiological evaluation of four radiation techniques in preoperative rectal cancer radiotherapy

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