Dosimetric Study of Pelvic Proton Radiotherapy for High-Risk Prostate Cancer

Chera, Bhishamjit S.; Vargas, Carlos; Morris, Christopher G.; Louis, Debbie; Flampouri, Stella; Yeung, Daniel; Duvvuri, S; Li, Zuofeng; Mendenhall, Nancy P.

doi:10.1016/j.ijrobp.2009.01.044

Cited by 65 publications

(41 citation statements)

References 26 publications

(40 reference statements)

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“…As expected, IMPT presented a significantly better sparing of non target tissues though without a substantial improvement on target coverage compared to IMXT or VMAT. A dosimetric study by Chera et al, demonstrated that protontherapy was able to reduce the OAR volume receiving low-to medium-dose irradiation compared to IMXT in prostate cancer patients treated to the pelvic LN (8). In our study we observed a similar finding and were able to show that even with the addition of the pararectal SNs in the pelvic target the IMPT technique VMAT (D 50G% 5 33.5  2.5 Gy) looked better than IMXT (D 50% 5 36.6  2.2 Gy) for the left femoral head (Figure 2 As in our study, Ganswindt et al, observed in 32% of their patients' positive pararectal SNs (11).…”

Section: Discussionmentioning

confidence: 99%

Pelvic Lymph Node Irradiation Including Pararectal Sentinel Nodes for Prostate Cancer Patients

Vees

Dipasquale

Nouet

et al. 2014

Technol Cancer Res Treat

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We aimed to assess the dosimetric impact of advanced delivery radiotherapy techniques using either intensity modulated x-ray beams (IMXT), volumetric modulated arc therapy (VMAT), or intensity modulated proton therapy (IMPT), for high-risk prostate cancer patients with sentinel nodes in the pararectal region. Twenty high-risk prostate cancer patients were included in a prospective trial evaluating sentinel nodes on pelvic SPECT acquisition. To be eligible for the dosimetric study, patients had to present with pararectal sentinel nodes usually not included in the clinical target volume encompassing the pelvic lymph nodes. Radiotherapy-plans including the prostate, the seminal vesicles, and the pelvic lymph nodes with the pararectal sentinel nodes were optimized for 6 eligible patients. IMXT and IMPT were delivered with 7 and 3 beams respectively and VMAT with 2 arcs. Results were assessed with Dose-Volume Histograms and predictive normal tissue complication probabilities (NTCPs) models between the three competing treatment modalities aiming to deliver a total dose of 50.4 Gy in 1.8 Gy daily fractions. Target coverage was optimized with IMPT when compared to IMXT and VMAT.Coverage of the sentinel node was slightly better with IMXT (D 98% 5 57.3  5.1 Gy) when compared with VMAT (D 98% 5 56.2  4.1 Gy). The irradiation of rectal, bladder, small bowel, and femoral heads volumes was significantly reduced with IMPT when compared to IMXT and VMAT. NTCPs rates for rectal and bladder  grade-3 late toxicity were better with IMPT (0.4  0.0% and 0.0  0.0%) compared with IMXT (4.6  3.3% and 1.4  1.1%), and VMAT (4.5  4.0% and 1.6  1.6%), respectively. Acceptable dose-volume distributions and low rectal and urinary NTCPs were estimated to geometrically complex pelvic volumes such as the ones proposed in this study using IMXT, VMAT and IMPT. IMPT succeeded, however, to propose the best physical and biological treatment plans compared to both X-ray derived plans.

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Section: Discussionmentioning

confidence: 99%

Pelvic Lymph Node Irradiation Including Pararectal Sentinel Nodes for Prostate Cancer Patients

Vees

Dipasquale

Nouet

et al. 2014

Technol Cancer Res Treat

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“…Compared with the IMRT and IMRT/3D-PRT plans, 3D-PRT plans reduced the mean dose to the rectum, rectal wall, bladder, bladder wall, small bowel, and pelvis. Femoral head doses were higher for the 3D-PRTP[39]. Talcott et al [40].…”

Section: Clinical Treatment Outcomes Of Proton Therapymentioning

confidence: 97%

Proton therapy in clinical practice

Liu¹,

Chang²

2011

Chin J Cancer

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Radiation dose escalation and acceleration improves local control but also increases toxicity. Proton radiation is an emerging therapy for localized cancers that is being sought with increasing frequency by patients. Compared with photon therapy, proton therapy spares more critical structures due to its unique physics. The physical properties of a proton beam make it ideal for clinical applications. By modulating the Bragg peak of protons in energy and time, a conformal radiation dose with or without intensity modulation can be delivered to the target while sparing the surrounding normal tissues. Thus, proton therapy is ideal when organ preservation is a priority. However, protons are more sensitive to organ motion and anatomy changes compared with photons. In this article, we review practical issues of proton therapy, describe its image-guided treatment planning and delivery, discuss clinical outcome for cancer patients, and suggest challenges and the future development of proton therapy.

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“…A recent pair of treatment planning studies demonstrated a significantly diminished risk of SMN with passively scattered protons over 6-MV IMRT, for both early- and advanced-stage prostate cancer radiotherapy, respectively. While both techniques provided acceptable dose coverage to target volumes, the proton plans demonstrated lower doses at low and intermediate levels in the bladder and rectum (Chera et al, 2009; Fontenot et al, 2009). A dosimetric analysis of prostate cancer treatment from Schneider et al (2007) further suggested the benefits of proton therapy over IMRT and 3D conformal radiotherapy (3DCRT) in dose-escalation models up to 100 Gy, with spot-scanned proton delivery associated with a 40% decreased risk of SMN as compared with 70 Gy 3DCRT.…”

Section: Consideration Of Radiotherapy Treatment Modalitymentioning

confidence: 99%

Radiotherapy-Induced Malignancies: Review of Clinical Features, Pathobiology, and Evolving Approaches for Mitigating Risk

Braunstein¹,

Nakamura²

2013

Front. Oncol.

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One of the most significant effects of radiation therapy on normal tissues is mutagenesis, which is the basis for radiation-induced malignancies. Radiation-induced malignancies are late complications arising after radiotherapy, increasing in frequency among survivors of both pediatric and adult cancers. Genetic backgrounds harboring germline mutations in tumor suppressor genes are recognized risk factors. Some success has been found with using genome wide association studies to identify germline polymorphisms associated with susceptibility. The insights generated by genetics, epidemiology, and the development of experimental models are defining potential strategies to offer to individuals at risk for radiation-induced malignancies. Concurrent technological efforts are developing novel radiotherapy delivery to reduce irradiation of normal tissues, and thereby, to mitigate the risk of radiation-induced malignancies. The goal of this review is to discuss epidemiologic, modeling, and radiotherapy delivery data, where these lines of research intersect and their potential impact on patient care.

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Dosimetric Study of Pelvic Proton Radiotherapy for High-Risk Prostate Cancer

Cited by 65 publications

References 26 publications

Pelvic Lymph Node Irradiation Including Pararectal Sentinel Nodes for Prostate Cancer Patients

Pelvic Lymph Node Irradiation Including Pararectal Sentinel Nodes for Prostate Cancer Patients

Proton therapy in clinical practice

Radiotherapy-Induced Malignancies: Review of Clinical Features, Pathobiology, and Evolving Approaches for Mitigating Risk

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