Intensity Modulated Proton Therapy Better Spares Non-Adjacent Organs and Reduces the Risk of Secondary Malignant Neoplasms in the Treatment of Sinonasal Cancers

Lewis, Luke; Kreinbrink, P.J.; Richardson, Mike; Westerfield, Morgan; Doberstein, M.; Zhang, Yongbin; Redmond, Kevin P.; Takiar, Vinita

doi:10.1016/j.meddos.2021.11.002

Cited by 2 publications

(1 citation statement)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Some studies reported interesting findings when comparing protons versus photons in SNCs. As a general remark, PT allows to deliver lower doses to several OARs in PNSCs without significant difference in terms of target coverage, conformity or homogeneity index [ 39 ], with the highest benefit for ethmoid tumors [ 40 ]. The horseshoe-shaped target volumes and the proximity or involvement of several critical structures such as temporal lobe, brain, middle cranial fossa, clivus, orbital apex and orbit, have led high expertise radiation oncology community to administer PT in clinical practice, when available, even without an overall plan comparison study.…”

Section: Discussionmentioning

confidence: 99%

A Patient Selection Approach Based on NTCP Models and DVH Parameters for Definitive Proton Therapy in Locally Advanced Sinonasal Cancer Patients

Mirandola

Russo

Bonora

et al. 2022

Cancers

View full text Add to dashboard Cite

(1) Background: In this work, we aim to provide selection criteria based on normal tissue complication probability (NTCP) models and additional explanatory dose-volume histogram parameters suitable for identifying locally advanced sinonasal cancer patients with orbital invasion benefitting from proton therapy. (2) Methods: Twenty-two patients were enrolled, and two advanced radiation techniques were compared: intensity modulated proton therapy (IMPT) and photon volumetric modulated arc therapy (VMAT). Plans were optimized with a simultaneous integrated boost modality: 70 and 56 Gy(RBE) in 35 fractions were prescribed to the high risk/low risk CTV. Several endpoints were investigated, classified for their severity and used as discriminating paradigms. In particular, when NTCP models were already available, a first selection criterion based on the delta-NTCP was adopted. Additionally, an overall analysis in terms of DVH parameters was performed. Furthermore, a second selection criterion based on a weighted sum of the ΔNTCP and ΔDVH was adopted. (3) Results: Four patients out of 22 (18.2%) were suitable for IMPT due to ΔNTCP > 3% for at least one severe toxicity, 4 (18.2%) due to ΔNTCP > 20% for at least three concurrent intermediate toxicities and 16 (72.7%) due to the mixed sum of ΔNTCP and ΔDVH criterion. Since, for some cases, both criteria were contemporary fulfilled, globally 17/22 patients (77.3%) would benefit from IMPT. (4) Conclusions: For this rare clinical scenario, the use of a strategy including DVH parameters and NTCPs when comparing VMAT and IMPT is feasible. We showed that patients affected by sinonasal cancer could profit from IMPT compared to VMAT in terms of optical and central nervous system organs at risk sparing.

show abstract

Section: Discussionmentioning

confidence: 99%

A Patient Selection Approach Based on NTCP Models and DVH Parameters for Definitive Proton Therapy in Locally Advanced Sinonasal Cancer Patients

Mirandola

Russo

Bonora

et al. 2022

Cancers

View full text Add to dashboard Cite

show abstract

Proton Therapy for Head and Neck Cancer

Budach

Thieme

2023

Critical Issues in Head and Neck Oncology

View full text Add to dashboard Cite

Treatment of localized cancer with protons therapy (PT) seems an appealing alternative to photons. PT has been available for decades and has unique dose distribution properties with the so-called Bragg-peak enabling protons to stop after their maximum depth is reached within millimeters. PT allows sparing of normal tissues and organs to a much greater extent than photons, even when modern photon techniques like intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) are involved. Whereas IMRT and VMAT techniques have demonstrated their superiority to older 3D-conformal irradiation techniques, there is still a large gap between the theoretical advantages of PT due to its superior dose distribution and high-level clinical evidence, particularly in head and neck cancer (HNC). So far, mostly non-randomized clinical studies exist with clinical results in oropharyngeal, nasopharyngeal, sinonasal, periorbital, and salivary gland cancer. The limited broad availability of this treatment method and its unknown cost-effectiveness need to be evaluated. In this chapter, we discuss the currently available evidence of PT for HNCs and viable options to generate further evidence like the model-based approach.

show abstract

Intensity Modulated Proton Therapy Better Spares Non-Adjacent Organs and Reduces the Risk of Secondary Malignant Neoplasms in the Treatment of Sinonasal Cancers

Cited by 2 publications

References 21 publications

A Patient Selection Approach Based on NTCP Models and DVH Parameters for Definitive Proton Therapy in Locally Advanced Sinonasal Cancer Patients

A Patient Selection Approach Based on NTCP Models and DVH Parameters for Definitive Proton Therapy in Locally Advanced Sinonasal Cancer Patients

Proton Therapy for Head and Neck Cancer

Contact Info

Product

Resources

About