Intensity-Modulated Proton Therapy Reduces the Dose to Normal Tissue Compared With Intensity-Modulated Radiation Therapy or Passive Scattering Proton Therapy and Enables Individualized Radical Radiotherapy for Extensive Stage IIIB Non-Small-Cell Lung Cancer: A Virtual Clinical Study

Zhang, Xiaodong; Li, Yupeng; Pan, Xun; Li, Xiaoqiang; Mohan, Radhe; Komaki, Ritsuko; Cox, James D.; Chang, Joe Y.

doi:10.1016/j.ijrobp.2009.04.028

Cited by 244 publications

(205 citation statements)

References 16 publications

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“…PBS treatment planning for thoracic tumors can achieve better sparing of organs at risk (OAR) than IMRT techniques 13 , 14 , 15 . Despite the dosimetric advantages of PBS, DS and IMRT remain the methods of choice for treating complex thoracic tumors.…”

Section: Introductionmentioning

confidence: 99%

Beam‐specific planning target volumes incorporating 4D CT for pencil beam scanning proton therapy of thoracic tumors

Lin

Kang

Huang

et al. 2015

J Applied Clin Med Phys

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The purpose of this study is to determine whether organ sparing and target coverage can be simultaneously maintained for pencil beam scanning (PBS) proton therapy treatment of thoracic tumors in the presence of motion, stopping power uncertainties, and patient setup variations. Ten consecutive patients that were previously treated with proton therapy to 66.6/1.8 Gy (RBE) using double scattering (DS) were replanned with PBS. Minimum and maximum intensity images from 4D CT were used to introduce flexible smearing in the determination of the beam specific PTV (BSPTV). Datasets from eight 4D CT phases, using ±3% uncertainty in stopping power and ±3 mm uncertainty in patient setup in each direction, were used to create 8×12×10=960 PBS plans for the evaluation of 10 patients. Plans were normalized to provide identical coverage between DS and PBS. The average lung V20, V5, and mean doses were reduced from 29.0%, 35.0%, and 16.4 Gy with DS to 24.6%, 30.6%, and 14.1 Gy with PBS, respectively. The average heart V30 and V45 were reduced from 10.4% and 7.5% in DS to 8.1% and 5.4% for PBS, respectively. Furthermore, the maximum spinal cord, esophagus, and heart doses were decreased from 37.1 Gy, 71.7 Gy, and 69.2 Gy with DS to 31.3 Gy, 67.9 Gy, and 64.6 Gy with PBS. The conformity index (CI), homogeneity index (HI), and global maximal dose were improved from 3.2, 0.08, 77.4 Gy with DS to 2.8, 0.04, and 72.1 Gy with PBS. All differences are statistically significant, with p‐values <0.05, with the exception of the heart V45 (p=0.146). PBS with BSPTV achieves better organ sparing and improves target coverage using a repainting method for the treatment of thoracic tumors. Incorporating motion‐related uncertainties is essential.PACS number: 87.55.D

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Section: Introductionmentioning

confidence: 99%

Beam‐specific planning target volumes incorporating 4D CT for pencil beam scanning proton therapy of thoracic tumors

Lin

Kang

Huang

et al. 2015

J Applied Clin Med Phys

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“…Most patients (81%) did not receive neoadjuvant chemotherapy. The authors demonstrated improved local control and OS with higher doses of radiation when patients were divided into three treatment groups (63)(64)(65)(66)(67)(68)(69)(74)(75)(76)(77)(78)(79)(80)(81)(82)(83)(84)(92)(93)(94)(95)(96)(97)(98)(99)(100)(101)(102)(103).…”

Section: Impact Of Heterogeneity Correctionmentioning

confidence: 99%

“…This approach allows for both improved proximal dose conformality and intensity-modulated proton therapy (IMPT) within the target. By utilizing multifield optimization and a few (usually 2-4) highly heterogeneous fields that sum to the desired improved dose distribution, IMPT has shown dosimetric improvements over IMRT and PS-PT in multiple in silico studies (99,100). However, these advantages do not come without some increase in uncertainties and diminution in robustness of plan delivery.…”

Section: Modalitiesmentioning

confidence: 99%

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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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“…[4][5][6][7] Furthermore, few other studies have reported that proton therapy has dosimetric advantages over photon based stereotactic body radiation therapy (SBRT) when a smaller size of lung tumor is involved. [7][8][9][10] However, Zhang et al 11 suggested that IMRT may be better than the passive-scatter proton therapy, especially when a tumor has an irregular shape and involves the mediastinum. Recently, a number of studies have reported the clinical results of NSCLC patients treated with proton therapy.…”

Section: Introductionmentioning

confidence: 99%

Treatment planning study comparing proton therapy, RapidArc and IMRT for a synchronous bilateral lung cancer case

Rana

Pokharel

Zheng

et al. 2014

Int J Cancer Ther Oncol

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Purpose: The main purpose of this study is to perform a treatment planning study on a synchronous bilateral non-small cell lung cancer case using three treatment modalities: uniform scanning proton therapy, RapidArc, and intensity modulated radiation therapy (IMRT). Methods: The maximum intensity projection (MIP) images obtained from the 4 dimensional-computed tomography (4DCT) scans were used for delineation of tumor volumes in the left and right lungs. The average 4D-CT was used for the treatment planning among all three modalities with identical patient contouring and treatment planning goal. A proton therapy plan was generated in XiO treatment planning system (TPS) using 2 fields for each target. For a comparative purpose, IMRT and RapidArc plans were generated in Eclipse TPS. Treatment plans were generated for a total dose of 74 CGE or Gy prescribed to each planning target volume (PTV) (left and right) with 2 CGE or Gy per fraction. In IMRT and RapidArc plans, normalization was done based on PTV coverage values in proton plans. Results: The mean PTV dose deviation from the prescription dose was lower in proton plan (within 3.4%), but higher in IMRT (6.5% to 11.3%) and RapidArc (3.8% to 11.5%) plans. Proton therapy produced lower mean dose to the total lung, heart, and esophagus when compared to IMRT and RapidArc. The relative volume of the total lung receiving 20, 10, and 5 CGE or Gy (V20, V10, and V5, respectively) were lower using proton therapy than using IMRT, with absolute differences of 9.71%, 22.88%, and 39.04%, respectively. The absolute differences in the V20, V10, and V5 between proton and RapidArc plans were 4.84%, 19.16%, and 36.8%, respectively, with proton therapy producing lower dosimetric values. Conclusion: Based on the results presented in this case study, uniform scanning proton therapy has a dosimetric advantage over both IMRT and RapidArc for a synchronous bi-lateral NSCLC, especially for the normal lung tissue, heart, and esophagus sparing. Further studies on a large group of patients with bi-lateral lung cancer are required to validate the dosimetric superiority of proton therapy over the IMRT and RapidArc.

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Intensity-Modulated Proton Therapy Reduces the Dose to Normal Tissue Compared With Intensity-Modulated Radiation Therapy or Passive Scattering Proton Therapy and Enables Individualized Radical Radiotherapy for Extensive Stage IIIB Non-Small-Cell Lung Cancer: A Virtual Clinical Study

Cited by 244 publications

References 16 publications

Beam‐specific planning target volumes incorporating 4D CT for pencil beam scanning proton therapy of thoracic tumors

Beam‐specific planning target volumes incorporating 4D CT for pencil beam scanning proton therapy of thoracic tumors

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

Treatment planning study comparing proton therapy, RapidArc and IMRT for a synchronous bilateral lung cancer case

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