Dosimetric comparison of distal esophageal carcinoma plans for patients treated with small-spot intensity-modulated proton versus volumetric-modulated arc therapies.
Aged
Aged, 80 and over
Esophageal Neoplasms
/ radiotherapy
Female
Humans
Male
Middle Aged
Organs at Risk
/ radiation effects
Patient Selection
Prognosis
Proton Therapy
/ methods
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted
/ methods
Radiotherapy, Intensity-Modulated
/ methods
Retrospective Studies
distal esophageal
intensity-modulated proton therapy
interplay effects
small spot size
volumetric-modulated arc therapy
Journal
Journal of applied clinical medical physics
ISSN: 1526-9914
Titre abrégé: J Appl Clin Med Phys
Pays: United States
ID NLM: 101089176
Informations de publication
Date de publication:
Jul 2019
Jul 2019
Historique:
received:
17
02
2019
revised:
24
04
2019
accepted:
02
05
2019
pubmed:
22
5
2019
medline:
21
12
2019
entrez:
22
5
2019
Statut:
ppublish
Résumé
Esophageal carcinoma is the eighth most common cancer in the world. Volumetric-modulated arc therapy (VMAT) is widely used to treat distal esophageal carcinoma due to high conformality to the target and good sparing of organs at risk (OAR). It is not clear if small-spot intensity-modulated proton therapy (IMPT) demonstrates a dosimetric advantage over VMAT. In this study, we compared dosimetric performance of VMAT and small-spot IMPT for distal esophageal carcinoma in terms of plan quality, plan robustness, and interplay effects. 35 distal esophageal carcinoma patients were retrospectively reviewed; 19 patients received small-spot IMPT and the remaining 16 of them received VMAT. Both plans were generated by delivering prescription doses to clinical target volumes (CTVs) on phase-averaged 4D-CT's. The dose-volume-histogram (DVH) band method was used to quantify plan robustness. Software was developed to evaluate interplay effects with randomized starting phases for each field per fraction. DVH indices were compared using Wilcoxon rank-sum test. For fair comparison, all the treatment plans were normalized to have the same CTV In the nominal scenario, small-spot IMPT delivered statistically significantly lower liver D Small-spot IMPT decreases doses to heart, liver, and total lung compared to VMAT as well as achieves clinically acceptable plan robustness. Our study supports the use of small-spot IMPT for the treatment of distal esophageal carcinoma.
Sections du résumé
BACKGROUND
BACKGROUND
Esophageal carcinoma is the eighth most common cancer in the world. Volumetric-modulated arc therapy (VMAT) is widely used to treat distal esophageal carcinoma due to high conformality to the target and good sparing of organs at risk (OAR). It is not clear if small-spot intensity-modulated proton therapy (IMPT) demonstrates a dosimetric advantage over VMAT. In this study, we compared dosimetric performance of VMAT and small-spot IMPT for distal esophageal carcinoma in terms of plan quality, plan robustness, and interplay effects.
METHODS
METHODS
35 distal esophageal carcinoma patients were retrospectively reviewed; 19 patients received small-spot IMPT and the remaining 16 of them received VMAT. Both plans were generated by delivering prescription doses to clinical target volumes (CTVs) on phase-averaged 4D-CT's. The dose-volume-histogram (DVH) band method was used to quantify plan robustness. Software was developed to evaluate interplay effects with randomized starting phases for each field per fraction. DVH indices were compared using Wilcoxon rank-sum test. For fair comparison, all the treatment plans were normalized to have the same CTV
RESULTS
RESULTS
In the nominal scenario, small-spot IMPT delivered statistically significantly lower liver D
CONCLUSIONS
CONCLUSIONS
Small-spot IMPT decreases doses to heart, liver, and total lung compared to VMAT as well as achieves clinically acceptable plan robustness. Our study supports the use of small-spot IMPT for the treatment of distal esophageal carcinoma.
Identifiants
pubmed: 31112371
doi: 10.1002/acm2.12623
pmc: PMC6612702
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
15-27Subventions
Organisme : NCI NIH HHS
ID : K25 CA168984
Pays : United States
Organisme : National Cancer Institute
ID : K25CA168984
Organisme : Kemper Marley Foundation
Organisme : Lawrence W. and Marilyn W. Matteson Fund
Organisme : Arizona Biomedical Research Commission
Informations de copyright
© 2019 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.
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