Proton arc therapy increases the benefit of proton therapy for oropharyngeal cancer patients in the model based clinic.

Oropharyngeal Neoplasms / radiotherapy Proton Therapy / methods Humans Prospective Studies Organs at Risk Radiotherapy Planning, Computer-Assisted
Head and neck cancer Model based clinic Patient selection Proton arc therapy Proton therapy Static arc

Journal

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
ISSN: 1879-0887
Titre abrégé: Radiother Oncol
Pays: Ireland
ID NLM: 8407192

Informations de publication

Date de publication:
07 2023
Historique:
received: 05 01 2023
revised: 04 04 2023
accepted: 05 04 2023
medline: 21 6 2023
pubmed: 15 4 2023
entrez: 14 4 2023
Statut: ppublish

Résumé

In the model-based approach, patients qualify for proton therapy when the reduction in risk of toxicity (ΔNTCP) obtained with IMPT relative to VMAT is larger than predefined thresholds as defined by the Dutch National Indication Protocol (NIPP). Proton arc therapy (PAT) is an emerging technology which has the potential to further decrease NTCPs compared to IMPT. The aim of this study was to investigate the potential impact of PAT on the number of oropharyngeal cancer (OPC) patients that qualify for proton therapy. A prospective cohort of 223 OPC patients subjected to the model-based selection procedure was investigated. 33 (15%) patients were considered unsuitable for proton treatment before plan comparison. When IMPT was compared to VMAT for the remaining 190 patients, 148 (66%) patients qualified for protons and 42 (19%) patients did not. For these 42 patients treated with VMAT, robust PAT plans were generated. PAT plans provided better or similar target coverage compared to IMPT plans. In the PAT plans, integral dose was significantly reduced by 18% relative to IMPT plans and by 54% relative to VMAT plans. PAT decreased the mean dose to numerous organs-at-risk (OARs), further reducing NTCPs. The ΔNTCP for PAT relative to VMAT passed the NIPP thresholds for 32 out of the 42 patients treated with VMAT, resulting in 180 patients (81%) of the complete cohort qualifying for protons. PAT outperforms IMPT and VMAT, leading to a further reduction of NTCP-values and higher ΔNTCP-values, significantly increasing the percentage of OPC patients selected for proton therapy.

Sections du résumé

BACKGROUND AND PURPOSE
In the model-based approach, patients qualify for proton therapy when the reduction in risk of toxicity (ΔNTCP) obtained with IMPT relative to VMAT is larger than predefined thresholds as defined by the Dutch National Indication Protocol (NIPP). Proton arc therapy (PAT) is an emerging technology which has the potential to further decrease NTCPs compared to IMPT. The aim of this study was to investigate the potential impact of PAT on the number of oropharyngeal cancer (OPC) patients that qualify for proton therapy.
MATERIALS AND METHODS
A prospective cohort of 223 OPC patients subjected to the model-based selection procedure was investigated. 33 (15%) patients were considered unsuitable for proton treatment before plan comparison. When IMPT was compared to VMAT for the remaining 190 patients, 148 (66%) patients qualified for protons and 42 (19%) patients did not. For these 42 patients treated with VMAT, robust PAT plans were generated.
RESULTS
PAT plans provided better or similar target coverage compared to IMPT plans. In the PAT plans, integral dose was significantly reduced by 18% relative to IMPT plans and by 54% relative to VMAT plans. PAT decreased the mean dose to numerous organs-at-risk (OARs), further reducing NTCPs. The ΔNTCP for PAT relative to VMAT passed the NIPP thresholds for 32 out of the 42 patients treated with VMAT, resulting in 180 patients (81%) of the complete cohort qualifying for protons.
CONCLUSION
PAT outperforms IMPT and VMAT, leading to a further reduction of NTCP-values and higher ΔNTCP-values, significantly increasing the percentage of OPC patients selected for proton therapy.

Identifiants

DOI: 10.1016/j.radonc.2023.109670 PMID: 37059337
pubmed: 37059337
pii: S0167-8140(23)00208-6
doi: 10.1016/j.radonc.2023.109670
pii:
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

109670

Informations de copyright

Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.

Auteurs

Bas A de Jong (BA)

Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands. Electronic address: b.a.de.jong@umcg.nl.

Erik W Korevaar (EW)

Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands.

Anneke Maring (A)

Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands.

Chimène I Werkman (CI)

Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands.

Daniel Scandurra (D)

Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands.

Guillaume Janssens (G)

Ion Beam Applications SA, Louvain-la-Neuve, Belgium.

Stefan Both (S)

Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands.

Johannes A Langendijk (JA)

Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, The Netherlands.

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Classifications MeSH

questionsmedicales.fr › Maladies oto-rhino-laryngologiques › Maladies du pharynx › Tumeurs du pharynx › Tumeurs de l'oropharynx › Proton arc therapy increases the benefit of...
questionsmedicales.fr › Thérapeutique › Radiothérapie › Radiothérapie par ions lourds › Protonthérapie › Proton arc therapy increases the benefit of...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Proton arc therapy increases the benefit of...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études prospectives › Proton arc therapy increases the benefit of...
questionsmedicales.fr › Régions du corps › Organes à risque › Proton arc therapy increases the benefit of...
questionsmedicales.fr › Sciences de l'information › Informatique › Informatique médicale › Applications de l'informatique médicale › Prise de décision assistée par ordinateur › Thérapie assistée par ordinateur › Radiothérapie assistée par ordinateur › Planification de radiothérapie assistée par ordinateur › Proton arc therapy increases the benefit of...