Volumetric modulated arc therapy versus intensity-modulated proton therapy in neoadjuvant irradiation of locally advanced oesophageal cancer

Autor: Simone Marnitz, Marta Scorsetti, Christian Baues, Eren Celik, Wolfgang W. Baus, Luca Cozzi, Wolfgang Schröder, Alessandro Clivio, Antonella Fogliata
Rok vydání: 2020
Předmět:
Organs at Risk
lcsh:Medical physics. Medical radiology. Nuclear medicine
Esophageal Neoplasms
Side effect
lcsh:R895-920
medicine.medical_treatment
VMAT
Secondary cancer risk estimate
lcsh:RC254-282
030218 nuclear medicine & medical imaging
Intensity-modulated proton therapy
Coronary artery disease
03 medical and health sciences
0302 clinical medicine
Proton Therapy
medicine
Humans
Computer Simulation
Radiology
Nuclear Medicine and imaging
Proton therapy
Retrospective Studies
business.industry
Radiotherapy Planning
Computer-Assisted
Research
Cancer
Radiotherapy Dosage
lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens
medicine.disease
Volumetric modulated arc therapy
Neoadjuvant Therapy
Intensity (physics)
Radiation therapy
Oncology
030220 oncology & carcinogenesis
Heart failure
Radiotherapy
Adjuvant
Radiotherapy
Intensity-Modulated
business
Nuclear medicine
RapidArc
Oesophagal cancer
Zdroj: Radiation Oncology, Vol 15, Iss 1, Pp 1-10 (2020)
Radiation Oncology (London, England)
ISSN: 1748-717X
DOI: 10.1186/s13014-020-01570-y
Popis: Background To investigate the role of intensity-modulated proton therapy (IMPT) compared to volumetric modulated arc therapy (VMAT), realised with RapidArc and RapidPlan methods (RA_RP) for neoadjuvant radiotherapy in locally advanced oesophagal cancer. Methods Twenty patients were retrospectively planned for IMPT (with two fields, (IMPT_2F) or with three fields (IMPT_3F)) and RA_RP and the results were compared according to dose-volume metrics. Estimates of the excess absolute risk (EAR) of secondary cancer induction were determined for the lungs. For the cardiac structures, the relative risk (RR) of coronary artery disease (CAD) and chronic heart failure (CHF) were estimated. Results Both the RA_RP and IMPT approached allowed to achieve the required coverage for the gross tumour volume, (GTV) and the clinical and the planning target volumes, CTV and PTV (V98% > 98 for CTV and GTV and V95% > 95 for the PTV)). The conformity index resulted in 0.88 ± 0.01, 0.89 ± 0.02 and 0.89 ± 0.02 for RA_RP, IMPT_2F and IMPT_3F respectively. With the same order, the homogeneity index for the PTV resulted in 5.6 ± 0.6%, 4.4 ± 0.9% and 4.5 ± 0.8%. Concerning the organs at risk, the IMPT plans showed a systematic and statistically significant incremental sparing when compared to RA_RP, especially for the heart. The mean dose to the combined lungs was 8.6 ± 2.9 Gy for RA_RP, 3.2 ± 1.5 Gy and 2.9 ± 1.2 Gy for IMPT_2F and IMPT_3F. The mean dose to the whole heart resulted to 9.9 ± 1.9 Gy for RA_RP compared to 3.7 ± 1.3 Gy or 4.0 ± 1.4 Gy for IMPT_2F or IMPT_3F; the mean dose to the left ventricle resulted to 6.5 ± 1.6 Gy, 1.9 ± 1.5 Gy, 1.9 ± 1.6 Gy respectively. Similar sparing effects were observed for the liver, the kidneys, the stomach, the spleen and the bowels. The EAR per 10,000 patients-years of secondary cancer induction resulted in 19.2 ± 5.7 for RA_RP and 6.1 ± 2.7 for IMPT_2F or 5.7 ± 2.4 for IMPT_3F. The RR for the left ventricle resulted in 1.5 ± 0.1 for RA_RP and 1.1 ± 0.1 for both IMPT sets. For the coronaries, the RR resulted in 1.6 ± 0.4 for RA_RP and 1.2 ± 0.3 for protons. Conclusion With regard to cancer of the oesophagogastric junction type I and II, the use of intensity-modulated proton therapy seems to have a clear advantage over VMAT. In particular, the reduction of the heart and abdominal structures dose could result in an optimised side effect profile. Furthermore, reduced risk of secondary neoplasia in the lung can be expected in long-term survivors and would be a great gain for cured patients.
Databáze: OpenAIRE
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