TY - JOUR
T1 - Evaluating proton stereotactic body radiotherapy to reduce chest wall dose in the treatment of lung cancer
AU - Welsh, James
AU - Amini, Arya
AU - Ciura, Katherine
AU - Nguyen, Ngoc
AU - Palmer, Matt
AU - Soh, Hendrick
AU - Allen, Pamela K.
AU - Paolini, Michael
AU - Liao, Zhongxing
AU - Bluett, Jaques
AU - Mohan, Radhe
AU - Gomez, Daniel
AU - Cox, James D.
AU - Komaki, Ritsuko
AU - Chang, Joe Y.
PY - 2013
Y1 - 2013
N2 - Stereotactic body radiotherapy (SBRT) can produce excellent local control of several types of solid tumor; however, toxicity to nearby critical structures is a concern. We found previously that in SBRT for lung cancer, the chest wall (CW) volume receiving 20, 30, or 40Gy (V20, V30, or V40) was linked with the development of neuropathy. Here we sought to determine whether the dosimetric advantages of protons could produce lower CW doses than traditional photon-based SBRT. We searched an institutional database to identify patients treated with photon SBRT for lung cancer with tumors within < 2.5cm of the CW. We found 260 cases; of these, chronic grade ≥ 2 CW pain was identified in 23 patients. We then selected 10 representative patients from this group and generated proton SBRT treatment plans, using the identical dose of 50Gy in 4 fractions, and assessed potential differences in CW dose between the 2 plans. The proton SBRT plans reduced the CW doses at all dose levels measured. The median CW V20 was 364.0cm3 and 160.0cm3 (p < 0.0001), V30 was 144.6cm3 vs 77.0cm3 (p = 0.0012), V35 was 93.9cm3 vs 57.9cm3 (p = 0.005), V40 was 66.5cm3 vs 45.4cm3 (p = 0.0112), and mean lung dose was 5.9Gy vs 3.8Gy (p = 0.0001) for photons and protons, respectively. Coverage of the planning target volume (PTV) was comparable between the 2 sets of plans (96.4% for photons and 97% for protons). From a dosimetric standpoint, proton SBRT can achieve the same coverage of the PTV while significantly reducing the dose to the CW and lung relative to photon SBRT and therefore may be beneficial for the treatment of lesions closer to critical structures.
AB - Stereotactic body radiotherapy (SBRT) can produce excellent local control of several types of solid tumor; however, toxicity to nearby critical structures is a concern. We found previously that in SBRT for lung cancer, the chest wall (CW) volume receiving 20, 30, or 40Gy (V20, V30, or V40) was linked with the development of neuropathy. Here we sought to determine whether the dosimetric advantages of protons could produce lower CW doses than traditional photon-based SBRT. We searched an institutional database to identify patients treated with photon SBRT for lung cancer with tumors within < 2.5cm of the CW. We found 260 cases; of these, chronic grade ≥ 2 CW pain was identified in 23 patients. We then selected 10 representative patients from this group and generated proton SBRT treatment plans, using the identical dose of 50Gy in 4 fractions, and assessed potential differences in CW dose between the 2 plans. The proton SBRT plans reduced the CW doses at all dose levels measured. The median CW V20 was 364.0cm3 and 160.0cm3 (p < 0.0001), V30 was 144.6cm3 vs 77.0cm3 (p = 0.0012), V35 was 93.9cm3 vs 57.9cm3 (p = 0.005), V40 was 66.5cm3 vs 45.4cm3 (p = 0.0112), and mean lung dose was 5.9Gy vs 3.8Gy (p = 0.0001) for photons and protons, respectively. Coverage of the planning target volume (PTV) was comparable between the 2 sets of plans (96.4% for photons and 97% for protons). From a dosimetric standpoint, proton SBRT can achieve the same coverage of the PTV while significantly reducing the dose to the CW and lung relative to photon SBRT and therefore may be beneficial for the treatment of lesions closer to critical structures.
KW - Lung cancer
KW - Normal tissue toxicity
KW - Protons
KW - Stereotactic body radiation therapy
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UR - http://www.scopus.com/inward/citedby.url?scp=84887041078&partnerID=8YFLogxK
U2 - 10.1016/j.meddos.2013.08.001
DO - 10.1016/j.meddos.2013.08.001
M3 - Article
C2 - 24200220
AN - SCOPUS:84887041078
SN - 0958-3947
VL - 38
SP - 442
EP - 447
JO - Medical Dosimetry
JF - Medical Dosimetry
IS - 4
ER -