Intensity modulated proton therapy compared to volumetric modulated arc therapy in the irradiation of young female patients with hodgkin's lymphoma. Assessment of risk of toxicity and secondary cancer induction

被引:15
作者
Scorsetti, Marta [1 ,2 ]
Cozzi, Luca [1 ,2 ]
Navarria, Pierina [1 ]
Fogliata, Antonella [1 ]
Rossi, Alexia [2 ,3 ]
Franceschini, Davide [1 ]
De Rose, Fiorenza [1 ]
Franzese, Ciro [1 ,2 ]
Carlo-Stella, Carmelo [2 ,4 ]
Santoro, Armando [2 ,4 ]
机构
[1] Humanitas Res Hosp & Canc Ctr, Radiotherapy & Radiosurg Dept, Via Manzoni 56, I-20089 Milan, Rozzano, Italy
[2] Humanitas Univ, Dept Biomed Sci, Milan, Rozzano, Italy
[3] Humanitas Res Hosp & Canc Ctr, Diagnost Imaging Dept, Milan, Rozzano, Italy
[4] Humanitas Res Hosp & Canc Ctr, Oncol & Hematol Dept, Milan, Rozzano, Italy
关键词
Intensity modulated proton therapy; VMAT; RapidArc; Lymphoma cancer; NTCP; Seconday cancer risk estimate; COMPLICATION PROBABILITY; HEART-DISEASE; CARDIAC EXPOSURE; RADIOTHERAPY; RADIATION; SURVIVORS; VALIDATION; SELECTION; MODELS;
D O I
10.1186/s13014-020-1462-2
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Background To investigate the role of intensity modulated proton therapy (IMPT) compared to volumetric modulated arc therapy (VMAT) for advanced supradiaphragmatic Hodgkin's lymphoma (HL) in young female patients by assessing dosimetric features and modelling the risk of treatment related complications and radiation-induced secondary malignancies. Methods A group of 20 cases (planned according to the involved-site approach) were retrospectively investigated in a comparative planning study. Intensity modulated proton plans (IMPT) were compared to VMAT RapidArc plans (RA). Estimates of toxicity were derived from normal tissue complication probability (NTCP) calculations with either the Lyman or the Poisson models for a number of endpoints. Estimates of the risk of secondary cancer induction were determined for lungs, breasts, esophagus and thyroid. A simple model-based selection strategy was considered as a feasibility proof for the individualized selection of patients suitable for proton therapy. Results IMPT and VMAT plans resulted equivalent in terms of target dose distributions, both were capable to ensure high coverage and homogeneity. In terms of conformality, IMPT resulted similar to 10% better than RA plans. Concerning organs at risk, IMPT data presented a systematic improvement (highly significant) over RA for all organs, particularly in the dose range up to 20Gy. This lead to a composite average reduction of NTCP of 2.90 +/- 2.24 and a reduction of 0.26 +/- 0.22 in the relative risk of cardiac failures. The excess absolute risk per 10,000 patients-years of secondary cancer induction was reduced, with IMPT, of 9.1 +/- 3.2, 7.2 +/- 3.7 for breast and lung compared to RA. The gain in EAR for thyroid and esophagus was lower than 1. Depending on the arbitrary thresholds applied, the selection rate for proton treatment would have ranged from 5 to 75%. Conclusion In relation to young female patients with advanced supradiaphragmatic HL, IMPT can in general offer improved dose-volume sparing of organs at risk leading to an anticipated lower risk of early or late treatment related toxicities. This would reflect also in significantly lower risk of secondary malignancies induction compared to advanced photon based techniques. Depending on the selection thresholds and with all the limits of a non-validated and very basic model, it can be anticipated that a significant fraction of patients might be suitable for proton treatments if all the risk factors would be accounted for.
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页数:12
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共 36 条
  • [1] AA.VV, 2010, 83 ICRU, V10
  • [2] Proton versus photon deep inspiration breath hold technique in patients with hodgkin lymphoma and mediastinal radiation A PLANNING COMPARISON OF DEEP INSPIRATION BREATH HOLD INTENSITY MODULATION RADIOTHERAPY AND INTENSITY MODULATED PROTON THERAPY
    Baues, Christian
    Marnitz, Simone
    Engert, Andreas
    Baus, Wolfgang
    Jablonska, Karolina
    Fogliata, Antonella
    Vasquez-Torres, Andres
    Scorsetti, Marta
    Cozzi, Luca
    [J]. RADIATION ONCOLOGY, 2018, 13
  • [3] Risk of Second Primary Thyroid Cancer after Radiotherapy for a Childhood Cancer in a Large Cohort Study: An Update from the Childhood Cancer Survivor Study
    Bhatti, Parveen
    Veiga, Lene H. S.
    Ronckers, Cecile M.
    Sigurdson, Alice J.
    Stovall, Marilyn
    Smith, Susan A.
    Weathers, Rita
    Leisenring, Wendy
    Mertens, Ann C.
    Hammond, Sue
    Friedman, Debra L.
    Neglia, Joseph P.
    Meadows, Anna T.
    Donaldson, Sarah S.
    Sklar, Charles A.
    Robison, Leslie L.
    Inskip, Peter D.
    [J]. RADIATION RESEARCH, 2010, 174 (06) : 741 - 752
  • [4] Toward a model-based patient selection strategy for proton therapy: External validation of photon-derived normal tissue complication probability models in a head and neck proton therapy cohort
    Blanchard, Pierre
    Wong, Andrew J.
    Gunn, G. Brandon
    Garden, Adam S.
    Mohamed, Abdallah S. R.
    Rosenthal, David I.
    Crutison, Joseph
    Wu, Richard
    Zhang, Xiaodong
    Zhu, X. Ronald
    Mohan, Radhe
    Amin, Mayankkumar V.
    Fuller, C. David
    Frank, Steven J.
    [J]. RADIOTHERAPY AND ONCOLOGY, 2016, 121 (03) : 381 - 386
  • [5] Normal tissue complication probability modeling for acute esophagitis in patients treated with conformal radiation therapy for non-small cell lung cancer
    Chapet, O
    Kong, FM
    Lee, JS
    Hayman, JA
    Ten Haken, RK
    [J]. RADIOTHERAPY AND ONCOLOGY, 2005, 77 (02) : 176 - 181
  • [6] Development and evaluation of an online three-level proton vs photon decision support prototype for head and neck cancer - Comparison of dose, toxicity and cost-effectiveness
    Cheng, Qing
    Roelofs, Erik
    Ramaekers, Bram L. T.
    Eekers, Danielle
    van Soest, Johan
    Lustberg, Tim
    Hendriks, Tim
    Hoebers, Frank
    van der Laan, Hans Paul
    Korevaar, Erik W.
    Dekker, Andre
    Langendijk, Johannes A.
    Lambin, Philippe
    [J]. RADIOTHERAPY AND ONCOLOGY, 2016, 118 (02) : 281 - 285
  • [7] Critical appraisal of the potential role of intensity modulated proton therapy in the hypofractionated treatment of advanced hepatocellular carcinoma
    Cozzi, Luca
    Comito, Tiziana
    Fogliata, Antonella
    Franzese, Ciro
    Tomatis, Stefano
    Scorsetti, Marta
    [J]. PLOS ONE, 2018, 13 (08):
  • [8] Proton therapy for adults with mediastinal lymphomas: the International Lymphoma Radiation Oncology Group guidelines
    Dabaja, Bouthaina Shbib
    Hoppe, Bradford S.
    Plastaras, John P.
    Newhauser, Wayne
    Rosolova, Katerina
    Flampouri, Stella
    Mohan, Radhe
    Mikhaeel, N. George
    Kirova, Youlia
    Specht, Lena
    Yahalom, Joachim
    [J]. BLOOD, 2018, 132 (16) : 1635 - 1646
  • [9] Risk of Ischemic Heart Disease in Women after Radiotherapy for Breast Cancer
    Darby, Sarah C.
    Ewertz, Marianne
    McGale, Paul
    Bennet, Anna M.
    Blom-Goldman, Ulla
    Bronnum, Dorthe
    Correa, Candace
    Cutter, David
    Gagliardi, Giovanna
    Gigante, Bruna
    Jensen, Maj-Britt
    Nisbet, Andrew
    Peto, Richard
    Rahimi, Kazem
    Taylor, Carolyn
    Hall, Per
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 2013, 368 (11) : 987 - 998
  • [10] Comparative treatment planning study for mediastinal Hodgkin's lymphoma: impact on normal tissue dose using deep inspiration breath hold proton and photon therapy
    Edvardsson, Anneli
    Kugele, Malin
    Alkner, Sara
    Enmark, Marika
    Nilsson, Joakim
    Kristensen, Ingrid
    Kjellen, Elisabeth
    Engelholm, Silke
    Ceberg, Sofie
    [J]. ACTA ONCOLOGICA, 2019, 58 (01) : 95 - 104