Assessing the robustness of passive scattering proton therapy with regard to local recurrence in stage III non-small cell lung cancer: a secondary analysis of a phase II trial

Radiation Oncology

Joe Y Chang²  Radhe Mohan¹  James D Cox²  Ritsuko Komaki²  Daniel R Gomez²  Michael Gillin¹  Wei Liu¹  Zhengfei Zhu³ 

[1] Departments of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA;Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA;Current address: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China

关键词: Worst-case scenario method;    Robustness analysis;    Passive scattering proton therapy;    Proton therapy;    Non-small cell lung cancer;   

Others  :  805309
DOI  :  10.1186/1748-717X-9-108

 received in 2014-02-10, accepted in 2014-04-05,  发布年份 2014

【 摘 要 】

Background

We assessed the robustness of passive scattering proton therapy (PSPT) plans for patients in a phase II trial of PSPT for stage III non-small cell lung cancer (NSCLC) by using the worst-case scenario method, and compared the worst-case dose distributions with the appearance of locally recurrent lesions.

Methods

Worst-case dose distributions were generated for each of 9 patients who experienced recurrence after concurrent chemotherapy and PSPT to 74 Gy(RBE) for stage III NSCLC by simulating and incorporating uncertainties associated with set-up, respiration-induced organ motion, and proton range in the planning process. The worst-case CT scans were then fused with the positron emission tomography (PET) scans to locate the recurrence.

Results

Although the volumes enclosed by the prescription isodose lines in the worst-case dose distributions were consistently smaller than enclosed volumes in the nominal plans, the target dose coverage was not significantly affected: only one patient had a recurrence outside the prescription isodose lines in the worst-case plan.

Conclusions

PSPT is a relatively robust technique. Local recurrence was not associated with target underdosage resulting from estimated uncertainties in 8 of 9 cases.

【 授权许可】

   
2014 Zhu et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]Jassem J: The role of radiotherapy in lung cancer: where is the evidence? Radiother Oncol 2007, 83:203-213.
• [2]Aupérin A, Le Péchoux C, Rolland E, Curran WJ, Furuse K, Fournel P, Belderbos J, Clamon G, Ulutin HC, Paulus R, Yamanaka T, Bozonnat MC, Uitterhoeve A, Wang X, Stewart L, Arriagada R, Burdett S, Pignon JP: Meta-analysis of concomitant versus sequential radiochemotherapy in locally advanced non-small-cell lung cancer. J Clin Oncol 2010, 28:2181-2190.
• [3]Chang JY, Zhang X, Wang X, Kang Y, Riley B, Bilton S, Mohan R, Komaki R, Cox JD: Significant reduction of normal tissue dose by proton radiotherapy compared with three-dimensional conformal or intensity-modulated radiation therapy in stage I or stage III non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2006, 65:1087-1096.
• [4]Zhang X, Li Y, Pan X, Xiaoqiang L, Mohan R, Komaki R, Cox JD, Chang JY: Intensity-modulated proton therapy reduces the dose to normal tissue compared with intensity-modulated radiation therapy or passive scattering proton therapy and enables individualized radical radiotherapy for extensive stage IIIB non-small cell lung cancer: a virtual clinical study. Int J Radiat Oncol Biol Phys 2010, 77:357-366.
• [5]Chang JY, Komaki R, Lu C, Wen HY, Allen PK, Tsao A, Gillin M, Mohan R, Cox JD: Phase 2 study of high-dose proton therapy with concurrent chemotherapy for unresectable stage III nonsmall cell lung cancer. Cancer 2011, 117:4007-4013.
• [6]Lomax AJ, Pedroni E, Rutz H, Goitein G: The clinical potential of intensity modulated proton therapy. Z Med Phys 2004, 14:147-152.
• [7]Liu W, Zhang X, Li Y, Mohan R: Robust optimization of intensity modulated proton therapy. Med Phys 2012, 39:1079-1091.
• [8]Liu W, Li Y, Li X, Cao W, Zhang X: Influence of robust optimization in intensity-modulated proton therapy with different dose delivery techniques. Med Phys 2012, 39:3089-3101.
• [9]Stuschke M, Kaiser A, Pöttgen C, Lübcke W, Farr J: Potentials of robust intensity modulated scanning proton plans for locally advanced lung cancer in comparison to intensity modulated photon plans. Radiother Oncol 2012, 104:45-51.
• [10]Unkelbach J, Bortfeld T, Martin BC, Soukup M: Reducing the sensitivity of IMPT treatment plans to setup errors and range uncertainties via probabilistic treatment planning. Med Phys 2009, 36:149-163.
• [11]Fredriksson A, Forsgren A, Hårdemark B: Minimax optimization for handling range and setup uncertainties in proton therapy. Med Phys 2011, 38:1672-1684.
• [12]Casiraghi M, Albertini F, Lomax AJ: Advantages and limitations of the ‘worst case scenario’ approach in IMPT treatment planning. Phys Med Biol 2013, 58:1323-1339.
• [13]Hui Z, Zhang X, Starkschall G, Li Y, Mohan R, Komaki R, Cox JD, Chang JY: Effects of interfractional motion and anatomic changes on proton therapy dose distribution in lung cancer. Int J Radiat Oncol Biol Phys 2008, 72:1385-1395.
• [14]Koay EJ, Lege D, Mohan R, Komaki R, Cox JD, Chang JY: Adaptive/nonadaptive proton radiation planning and outcomes in a phase II trial for locally advanced non-small cell lung cancer. Int J Radiat Oncol Biol Phys 2012, 84:1093-1100.
• [15]Wang H, Dong L, O'Daniel J, Mohan R, Garden AS, Ang KK, Kuban DA, Bonnen M, Chang JY, Cheung R: Validation of an accelerated 'demons' algorithm for deformable image registration in radiation therapy. Phys Med Biol 2005, 50:2887-2905.
• [16]Li Y, Liu W, Li X, Quan E, Zhang X: Toward a thorough evaluation of IMPT plan sensitivity to uncertainties: revisit the worst-case analysis with an exhaustively sampling approach. Med Phys 2011, 38:3853.
• [17]Kang Y, Zhang X, Chang JY, Wang H, Wei X, Liao Z, Komaki R, Cox JD, Balter PA, Liu H, Zhu XR, Mohan R, Dong L: 4D proton treatment planning strategy for mobile lung tumors. Int J Radiat Oncol Biol Phys 2007, 67:906-914.
• [18]Nguyen GH, Murph MM, Chang JY: Cancer stem cell radioresistance and enrichment: where frontline radiation therapy may fail in lung and esophageal cancers. Cancers (Basel) 2011, 3:1232-1252.
• [19]Gomez DR, Gillin M, Liao Z, Wei C, Lin SH, Swanick C, Alvarado T, Komaki R, Cox JD, Chang JY: Phase I study of dose escalation in hypofractionated proton beam therapy for non-small cell lung cancer. Int J Radiat Oncol Biol Phys 2013, 86:665-670.