Which technique for radiation is most beneficial for patients with locally advanced cervical cancer? Intensity modulated proton therapy versus intensity modulated photon treatment, helical tomotherapy and volumetric arc therapy for primary radiation – an intraindividual comparison

Radiation Oncology

Luca Cozzi¹  Volker Budach³  Mirko Weihrauch³  Christhardt Koehler²  Oliver Neumann³  Waldemar Wlodarczyk³  Simone Marnitz³ 

[1] Radiosurgery and Radiotherapy Department, Istituto Clinico Humanitas Cancer Center and Reaserch Hospital, Rozzano, 20100, Italy;Department of Gynecology, Charité University Medicine, Berlin, Germany;Department of Radiation Oncology, Charité University Hospital, Berlin, Germany

关键词: Proton therapy;    VMAT;    Intensity-modulated radiotherapy;    Cervical cancer;   

Others  :  1177385
DOI  :  10.1186/s13014-015-0402-z

 received in 2015-01-09, accepted in 2015-04-08,  发布年份 2015

【 摘 要 】

Background

To compare highly sophisticated intensity-modulated radiotherapy (IMRT) delivered by either helical tomotherapy (HT), RapidArc (RA), IMRT with protons (IMPT) in patients with locally advanced cervical cancer.

Methods and materials

Twenty cervical cancer patients were irradiated using either conventional IMRT, VMAT or HT; ten received pelvic (PEL) and ten extended field irradiation (EFRT). The dose to the planning-target volume A (PTV_A: cervix, uterus, pelvic ± para-aortic lymph nodes) was 1.8/50.4 Gy. The SIB dose for the parametrium (PTV_B), was 2.12/59.36 Gy. MRI-guided brachytherapy was administered with 5 fractions up to 25 Gy. For EBRT, the lower target constraints were 95% of the prescribed dose in 95% of the target volume. The irradiated small bowel (SB) volumes were kept as low as possible. For every patient, target parameters as well as doses to the organs at risk (SB, bladder, rectum) were evaluated intra-individually for IMRT, HT, VMAT and IMPT.

Results

All techniques provided excellent target volume coverage, homogeneity, conformity. With IMPT, there was a significant reduction of the mean dose (D_mean) of the SB from 30.2 ± 4.0 Gy (IMRT); 27.6 ± 5.6 Gy (HT); 34.1 ± 7.0 (RA) to 18.6 ± 5.9 Gy (IMPT) for pelvic radiation and 26.3 ± 3.2 Gy (IMRT); 24.0 ± 4.1 (HT); 25.3 ± 3.7 (RA) to 13.8 ± 2.8 Gy (IMPT) for patients with EFRT, which corresponds to a reduction of 38-52% for the D_mean (SB). Futhermore, the low dose bath (V_10Gy) to the small bowel was reduced by 50% with IMPT in comparison to all photon techniques. Furthermore, D_mean to the bladder and rectum was decresed by 7-9 Gy with IMPT in patents with pelvic radiation and EFRT.

Conclusion

All modern techniques (were proved to be dosimetrically adequate regarding coverage, conformity and homogeneity of the target. Protons offered the best sparing of small bowel and rectum and therefore could contribute to a significant reduction of acute and late toxicity in cervical cancer treatment.

【 授权许可】

   
2015 Marnitz et al.; licensee BioMed Central.

【 图 表 】

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