Cardiac-Sparing and Breast-Sparing Whole Lung Irradiation Using Intensity-Modulated Proton Therapy

Overview

Journal Int J Part Ther

Publisher Elsevier

Specialty Radiology

Date 2021 Apr 8

PMID 33829074

Citations 3

Authors

Ru Xin Wong

Jacqueline Faught

Melissa Gargone

William Myers

Matthew Krasin

Austin Faught

Sahaja Acharya

Affiliations

Soon will be listed here.

Abstract

Purpose: Whole lung irradiation (WLI) is indicated for certain pediatric patients with lung metastases. This study investigated whether WLI delivered as intensity-modulated proton therapy (IMPT) could significantly spare the heart and breasts when compared with conventional WLI delivered with anteroposterior/posteroanterior photon fields and with intensity-modulated photon therapy (IMRT) WLI.

Materials And Methods: Conventional, IMRT, and IMPT plans were generated for 5 patients (aged 5-22 years). The prescription dose was 16.5 GyRBE in 1.5-GyRBE fractions. Conventional plans used 6-MV photons prescribed to the midline and a field-in-field technique to cover the planning target volume (the internal target volume [ITV] + 1 cm). IMRT plans used 6-MV photons with a 7-beam arrangement with dose prescribed to the planning target volume. IMPT plans used scenario-based optimization with 5% range uncertainty and 5-mm positional uncertainty to cover the ITV robustly. Monte Carlo dose calculation was used for all IMPT plans. Doses were compared with paired Student test.

Results: The ITV Dmean was similar for the IMPT, conventional, and IMRT plans, but the IMPT plans had a lower Dmin and a higher Dmax at tissue interfaces than conventional plans (Dmean ratio: 0.96, > .05; Dmin ratio: 0.9, < .001; Dmax ratio: 1.1, = .014). Dmeans for breast and heart substructures were lower with IMPT plans than with conventional/IMRT plans (heart ratios, 0.63:0.73; left ventricle ratios, 0.61:0.72; right ventricle ratios, 0.45:0.57; left atrium ratios, 0.79:0.85; right atrium ratios, 0.81:0.86; left breast ratios, 0.40:0.51; right breast ratio, 0.46:0.52; all < .05).

Conclusions: IMPT resulted in comparable ITV coverage and lower mean doses to the heart and breasts when compared with other techniques. Whole lung irradiation delivered as IMPT warrants prospective evaluation in pediatric patients.

Citing Articles

Use of Virtual CT and On-Treatment MRI to Reduce Radiation Dose and Anesthesia Exposure Associated With the Adaptive Workflow in Pediatric Patients Treated With Intensity Modulated Proton Therapy.

Sheikh K, Oglesby R, Hrinivich W, Li H, Ladra M, Acharya S Adv Radiat Oncol. 2024; 9(11):101634.

PMID: 39610801 PMC: 11602994. DOI: 10.1016/j.adro.2024.101634.

Clinical Characterization of a Table Mounted Range Shifter Board for Synchrotron-Based Intensity Modulated Proton Therapy for Pediatric Craniospinal Irradiation.

Hrinivich W, Li H, Tran A, Acharya S, Ladra M, Sheikh K Cancers (Basel). 2023; 15(11).

PMID: 37296845 PMC: 10251994. DOI: 10.3390/cancers15112882.

Particle Therapy: Clinical Applications and Biological Effects.

Kiseleva V, Gordon K, Vishnyakova P, Gantsova E, Elchaninov A, Fatkhudinov T Life (Basel). 2022; 12(12).

PMID: 36556436 PMC: 9785772. DOI: 10.3390/life12122071.

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