Eric Dinges1, Nicole Felderman1, Sarah McGuire2, Brandie Gross1, Sudershan Bhatia2, Sarah Mott3, John Buatti2, Dongxu Wang4. 1. Department of Radiation Oncology, University of Iowa, USA. 2. Department of Radiation Oncology, University of Iowa, USA; Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, USA. 3. Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, USA. 4. Department of Radiation Oncology, University of Iowa, USA; Holden Comprehensive Cancer Center, University of Iowa Hospitals and Clinics, USA. Electronic address: dongxu-wang@uiowa.edu.
Abstract
BACKGROUND AND PURPOSE: This study evaluates the potential efficacy and robustness of functional bone marrow sparing (BMS) using intensity-modulated proton therapy (IMPT) for cervical cancer, with the goal of reducing hematologic toxicity. MATERIAL AND METHODS: IMPT plans with prescription dose of 45 Gy were generated for ten patients who have received BMS intensity-modulated X-ray therapy (IMRT). Functional bone marrow was identified by (18)F-flourothymidine positron emission tomography. IMPT plans were designed to minimize the volume of functional bone marrow receiving 5-40 Gy while maintaining similar target coverage and healthy organ sparing as IMRT. IMPT robustness was analyzed with ±3% range uncertainty errors and/or ±3 mm translational setup errors in all three principal dimensions. RESULTS: In the static scenario, the median dose volume reductions for functional bone marrow by IMPT were: 32% for V(5Gy), 47% for V(10Gy), 54% for V(20Gy), and 57% for V(40Gy), all with p<0.01 compared to IMRT. With assumed errors, even the worst-case reductions by IMPT were: 23% for V(5Gy), 37% for V(10Gy), 41% for V(20Gy), and 39% for V(40Gy), all with p<0.01. CONCLUSIONS: The potential sparing of functional bone marrow by IMPT for cervical cancer is significant and robust under realistic systematic range uncertainties and clinically relevant setup errors.
BACKGROUND AND PURPOSE: This study evaluates the potential efficacy and robustness of functional bone marrow sparing (BMS) using intensity-modulated proton therapy (IMPT) for cervical cancer, with the goal of reducing hematologic toxicity. MATERIAL AND METHODS: IMPT plans with prescription dose of 45 Gy were generated for ten patients who have received BMS intensity-modulated X-ray therapy (IMRT). Functional bone marrow was identified by (18)F-flourothymidine positron emission tomography. IMPT plans were designed to minimize the volume of functional bone marrow receiving 5-40 Gy while maintaining similar target coverage and healthy organ sparing as IMRT. IMPT robustness was analyzed with ±3% range uncertainty errors and/or ±3 mm translational setup errors in all three principal dimensions. RESULTS: In the static scenario, the median dose volume reductions for functional bone marrow by IMPT were: 32% for V(5Gy), 47% for V(10Gy), 54% for V(20Gy), and 57% for V(40Gy), all with p<0.01 compared to IMRT. With assumed errors, even the worst-case reductions by IMPT were: 23% for V(5Gy), 37% for V(10Gy), 41% for V(20Gy), and 39% for V(40Gy), all with p<0.01. CONCLUSIONS: The potential sparing of functional bone marrow by IMPT for cervical cancer is significant and robust under realistic systematic range uncertainties and clinically relevant setup errors.
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