Pei Yang1, Ting Xu2, Daniel R Gomez2, Weiye Deng3, Xiong Wei2, Hesham Elhalawani4, Hekun Jin5, Fada Guan4, Dragan Mirkovic4, Yujin Xu6, Radhe Mohan4, Zhongxing Liao7. 1. Human Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China; Department of Radiation Oncology, Division of Radiation Oncology, The Univresity of Texas MD Anderson Cancer Center, Houston, Texas. 2. Human Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China. 3. Human Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China; The University of Texas School of Public Health at Houston, Houston, Texas. 4. Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas. 5. Department of Radiation Oncology, Division of Radiation Oncology, The Univresity of Texas MD Anderson Cancer Center, Houston, Texas. 6. Human Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China; Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China. 7. Human Key Laboratory of Translational Radiation Oncology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China. Electronic address: zliao@mdanderson.org.
Abstract
PURPOSE: We compared differences in patterns of locoregional failure, and the influence of adaptive planning on those patterns, in patients who received passive scattering proton therapy (PSPT) versus intensity modulated photon therapy (IMRT) for non-small cell lung cancer. METHODS AND MATERIALS: Treatment simulation computed tomography scans and dose distributions were registered with images depicting the recurrence. Local failure (LF) was defined as failure within the internal target volume (ITV); marginal failure (MF) as failure between the ITV and planning target volume (PTV) plus a 10-mm margin (PTV+10mm); and regional failure (RF) as outside the PTV+10mm. Weekly during-treatment 4-dimensional computed tomography simulation and verification plans were obtained for all patients. Adaptive plans were developed if the verification plan showed deviations in protocol-specified dose distribution, and failure locations were recorded for those patients as well. RESULTS: Of the 212 patients analyzed, most (152 [72%]) had no failure; of the 60 patients with failure, 27 (45%) had LF (within the ITV), 23 (38%) had MF (between the ITV and PTV+10mm), and 10 (17%) had RF (>10 mm outside the PTV). MF rates were no different for IMRT patients (16 of 136 [12%]) or PSPT patients (7 of 76 [9%], log-rank P = .558). The only independent predictor of MF on Cox proportional hazards analysis was T3-4 status. Large tumors and use of PSPT independently predicted the need for adaptive planning. Although 5-year overall survival rates were poorer for patients with large tumors versus small tumors (P < .001), the rates were similar for patients with large tumors who received adaptive planning versus small tumors. CONCLUSIONS: No differences in LF, MF, or RF patterns were found for IMRT versus PSPT. Proton therapy more often required adaptive planning, and the techniques used for adaptive planning did not compromise tumor control. Response to chemoradiation by larger tumors predicted favorable survival.
PURPOSE: We compared differences in patterns of locoregional failure, and the influence of adaptive planning on those patterns, in patients who received passive scattering proton therapy (PSPT) versus intensity modulated photon therapy (IMRT) for non-small cell lung cancer. METHODS AND MATERIALS: Treatment simulation computed tomography scans and dose distributions were registered with images depicting the recurrence. Local failure (LF) was defined as failure within the internal target volume (ITV); marginal failure (MF) as failure between the ITV and planning target volume (PTV) plus a 10-mm margin (PTV+10mm); and regional failure (RF) as outside the PTV+10mm. Weekly during-treatment 4-dimensional computed tomography simulation and verification plans were obtained for all patients. Adaptive plans were developed if the verification plan showed deviations in protocol-specified dose distribution, and failure locations were recorded for those patients as well. RESULTS: Of the 212 patients analyzed, most (152 [72%]) had no failure; of the 60 patients with failure, 27 (45%) had LF (within the ITV), 23 (38%) had MF (between the ITV and PTV+10mm), and 10 (17%) had RF (>10 mm outside the PTV). MF rates were no different for IMRT patients (16 of 136 [12%]) or PSPT patients (7 of 76 [9%], log-rank P = .558). The only independent predictor of MF on Cox proportional hazards analysis was T3-4 status. Large tumors and use of PSPT independently predicted the need for adaptive planning. Although 5-year overall survival rates were poorer for patients with large tumors versus small tumors (P < .001), the rates were similar for patients with large tumors who received adaptive planning versus small tumors. CONCLUSIONS: No differences in LF, MF, or RF patterns were found for IMRT versus PSPT. Proton therapy more often required adaptive planning, and the techniques used for adaptive planning did not compromise tumor control. Response to chemoradiation by larger tumors predicted favorable survival.
Authors: Nathan Y Yu; Todd A DeWees; Chenbin Liu; Thomas B Daniels; Jonathan B Ashman; Staci E Beamer; Dawn E Jaroszewski; Helen J Ross; Harshita R Paripati; Jean-Claude M Rwigema; Julia X Ding; Jie Shan; Wei Liu; Steven E Schild; Terence T Sio Journal: Adv Radiat Oncol Date: 2019-08-21
Authors: Maria E Goossens; Marc Van den Bulcke; Thierry Gevaert; Lydie Meheus; Dirk Verellen; Jean-Marc Cosset; Guy Storme Journal: Ecancermedicalscience Date: 2019-12-09
Authors: Harald Paganetti; Chris Beltran; Stefan Both; Lei Dong; Jacob Flanz; Keith Furutani; Clemens Grassberger; David R Grosshans; Antje-Christin Knopf; Johannes A Langendijk; Hakan Nystrom; Katia Parodi; Bas W Raaymakers; Christian Richter; Gabriel O Sawakuchi; Marco Schippers; Simona F Shaitelman; B K Kevin Teo; Jan Unkelbach; Patrick Wohlfahrt; Tony Lomax Journal: Phys Med Biol Date: 2021-02-26 Impact factor: 4.174