David Y Mak1, Zain Siddiqui2, Zhihui Amy Liu3, Hitesh Dama1, Shannon M MacDonald4, Shengjie Wu5, Erin S Murphy6, Matthew D Hall7, Victor Malkov1, Arzu Onar-Thomas5, Sameera Ahmed1, Girish Dhall8, Derek S Tsang1,9. 1. Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. 2. Division of Radiation Oncology, Cancer Center of Southeastern Ontario, Kingston, Ontario, Canada. 3. Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada. 4. Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA. 5. Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee, USA. 6. Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio, USA. 7. Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA. 8. Division of Hematology, Oncology and Blood & Marrow Transplantation, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama, USA. 9. Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada.
Abstract
PURPOSE: To determine if proton therapy reduces doses to cranial organs at risk (OARs) as compared to photon therapy in children with non-germinomatous germ cell tumors (NGGCT) receiving whole ventricular radiotherapy (WVRT). METHODS AND MATERIALS: Dosimetric data for patients with NGGCT prospectively enrolled in stratum 1 of the Children's Oncology Group study ACNS1123 who received 30.6 Gy WVRT were compared. Target segmentation was standardized using a contouring atlas. Doses to cranial OARs were compared between proton and photon treatments. Clinically relevant dose-volume parameters that were analyzed included mean dose and dose to 40% of the OAR volume (D40). RESULTS: Mean and D40 doses to the supratentorial brain, cerebellum, and bilateral temporal, parietal, and frontal lobes were statistically significantly lower amongst proton-treated patients, as compared to photon-treated patients. In a subgroup analysis of patients uniformly treated with a 3-mm planning target volume, patients who received proton therapy continued to have statistically significantly lower doses to brain OARs. CONCLUSIONS: Children treated with proton therapy for WVRT had lower doses to normal brain structures, when compared to those treated with photon therapy. Proton therapy should be considered for patients receiving WVRT for NGGCT.
PURPOSE: To determine if proton therapy reduces doses to cranial organs at risk (OARs) as compared to photon therapy in children with non-germinomatous germ cell tumors (NGGCT) receiving whole ventricular radiotherapy (WVRT). METHODS AND MATERIALS: Dosimetric data for patients with NGGCT prospectively enrolled in stratum 1 of the Children's Oncology Group study ACNS1123 who received 30.6 Gy WVRT were compared. Target segmentation was standardized using a contouring atlas. Doses to cranial OARs were compared between proton and photon treatments. Clinically relevant dose-volume parameters that were analyzed included mean dose and dose to 40% of the OAR volume (D40). RESULTS: Mean and D40 doses to the supratentorial brain, cerebellum, and bilateral temporal, parietal, and frontal lobes were statistically significantly lower amongst proton-treated patients, as compared to photon-treated patients. In a subgroup analysis of patients uniformly treated with a 3-mm planning target volume, patients who received proton therapy continued to have statistically significantly lower doses to brain OARs. CONCLUSIONS: Children treated with proton therapy for WVRT had lower doses to normal brain structures, when compared to those treated with photon therapy. Proton therapy should be considered for patients receiving WVRT for NGGCT.
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