Proton Therapy for Malignant Pleural Mesothelioma After Extrapleural Pleuropneumonectomy

Journal Article · Fri Oct 01 00:00:00 EDT 2010 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2009.11.006· OSTI ID:21436207

Krayenbuehl, Jerome ^[1]; Hartmann, Matthias; Lomax, Anthony J ^[2]

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1. Department of Radiation Oncology, Zurich University Hospital, Zurich (Switzerland)
2. Center for Proton Radiation Therapy, Paul Scherrer Institute, Villigen (Switzerland)

Purpose: To perform comparative planning for intensity-modulated radiotherapy (IMRT) and proton therapy (PT) for malignant pleural mesothelioma after radical surgery. Methods and Materials: Eight patients treated with IMRT after extrapleural pleuropneumonectomy (EPP) were replanned for PT, comparing dose homogeneity, target volume coverage, and mean and maximal dose to organs at risk. Feasibility of PT was evaluated regarding the dose distribution with respect to air cavities after EPP. Results: Dose coverage and dose homogeneity of the planning target volume (PTV) were significantly better for PT than for IMRT regarding the volume covered by >95% (V95) for the high-dose PTV. The mean dose to the contralateral kidney, ipsilateral kidney, contralateral lung, liver, and heart and spinal cord dose were significantly reduced with PT compared with IMRT. After EPP, air cavities were common (range, 0-850 cm{sup 3}), decreasing from 0 to 18.5 cm{sup 3}/day. In 2 patients, air cavity changes during RT decreased the generalized equivalent uniform dose (gEUD) in the case of using an a value of < - 10 to the PTV2 to <2 Gy in the presence of changing cavities for PT, and to 40 Gy for IMRT. Small changes were observed for gEUD of PTV1 because PTV1 was reached by the beams before air. Conclusion: Both PT and IMRT achieved good target coverage and dose homogeneity. Proton therapy accomplished additional dose sparing of most organs at risk compared with IMRT. Proton therapy dose distributions were more susceptible to changing air cavities, emphasizing the need for adaptive RT and replanning.

• OSTI ID: 21436207
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Vol. 78, Issue 2; Other Information: DOI: 10.1016/j.ijrobp.2009.11.006; PII: S0360-3016(09)03513-5; Copyright (c) 2010 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
AIR
CAVITIES
HEART
KIDNEYS
LIVER
LUNGS
PLANNING
PROTONS
RADIATION DOSE DISTRIBUTIONS
RADIATION DOSES
RADIOTHERAPY
SPINAL CORD
BARYONS
BODY
CARDIOVASCULAR SYSTEM
CENTRAL NERVOUS SYSTEM
DIGESTIVE SYSTEM
DOSES
ELEMENTARY PARTICLES
FERMIONS
FLUIDS
GASES
GLANDS
HADRONS
MEDICINE
NERVOUS SYSTEM
NUCLEAR MEDICINE
NUCLEONS
ORGANS
RADIOLOGY
RESPIRATORY SYSTEM
THERAPY