Proton Stereotactic Body Radiation Therapy for Clinically Challenging Cases of Centrally and Superiorly Located Stage I Non-Small-Cell Lung Cancer

Journal Article · Fri Jul 15 04:00:00 EDT 2011 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2010.03.012· OSTI ID:21587601

Register, Steven P ^[1]; Xiaodong, Zhang; Mohan, Radhe ^[2]

---

1. Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States)
2. Department of Radiation Physics, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States)

Purpose: To minimize toxicity while maintaining tumor coverage with stereotactic body radiation therapy (SBRT) for centrally or superiorly located stage I non-small-cell lung cancer (NSCLC), we investigated passive-scattering proton therapy (PSPT) and intensity-modulated proton therapy (IMPT). Methods and Materials: Fifteen patients with centrally or superiorly located (within 2 cm of critical structures) stage I NSCLC were treated clinically with three-dimensional photon SBRT (50 Gy in 4 fractions). The photon SBRT plan was compared with the PSPT and IMPT plans. The maximum tolerated dose (MTD) was defined as the dose that exceeded the dose--volume constraints in the critical structures. Results: Only 6 photon plans satisfied the >95% planning target volume (PTV) coverage and MTD constraints, compared to 12 PSPT plans (p = 0.009) and 14 IMPT plans (p = 0.001). Compared with the photon SBRT plans, the PSPT and IMPT plans significantly reduced the mean total lung dose from 5.4 Gy to 3.5 Gy (p < 0.001) and 2.8 Gy (p < 0.001) and reduced the total lung volume receiving 5 Gy, 10 Gy, and 20 Gy (p < 0.001). When the PTV was within 2 cm of the critical structures, the PSPT and IMPT plans significantly reduced the mean maximal dose to the aorta, brachial plexus, heart, pulmonary vessels, and spinal cord. Conclusions: For centrally or superiorly located stage I NSCLC, proton therapy, particularly IMPT, delivered ablative doses to the target volume and significantly reduced doses to the surrounding normal tissues compared with photon SBRT.

• OSTI ID: 21587601
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 4 Vol. 80; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
AORTA
ARTERIES
BARYONS
BLOOD VESSELS
BODY
BOSONS
CARDIOVASCULAR SYSTEM
CENTRAL NERVOUS SYSTEM
DISEASES
DOSES
ELEMENTARY PARTICLES
FERMIONS
HADRONS
HEART
LUNGS
MASSLESS PARTICLES
MEDICINE
NEOPLASMS
NERVOUS SYSTEM
NUCLEAR MEDICINE
NUCLEONS
ORGANS
PHOTONS
PROTONS
RADIATION DOSES
RADIOLOGY
RADIOTHERAPY
RESPIRATORY SYSTEM
SPINAL CORD
THERAPY
TOXICITY