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Adjuvant Intensity-modulated Proton Therapy In Malignant Pleural Mesothelioma

S. Lorentini, M. Amichetti, L. Spiazzi, S. Tonoli, S. Magrini, F. Fellin, M. Schwarz
Published 2011 · Medicine

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PurposeIntensity-modulated radiation therapy (IMRT) is the state-of-the-art treatment for patients with malignant pleural mesothelioma (MPM). The goal of this work was to assess whether intensity-modulated proton therapy (IMPT) could further improve the dosimetric results allowed by IMRT.Patients and methodsWe re-planned 7 MPM cases using both photons and protons, by carrying out IMRT and IMPT plans. For both techniques, conventional dose comparisons and normal tissue complication probability (NTCP) analysis were performed. In 3 cases, additional IMPT plans were generated with different beam dimensions.ResultsIMPT allowed a slight improvement in target coverage and clear advantages in dose conformity (p < 0.001) and dose homogeneity (p = 0.01). Better organ at risk (OAR) sparing was obtained with IMPT, in particular for the liver (Dmean reduction of 9.5 Gy, p = 0.001) and ipsilateral kidney (V20 reduction of 58%, p = 0.001), together with a very large reduction of mean dose for the contralateral lung (0.2 Gy vs 6.1 Gy, p = 0.0001). NTCP values for the liver showed a systematic superiority of IMPT with respect to IMRT for both the esophagus (average NTCP 14% vs. 30.5%) and the ipsilateral kidney (p = 0.001). Concerning plans obtained with different spot dimensions, a slight loss of target coverage was observed along with sigma increase, while maintaining OAR irradiation always under planning constraints.ConclusionResults suggest that IMPT allows better OAR sparing with respect to IMRT, mainly for the liver, ipsilateral kidney, and contralateral lung. The use of a spot dimension larger than 3 × 3 mm (up to 9 × 9 mm) does not compromise dosimetric results and allows a shorter delivery time.ZusammenfassungZielDie intensitätsmodulierte Strahlentherapie (IMRT) erhöht die therapeutische Dosis auf die Pleurahöhle und reduziert die Dosis auf die Risikoorgane (OAR) bei Patienten mit malignem Pleuramesotheliom (MPM). Ziel dieser Arbeit ist zu prüfen, ob Protonen, als intensitätsmodulierte Protonentherapie (IMPT) angewendet, die dosimetrischen Ergebnisse im Vergleich zu einer IMRT weiter verbessern können.Patienten und MethodenWir haben für 7 MPM-Fälle jeweils mit Photonen und Protonen, unter Verwendung von IMRT und IMPT, Bestrahlungspläne wiedererstellt. Für beide Verfahren haben wir eine Analyse der Normalgewebskomplikationen (NTCP) durchgeführt. In 3 Fällen wurden zusätzliche IMPT-Pläne mit geänderter Fokusgröße erstellt.ErgebnisseDie IMPT erlaubt eine leichte Verbesserung der Zielvolumenabdeckung und klare Vorteile in der Konformität (p < 0,001) sowie in der Homogenität (p = 0,01). Durch IMPT wurde eine bessere Schonung der OAR erreicht, im Einzelnen für die Leber mit einer Reduktion der Dmean auf 9,5 Gy, (p = 0,001), für die ipsilaterale Niere (58%-Reduktion von V20; p = 0,001) sowie eine starke Reduktion der mittleren Dosis der kontralateralen Lunge (0,2 Gy vs. 6,1 Gy; p = 0,0001). NTCP-Werte für die Leber zeigten eine systematische Überlegenheit der IMPT gegenüber der IMRT, Ähnliches für die Speiseröhre (Durchschnitts-NTCP 14% vs. 30,5%) und die ipsilaterale Niere (p = 0,001). Bezüglich der Pläne mit anderer Fokusgröße zeigt sich ein leichter Verlust der Zielvolumenabdeckung zusammen mit einer Sigma-Erhöhung. Die vorgegebenen Dosisbegrenzungen für die Risikoorgane wurden immer eingehalten.SchlussfolgerungenDie Ergebnisse zeigen, dass IMPT eine bessere Schonung der OAR ermöglicht, vor allem für Leber, ipsilaterale Niere und kontralaterale Lunge. Die Verwendung von Fokusgrößen größer als 3 × 3 mm (bis 9 × 9 mm) gefährdet nicht die dosimetrischen Ergebnisse und ermöglicht eine kürzere Bestrahlungszeit.
This paper references
Radiation dose-volume effects in the lung.
L. Marks (2010)
Helical tomotherapy . Experiences of the first 150 patients in Heidelberg
F Sterzing (2008)
Definition of the CTV Prostate in CT and MRI by Using CT–MRI Image Fusion in IMRT Planning for Prostate Cancer
B. Hentschel (2010)
Malignant mesothelioma: a clinical study of 238 cases.
Steven E. Haber (2011)
reotactic intensity - modulated radiation therapy ( IMRT ) and inverse treatment planning for advanced pleural mesothelioma . Feasibility and initial results
M Pinkawa (2011)
Excellent Local Control and Survival After Extrapleural Pneumonectomy and IMRT for Mesothelioma
C. Stevens (2005)
A review of human carcinogens--Part C: metals, arsenic, dusts, and fibres.
K. Straif (2009)
Trimodality Treatment of Malignant Pleural Mesothelioma
H. Batırel (2008)
F. Dessy (2011)
Thymic small cell carcinoma shows marked response to amrubicin.
S. Igawa (2009)
Trimodality therapy for malignant pleural mesothelioma.
G. Buduhan (2009)
In - tensity - modulated radiation therapy : a novel approach to the management of malignant pleural mesothelioma
WR Smythe (2003)
Stereotactic Intensity-Modulated Radiation Therapy (IMRT) and Inverse Treatment Planning for Advanced Pleural Mesothelioma
M. Muenter (2003)
Intensity-modulated radiotherapy following extrapleural pneumonectomy for the treatment of malignant mesothelioma: clinical implementation.
K. Forster (2003)
Intensity-modulated radiation therapy: a novel approach to the management of malignant pleural mesothelioma.
A. Ahamad (2003)
Patterns of failure after trimodality therapy for malignant pleural mesothelioma.
E. Baldini (1997)
Assessing a set of optimal user interface parameters for intensity‐modulated proton therapy planning
M. Hillbrand (2010)
Combined photon and electron three-dimensional conformal versus intensity-modulated radiotherapy with integrated boost for adjuvant treatment of malignant pleural mesothelioma after pleuropneumonectomy.
J. Krayenbuehl (2007)
A pencil beam algorithm for intensity modulated proton therapy derived from Monte Carlo simulations.
M. Soukup (2005)
Treatment of malignant pleural mesothelioma: current status and future directions.
X. Dhalluin (2010)
Expert Opinions of the First Italian Consensus Conference on the Management of Malignant Pleural Mesothelioma
C. Pinto (2011)
Restricted field IMRT dramatically enhances IMRT planning for mesothelioma.
A. Allen (2007)
Volumetric modulation arc radiotherapy compared with static gantry intensity-modulated radiotherapy for malignant pleural mesothelioma tumor: a feasibility study.
M. Scorsetti (2010)
Adjuvant radiotherapy after extrapleural pneumonectomy for mesothelioma. Prospective analysis of a multi-institutional series.
S. Tonoli (2011)
Combi - nation of dose escalation with technological advances ( intensity - modulated and image - guided radiotherapy ) is not associated with increased morbidity for patients with prostate cancer
C Pinto
Dose-dependent pulmonary toxicity after postoperative intensity-modulated radiotherapy for malignant pleural mesothelioma.
D. Rice (2007)
Analysis of radiation-induced liver disease using the Lyman NTCP model.
L. Dawson (2002)
Prediction of radiation-induced liver disease by Lyman normal-tissue complication probability model in three-dimensional conformal radiation therapy for primary liver carcinoma.
Z. Xu (2006)
New Approach for Treatment of Vertebral Metastases Using Intensity-Modulated Radiotherapy*
Toshihiko Inoue (2010)
Non-occupational exposure to asbestos and malignant mesothelioma in the Italian National Registry of Mesotheliomas
D. Mirabelli (2010)
Radiation DoseVolume Effects in the Lung
L. Marks (2010)
Fatal pneumonitis associated with intensity-modulated radiation therapy for mesothelioma.
A. Allen (2006)
A finite size pencil beam algorithm for IMRT dose optimization: density corrections.
U. Jelen (2007)
Outcomes after extrapleural pneumonectomy and intensity-modulated radiation therapy for malignant pleural mesothelioma.
D. Rice (2007)
Influence of radiotherapy technique and dose on patterns of failure for mesothelioma patients after extrapleural pneumonectomy.
A. Allen (2007)
Proton therapy for malignant pleural mesothelioma after extrapleural pleuropneumonectomy.
J. Krayenbuehl (2010)
Combination of Dose Escalation with Technological Advances (Intensity-Modulated and Image-Guided Radiotherapy) Is Not Associated with Increased Morbidity for Patients with Prostate Cancer
M. Pinkawa (2011)
Reirradiation of Spinal Column Metastases
F. Stieler (2011)
Intensity modulation methods for proton radiotherapy.
A. Lomax (1999)
A phase II trial of surgical resection and adjuvant high-dose hemithoracic radiation for malignant pleural mesothelioma.
V. Rusch (2001)
Acute esophageal toxicity in non-small cell lung cancer patients after high dose conformal radiotherapy.
J. Belderbos (2005)
Tolerance of normal tissue to therapeutic irradiation.
B. Emami (1991)
Malignant pleural mesothelioma
H. Kindler (2000)
Pulmonary toxicity following IMRT after extrapleural pneumonectomy for malignant pleural mesothelioma.
C. Kristensen (2009)
A phase II study of intrapleural immuno-chemotherapy, pleurectomy/decortication, radiotherapy, systemic chemotherapy and long-term sub-cutaneous IL-2 in stage II-III malignant pleural mesothelioma.
M. Lucchi (2007)
Intensity-modulated radiotherapy for resected mesothelioma: the Duke experience.
E. Miles (2008)
Evaluating target coverage and normal tissue sparing in the adjuvant radiotherapy of malignant pleural mesothelioma: helical tomotherapy compared with step-and-shoot IMRT.
F. Sterzing (2008)
Hyperion — An integrated IMRT planning tool
M. Alber (2000)

This paper is referenced by
Proton Therapy in Practice: Clinical Indications-Thoracic Cancers
Long-term survival after treatment of glioblastoma multiforme with hyperfractionated concomitant boost proton beam therapy.
M. Mizumoto (2015)
Clinical results of proton beam therapy for advanced neuroblastoma
Y. Oshiro (2013)
Metastasis inhibition after proton beam, β- and γ-irradiation of melanoma growing in the hamster eye.
B. Romanowska-Dixon (2013)
Can treatment of pediatric Hodgkin’s lymphoma be improved by PET imaging and proton therapy?
B. Knaeusl (2012)
[Current situation and perspectives of proton therapy].
J. Doyen (2015)
Optimizing hemithoracic pleural intensity-modulated radiation therapy for malignant pleural mesothelioma
F. Shaikh (2015)
Intensity-Modulated Radiation Therapy Improves the Target Coverage Over 3-D Planning While Meeting Lung Tolerance Doses for All Patients With Malignant Pleural Mesothelioma
S. Ulger (2017)
Cardiotoxicity of mediastinal radiotherapy.
I. Ratosa (2019)
Proton beams in cancer treatments: Clinical outcomes and dosimetric comparisons with photon therapy.
J. Doyen (2016)
État des lieux et perspectives de la protonthérapie
J. Doyen (2015)
Role of Radiotherapy in Malignant Pleural Mesothelioma
M. Scorsetti (2019)
A Novel Prospective Study Assessing the Combination of Photodynamic Therapy and Proton Radiation Therapy: Safety and Outcomes When Treating Malignant Pleural Mesothelioma
S. Rice (2019)
Reirradiation for recurrent malignant brain tumor with radiotherapy or proton beam therapy
M. Mizumoto (2013)
Proton beam therapy for malignancy in Bloom syndrome
M. Mizumoto (2012)
Consensus Statement on Proton Therapy in Mesothelioma.
J. Zeng (2020)
Role of new radiation techniques in the treatment of pleural mesothelioma
M. Amichetti (2013)
Novel radiation therapy approaches in malignant pleural mesothelioma.
A. Rimner (2012)
Utilization of Intensity‐Modulated Radiation Therapy for Malignant Pleural Mesothelioma in the United States
S. Shaaban (2018)
Proton beam therapy for malignant pleural mesothelioma.
S. Badiyan (2018)
Proton Therapy for Malignant Pleural Mesothelioma: A Three Case Series Describing the Clinical and Dosimetric Advantages of Proton-Based Therapy
H. Lee (2017)
Modern Radiotherapy Techniques in Malignant Pleural Mesothelioma
G. Ozyigit (2016)
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