Intensity-modulated proton therapy reduces the dose to normal tissue compared with intensity-modulated radiation therapy or passive scattering proton therapy and enables individualized radical radiotherapy for extensive stage IIIB non-small-cell lung cancer: a virtual clinical study.
Intensity-modulated proton therapy reduces the dose to normal tissue compared with intensity-modulated radiation therapy or passive scattering proton therapy and enables individualized radical radiotherapy for extensive stage IIIB non-small-cell lung cancer: a virtual clinical study.
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DOI：
10.1016/j.ijrobp.2009.04.028
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发表时间：
2010-06-01
影响因子：
7
通讯作者：
Chang, Joe Y.
中科院分区：
文献类型：
--
作者：
Zhang, Xiaodong;Li, Yupeng;Pan, Xiaoning;Li Xiaoqiang;Mohan, Radhe;Komaki, Ritsuko;Cox, James D.;Chang, Joe Y.
关键词：
比较IIIB期非小细胞肺癌（NSCLC）调强质子治疗（IMPT）、调强放射治疗（IMRT）和被动散射质子治疗（PSPT）的剂量-体积直方图（DVH），探讨个体化根治性放疗的可能性。比较了IMPT、PSPT和IMRT的DVH，IMRT设计为在广泛IIIB期NSCLC患者中提供60至63戈伊的IMRT、74戈伊的PSPT和相同剂量的IMPT以及个体化根治性放疗（每种方法N = 10）。这些患者是根据其广泛的疾病选择的，并且根据正常组织剂量-体积限制（肺V20<35%，总平均肺剂量<20戈伊;脊髓剂量<45戈伊），认为对60至63戈伊的IMRT没有耐受性或具有临界耐受性。还研究了在不超过剂量体积限制（最大耐受剂量，MTD）的情况下通过IMPT增加每位患者的总肿瘤剂量的可能性。与IMRT相比，IMPT在剂量从63戈伊增加到83.5戈伊时，对肺、心脏、脊髓和食管的保护更多，平均MTD为74戈伊。与PSPT相比，IMPT允许进一步剂量递增，从74戈伊增加到平均MTD 84.4戈伊（范围79.4-88.4戈伊），同时保持正常组织保留的所有参数较低或相似。此外，IMPT可防止肿瘤解剖结构复杂患者的靶区覆盖率降低。结论：IMPT降低了正常组织剂量，并允许广泛IIIB期NSCLC的个体化根治性放疗。
To compare dose-volume histograms (DVHs) for intensity-modulated proton therapy (IMPT) with intensity-modulated radiation therapy (IMRT) and passive scattering proton therapy (PSPT) for stage IIIB non-small cell lung cancer (NSCLC) and explore the possibility of individualized radical radiotherapy. DVHs for IMPT, PSPT, and IMRT designed to deliver IMRT at 60 to 63 Gy, PSPT at 74 Gy, and IMPT at the same doses and individualized radical radiotherapy in patients with extensive stage IIIB NSCLC (N = 10 for each approach) were compared. These patients were selected based on their extensive disease and considered to have no or borderline tolerance of IMRT at 60 to 63 Gy based on normal tissue dose-volume constraints (lung V20<35%, total mean lung dose <20 Gy; spinal cord dose, <45 Gy). The possibility of increasing the total tumor dose with IMPT for each patient without exceeding the dose-volume constraints (maximum tolerant dose, MTD) was also investigated. Compared with IMRT, IMPT spared more lung, heart, spinal cord, and esophagus even with dose escalation from 63 Gy to 83.5 Gy, with a mean MTD of 74 Gy. Compared with PSPT, IMPT allowed further dose escalation from 74 Gy to mean MTD of 84.4 Gy (range 79.4-88.4 Gy) while keeping all parameters of normal tissue sparing lower or similar. In addition, IMPT prevented lower target coverage in patients with complicated tumor anatomies. Conclusions: IMPT reduces the normal tissue dose and allows individualized radical radiotherapy for extensive stage IIIB NSCLC.
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