Comparing Ultra-hypofractionated Proton versus Photon Therapy in Extremity Soft Tissue Sarcoma
Purpose: Recent single institution, phase II evidence has demonstrated the feasibility and efficacy of ultra-hypofractionated, preoperative photon therapy in 5 fractions for the treatment of soft tissue sarcoma (STS). Our purpose was to evaluate the dosimetric benefits of modern scanning beam proton...
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| Format: | Article |
| Language: | English |
| Published: |
Particle Therapy Co-operative Group
2023-01-01
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| Series: | International Journal of Particle Therapy |
| Subjects: | |
| Online Access: | https://theijpt.org/doi/pdf/10.14338/IJPT-22-00022.1 |
| _version_ | 1797204384435666944 |
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| author | Rehema Thomas, MD Hao Chen, PhD Emile Gogineni, DO Aditya Halthore, MD Bethlehem Floreza, BS, RT(T), CMD Temiloluwa Esho-Voltaire, BS, CMD Arcelia Weaver, RT(T), CMD Sara Alcorn, MD, PhD, MPH Matthew Ladra, MD, MPH Heng Li, PhD Curtiland Deville Jr, MD |
| author_facet | Rehema Thomas, MD Hao Chen, PhD Emile Gogineni, DO Aditya Halthore, MD Bethlehem Floreza, BS, RT(T), CMD Temiloluwa Esho-Voltaire, BS, CMD Arcelia Weaver, RT(T), CMD Sara Alcorn, MD, PhD, MPH Matthew Ladra, MD, MPH Heng Li, PhD Curtiland Deville Jr, MD |
| author_sort | Rehema Thomas, MD |
| collection | DOAJ |
| description | Purpose: Recent single institution, phase II evidence has demonstrated the feasibility and efficacy of ultra-hypofractionated, preoperative photon therapy in 5 fractions for the treatment of soft tissue sarcoma (STS). Our purpose was to evaluate the dosimetric benefits of modern scanning beam proton therapy compared with conventional photon radiation therapy (RT) for the neoadjuvant treatment of adult extremity STS.
Materials and Methods: Existing proton and photon plans for 11 adult patients with STS of the lower extremities previously treated preoperatively with neoadjuvant RT at our center were used to create proton therapy plans using Raystation Treatment Planning System v10.A. Volumes were delineated, and doses reported consistent with International Commission on Radiation Units and Measurements reports 50, 62, and 78. Target volumes were optimized such that 100% clinical target volume (CTV) was covered by 99% of the prescription dose. The prescribed dose was 30 Gy for PT and RT delivered in 5 fractions. For proton therapy, doses are reported in GyRBE = 1.1 Gy. The constraints for adjacent organs at risk (OARs) within 1 cm of the CTV were the following: femur V30Gy ≤ 50%, joint V30Gy < 50%, femoral head V30Gy ≤ 5cm3,stripV12 ≤ 10%, and skin V12 < 50%. Target coverage goals, OAR constraints, and integral dose were compared by Student t test with P < .05 significance.
Results: A minimum 99% CTV coverage was achieved for all plans. OAR dose constraints were achieved for all proton and photon plans; however, mean doses to the femur (10.7 ± 8.5 vs 16.1 ± 7.7 GyRBE), femoral head (2.0 ± 4.4 vs 3.6 ± 6.4 GyRBE), and proximal joint (1.8 ± 2.4 vs 3.5 ± 4.4 GyRBE) were all significantly lower with PT vs intensity-modulated radiation therapy (IMRT) (all P < .05). Integral dose was significantly reduced for proton vs photon plans. Conformity and heterogeneity indices were significantly better for proton therapy.
Conclusion: Proton therapy maintained target coverage while significantly reducing integral and mean doses to the proximal organs at risk compared with RT. Further prospective investigation is warranted to validate these findings and potential benefit in the management of adult STS. |
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| format | Article |
| id | doaj.art-481b42594dc547ae98f087abcb0062bb |
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| language | English |
| last_indexed | 2024-04-24T08:34:22Z |
| publishDate | 2023-01-01 |
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| series | International Journal of Particle Therapy |
| spelling | doaj.art-481b42594dc547ae98f087abcb0062bb2024-04-16T17:39:45ZengParticle Therapy Co-operative GroupInternational Journal of Particle Therapy2331-51802023-01-01303910.14338/IJPT-22-00022.1i2331-5180-9-3-30Comparing Ultra-hypofractionated Proton versus Photon Therapy in Extremity Soft Tissue SarcomaRehema Thomas, MD0Hao Chen, PhD1Emile Gogineni, DO2Aditya Halthore, MD3Bethlehem Floreza, BS, RT(T), CMD4Temiloluwa Esho-Voltaire, BS, CMD5Arcelia Weaver, RT(T), CMD6Sara Alcorn, MD, PhD, MPH7Matthew Ladra, MD, MPH8Heng Li, PhD9Curtiland Deville Jr, MD101 Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA2 Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA2 Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA2 Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA2 Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA2 Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA2 Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA3 Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, MN, USA2 Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA2 Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA2 Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USAPurpose: Recent single institution, phase II evidence has demonstrated the feasibility and efficacy of ultra-hypofractionated, preoperative photon therapy in 5 fractions for the treatment of soft tissue sarcoma (STS). Our purpose was to evaluate the dosimetric benefits of modern scanning beam proton therapy compared with conventional photon radiation therapy (RT) for the neoadjuvant treatment of adult extremity STS. Materials and Methods: Existing proton and photon plans for 11 adult patients with STS of the lower extremities previously treated preoperatively with neoadjuvant RT at our center were used to create proton therapy plans using Raystation Treatment Planning System v10.A. Volumes were delineated, and doses reported consistent with International Commission on Radiation Units and Measurements reports 50, 62, and 78. Target volumes were optimized such that 100% clinical target volume (CTV) was covered by 99% of the prescription dose. The prescribed dose was 30 Gy for PT and RT delivered in 5 fractions. For proton therapy, doses are reported in GyRBE = 1.1 Gy. The constraints for adjacent organs at risk (OARs) within 1 cm of the CTV were the following: femur V30Gy ≤ 50%, joint V30Gy < 50%, femoral head V30Gy ≤ 5cm3,stripV12 ≤ 10%, and skin V12 < 50%. Target coverage goals, OAR constraints, and integral dose were compared by Student t test with P < .05 significance. Results: A minimum 99% CTV coverage was achieved for all plans. OAR dose constraints were achieved for all proton and photon plans; however, mean doses to the femur (10.7 ± 8.5 vs 16.1 ± 7.7 GyRBE), femoral head (2.0 ± 4.4 vs 3.6 ± 6.4 GyRBE), and proximal joint (1.8 ± 2.4 vs 3.5 ± 4.4 GyRBE) were all significantly lower with PT vs intensity-modulated radiation therapy (IMRT) (all P < .05). Integral dose was significantly reduced for proton vs photon plans. Conformity and heterogeneity indices were significantly better for proton therapy. Conclusion: Proton therapy maintained target coverage while significantly reducing integral and mean doses to the proximal organs at risk compared with RT. Further prospective investigation is warranted to validate these findings and potential benefit in the management of adult STS.https://theijpt.org/doi/pdf/10.14338/IJPT-22-00022.1soft tissue sarcomaproton therapyhypofractionationultra-hypofractionationstereotactic body radiation therapystereotactic body proton therapypreoperative radiationneoadjuvant radiation |
| spellingShingle | Rehema Thomas, MD Hao Chen, PhD Emile Gogineni, DO Aditya Halthore, MD Bethlehem Floreza, BS, RT(T), CMD Temiloluwa Esho-Voltaire, BS, CMD Arcelia Weaver, RT(T), CMD Sara Alcorn, MD, PhD, MPH Matthew Ladra, MD, MPH Heng Li, PhD Curtiland Deville Jr, MD Comparing Ultra-hypofractionated Proton versus Photon Therapy in Extremity Soft Tissue Sarcoma International Journal of Particle Therapy soft tissue sarcoma proton therapy hypofractionation ultra-hypofractionation stereotactic body radiation therapy stereotactic body proton therapy preoperative radiation neoadjuvant radiation |
| title | Comparing Ultra-hypofractionated Proton versus Photon Therapy in Extremity Soft Tissue Sarcoma |
| title_full | Comparing Ultra-hypofractionated Proton versus Photon Therapy in Extremity Soft Tissue Sarcoma |
| title_fullStr | Comparing Ultra-hypofractionated Proton versus Photon Therapy in Extremity Soft Tissue Sarcoma |
| title_full_unstemmed | Comparing Ultra-hypofractionated Proton versus Photon Therapy in Extremity Soft Tissue Sarcoma |
| title_short | Comparing Ultra-hypofractionated Proton versus Photon Therapy in Extremity Soft Tissue Sarcoma |
| title_sort | comparing ultra hypofractionated proton versus photon therapy in extremity soft tissue sarcoma |
| topic | soft tissue sarcoma proton therapy hypofractionation ultra-hypofractionation stereotactic body radiation therapy stereotactic body proton therapy preoperative radiation neoadjuvant radiation |
| url | https://theijpt.org/doi/pdf/10.14338/IJPT-22-00022.1 |
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