Intensity modulated proton therapy compared to volumetric modulated arc therapy in the irradiation of young female patients with hodgkin’s lymphoma. Assessment of risk of toxicity and secondary cancer induction
Abstract Background To investigate the role of intensity modulated proton therapy (IMPT) compared to volumetric modulated arc therapy (VMAT) for advanced supradiaphragmatic Hodgkin’s lymphoma (HL) in young female patients by assessing dosimetric features and modelling the risk of treatment related c...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2020-01-01
|
| Series: | Radiation Oncology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13014-020-1462-2 |
| _version_ | 1811270947929325568 |
|---|---|
| author | Marta Scorsetti Luca Cozzi Pierina Navarria Antonella Fogliata Alexia Rossi Davide Franceschini Fiorenza De Rose Ciro Franzese Carmelo Carlo-Stella Armando Santoro |
| author_facet | Marta Scorsetti Luca Cozzi Pierina Navarria Antonella Fogliata Alexia Rossi Davide Franceschini Fiorenza De Rose Ciro Franzese Carmelo Carlo-Stella Armando Santoro |
| author_sort | Marta Scorsetti |
| collection | DOAJ |
| description | Abstract Background To investigate the role of intensity modulated proton therapy (IMPT) compared to volumetric modulated arc therapy (VMAT) for advanced supradiaphragmatic Hodgkin’s lymphoma (HL) in young female patients by assessing dosimetric features and modelling the risk of treatment related complications and radiation-induced secondary malignancies. Methods A group of 20 cases (planned according to the involved-site approach) were retrospectively investigated in a comparative planning study. Intensity modulated proton plans (IMPT) were compared to VMAT RapidArc plans (RA). Estimates of toxicity were derived from normal tissue complication probability (NTCP) calculations with either the Lyman or the Poisson models for a number of endpoints. Estimates of the risk of secondary cancer induction were determined for lungs, breasts, esophagus and thyroid. A simple model-based selection strategy was considered as a feasibility proof for the individualized selection of patients suitable for proton therapy. Results IMPT and VMAT plans resulted equivalent in terms of target dose distributions, both were capable to ensure high coverage and homogeneity. In terms of conformality, IMPT resulted ~ 10% better than RA plans. Concerning organs at risk, IMPT data presented a systematic improvement (highly significant) over RA for all organs, particularly in the dose range up to 20Gy. This lead to a composite average reduction of NTCP of 2.90 ± 2.24 and a reduction of 0.26 ± 0.22 in the relative risk of cardiac failures. The excess absolute risk per 10,000 patients-years of secondary cancer induction was reduced, with IMPT, of 9.1 ± 3.2, 7.2 ± 3.7 for breast and lung compared to RA. The gain in EAR for thyroid and esophagus was lower than 1. Depending on the arbitrary thresholds applied, the selection rate for proton treatment would have ranged from 5 to 75%. Conclusion In relation to young female patients with advanced supradiaphragmatic HL, IMPT can in general offer improved dose-volume sparing of organs at risk leading to an anticipated lower risk of early or late treatment related toxicities. This would reflect also in significantly lower risk of secondary malignancies induction compared to advanced photon based techniques. Depending on the selection thresholds and with all the limits of a non-validated and very basic model, it can be anticipated that a significant fraction of patients might be suitable for proton treatments if all the risk factors would be accounted for. |
| first_indexed | 2024-04-12T22:12:27Z |
| format | Article |
| id | doaj.art-dcad24b3bf2d48208a1c0892cd550076 |
| institution | Directory Open Access Journal |
| issn | 1748-717X |
| language | English |
| last_indexed | 2024-04-12T22:12:27Z |
| publishDate | 2020-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Radiation Oncology |
| spelling | doaj.art-dcad24b3bf2d48208a1c0892cd5500762022-12-22T03:14:43ZengBMCRadiation Oncology1748-717X2020-01-0115111210.1186/s13014-020-1462-2Intensity modulated proton therapy compared to volumetric modulated arc therapy in the irradiation of young female patients with hodgkin’s lymphoma. Assessment of risk of toxicity and secondary cancer inductionMarta Scorsetti0Luca Cozzi1Pierina Navarria2Antonella Fogliata3Alexia Rossi4Davide Franceschini5Fiorenza De Rose6Ciro Franzese7Carmelo Carlo-Stella8Armando Santoro9Humanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery DepartmentHumanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery DepartmentHumanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery DepartmentHumanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery DepartmentDepartment of Biomedical Sciences, Humanitas UniversityHumanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery DepartmentHumanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery DepartmentHumanitas Research Hospital and Cancer Center, Radiotherapy and Radiosurgery DepartmentDepartment of Biomedical Sciences, Humanitas UniversityDepartment of Biomedical Sciences, Humanitas UniversityAbstract Background To investigate the role of intensity modulated proton therapy (IMPT) compared to volumetric modulated arc therapy (VMAT) for advanced supradiaphragmatic Hodgkin’s lymphoma (HL) in young female patients by assessing dosimetric features and modelling the risk of treatment related complications and radiation-induced secondary malignancies. Methods A group of 20 cases (planned according to the involved-site approach) were retrospectively investigated in a comparative planning study. Intensity modulated proton plans (IMPT) were compared to VMAT RapidArc plans (RA). Estimates of toxicity were derived from normal tissue complication probability (NTCP) calculations with either the Lyman or the Poisson models for a number of endpoints. Estimates of the risk of secondary cancer induction were determined for lungs, breasts, esophagus and thyroid. A simple model-based selection strategy was considered as a feasibility proof for the individualized selection of patients suitable for proton therapy. Results IMPT and VMAT plans resulted equivalent in terms of target dose distributions, both were capable to ensure high coverage and homogeneity. In terms of conformality, IMPT resulted ~ 10% better than RA plans. Concerning organs at risk, IMPT data presented a systematic improvement (highly significant) over RA for all organs, particularly in the dose range up to 20Gy. This lead to a composite average reduction of NTCP of 2.90 ± 2.24 and a reduction of 0.26 ± 0.22 in the relative risk of cardiac failures. The excess absolute risk per 10,000 patients-years of secondary cancer induction was reduced, with IMPT, of 9.1 ± 3.2, 7.2 ± 3.7 for breast and lung compared to RA. The gain in EAR for thyroid and esophagus was lower than 1. Depending on the arbitrary thresholds applied, the selection rate for proton treatment would have ranged from 5 to 75%. Conclusion In relation to young female patients with advanced supradiaphragmatic HL, IMPT can in general offer improved dose-volume sparing of organs at risk leading to an anticipated lower risk of early or late treatment related toxicities. This would reflect also in significantly lower risk of secondary malignancies induction compared to advanced photon based techniques. Depending on the selection thresholds and with all the limits of a non-validated and very basic model, it can be anticipated that a significant fraction of patients might be suitable for proton treatments if all the risk factors would be accounted for.https://doi.org/10.1186/s13014-020-1462-2Intensity modulated proton therapyVMATRapidArcLymphoma cancerNTCPSeconday cancer risk estimate |
| spellingShingle | Marta Scorsetti Luca Cozzi Pierina Navarria Antonella Fogliata Alexia Rossi Davide Franceschini Fiorenza De Rose Ciro Franzese Carmelo Carlo-Stella Armando Santoro Intensity modulated proton therapy compared to volumetric modulated arc therapy in the irradiation of young female patients with hodgkin’s lymphoma. Assessment of risk of toxicity and secondary cancer induction Radiation Oncology Intensity modulated proton therapy VMAT RapidArc Lymphoma cancer NTCP Seconday cancer risk estimate |
| title | Intensity modulated proton therapy compared to volumetric modulated arc therapy in the irradiation of young female patients with hodgkin’s lymphoma. Assessment of risk of toxicity and secondary cancer induction |
| title_full | Intensity modulated proton therapy compared to volumetric modulated arc therapy in the irradiation of young female patients with hodgkin’s lymphoma. Assessment of risk of toxicity and secondary cancer induction |
| title_fullStr | Intensity modulated proton therapy compared to volumetric modulated arc therapy in the irradiation of young female patients with hodgkin’s lymphoma. Assessment of risk of toxicity and secondary cancer induction |
| title_full_unstemmed | Intensity modulated proton therapy compared to volumetric modulated arc therapy in the irradiation of young female patients with hodgkin’s lymphoma. Assessment of risk of toxicity and secondary cancer induction |
| title_short | Intensity modulated proton therapy compared to volumetric modulated arc therapy in the irradiation of young female patients with hodgkin’s lymphoma. Assessment of risk of toxicity and secondary cancer induction |
| title_sort | intensity modulated proton therapy compared to volumetric modulated arc therapy in the irradiation of young female patients with hodgkin s lymphoma assessment of risk of toxicity and secondary cancer induction |
| topic | Intensity modulated proton therapy VMAT RapidArc Lymphoma cancer NTCP Seconday cancer risk estimate |
| url | https://doi.org/10.1186/s13014-020-1462-2 |
| work_keys_str_mv | AT martascorsetti intensitymodulatedprotontherapycomparedtovolumetricmodulatedarctherapyintheirradiationofyoungfemalepatientswithhodgkinslymphomaassessmentofriskoftoxicityandsecondarycancerinduction AT lucacozzi intensitymodulatedprotontherapycomparedtovolumetricmodulatedarctherapyintheirradiationofyoungfemalepatientswithhodgkinslymphomaassessmentofriskoftoxicityandsecondarycancerinduction AT pierinanavarria intensitymodulatedprotontherapycomparedtovolumetricmodulatedarctherapyintheirradiationofyoungfemalepatientswithhodgkinslymphomaassessmentofriskoftoxicityandsecondarycancerinduction AT antonellafogliata intensitymodulatedprotontherapycomparedtovolumetricmodulatedarctherapyintheirradiationofyoungfemalepatientswithhodgkinslymphomaassessmentofriskoftoxicityandsecondarycancerinduction AT alexiarossi intensitymodulatedprotontherapycomparedtovolumetricmodulatedarctherapyintheirradiationofyoungfemalepatientswithhodgkinslymphomaassessmentofriskoftoxicityandsecondarycancerinduction AT davidefranceschini intensitymodulatedprotontherapycomparedtovolumetricmodulatedarctherapyintheirradiationofyoungfemalepatientswithhodgkinslymphomaassessmentofriskoftoxicityandsecondarycancerinduction AT fiorenzaderose intensitymodulatedprotontherapycomparedtovolumetricmodulatedarctherapyintheirradiationofyoungfemalepatientswithhodgkinslymphomaassessmentofriskoftoxicityandsecondarycancerinduction AT cirofranzese intensitymodulatedprotontherapycomparedtovolumetricmodulatedarctherapyintheirradiationofyoungfemalepatientswithhodgkinslymphomaassessmentofriskoftoxicityandsecondarycancerinduction AT carmelocarlostella intensitymodulatedprotontherapycomparedtovolumetricmodulatedarctherapyintheirradiationofyoungfemalepatientswithhodgkinslymphomaassessmentofriskoftoxicityandsecondarycancerinduction AT armandosantoro intensitymodulatedprotontherapycomparedtovolumetricmodulatedarctherapyintheirradiationofyoungfemalepatientswithhodgkinslymphomaassessmentofriskoftoxicityandsecondarycancerinduction |