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. 2015 May;16(3):237-44.
doi: 10.1016/j.cllc.2014.12.001. Epub 2014 Dec 9.

Intensity-modulated proton therapy for elective nodal irradiation and involved-field radiation in the definitive treatment of locally advanced non-small-cell lung cancer: a dosimetric study

Aparna H Kesarwala  1 , Christine J Ko  2 , Holly Ning  3 , Eric Xanthopoulos  4 , Karl E Haglund  3 , William P O'Meara  2 , Charles B Simone 2nd  4 , Ramesh Rengan  5
Affiliations

Intensity-modulated proton therapy for elective nodal irradiation and involved-field radiation in the definitive treatment of locally advanced non-small-cell lung cancer: a dosimetric study

Aparna H Kesarwala et al. Clin Lung Cancer. 2015 May.

Abstract

Background: Photon involved-field (IF) radiation therapy (IFRT), the standard for locally advanced (LA) non-small cell lung cancer (NSCLC), results in favorable outcomes without increased isolated nodal failures, perhaps from scattered dose to elective nodal stations. Because of the high conformality of intensity-modulated proton therapy (IMPT), proton IFRT could increase nodal failures. We investigated the feasibility of IMPT for elective nodal irradiation (ENI) in LA-NSCLC.

Patients and methods: IMPT IFRT plans were generated to the same total dose of 66.6-72 Gy received by 20 LA-NSCLC patients treated with photon IFRT. IMPT ENI plans were generated to 46 cobalt Gray equivalent (CGE) to elective nodal planning treatment volumes (PTV) plus 24 CGE to IF-PTVs.

Results: Proton IFRT and ENI improved the IF-PTV percentage of volume receiving 95% of the prescribed dose (D95) by 4% (P < .01) compared with photon IFRT. All evaluated dosimetric parameters improved significantly with both proton plans. The lung percentage of volume receiving 20 Gy/CGE (V20) and mean lung dose decreased 18% (P < .01) and 36% (P < .01), respectively, with proton IFRT, and 11% (P = .03) and 26% (P < .01) with ENI. The mean esophagus dose decreased 16% with IFRT and 12% with ENI; heart V25 decreased 63% with both (all P < .01).

Conclusion: This study demonstrates the feasibility of IMPT for LA-NSCLC ENI. Potential decreased toxicity indicates that IMPT could allow ENI while maintaining a favorable therapeutic ratio compared with photon IFRT.

Keywords: ENI; IFRT; IMPT; NSCLC; Radiation therapy.

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Conflict of interest statement

CONFLICT OF INTEREST

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
(A) Axial, sagittal, and coronal (ASC) views of photon involved-field radiation therapy (IFRT) plan. (B) ASC views of proton IFRT plan. (C) ASC views of proton elective nodal irradiation (ENI) plan. In (A), (B), and (C), the involved-field PTV is outlined in pink and the ENI PTV is outlined in red. (D) Dose-volume histogram (DVH) comparing photon IFRT (squares) with proton IFRT (triangles). (E) DVH comparing photon IFRT (squares) with proton ENI (triangles). In (D) and (E), structures and organs at risk are: Involved-field PTV (pink), ENI PTV (brown), esophagus (green), lung (blue), and heart (red).
Figure 1
Figure 1
(A) Axial, sagittal, and coronal (ASC) views of photon involved-field radiation therapy (IFRT) plan. (B) ASC views of proton IFRT plan. (C) ASC views of proton elective nodal irradiation (ENI) plan. In (A), (B), and (C), the involved-field PTV is outlined in pink and the ENI PTV is outlined in red. (D) Dose-volume histogram (DVH) comparing photon IFRT (squares) with proton IFRT (triangles). (E) DVH comparing photon IFRT (squares) with proton ENI (triangles). In (D) and (E), structures and organs at risk are: Involved-field PTV (pink), ENI PTV (brown), esophagus (green), lung (blue), and heart (red).
Figure 1
Figure 1
(A) Axial, sagittal, and coronal (ASC) views of photon involved-field radiation therapy (IFRT) plan. (B) ASC views of proton IFRT plan. (C) ASC views of proton elective nodal irradiation (ENI) plan. In (A), (B), and (C), the involved-field PTV is outlined in pink and the ENI PTV is outlined in red. (D) Dose-volume histogram (DVH) comparing photon IFRT (squares) with proton IFRT (triangles). (E) DVH comparing photon IFRT (squares) with proton ENI (triangles). In (D) and (E), structures and organs at risk are: Involved-field PTV (pink), ENI PTV (brown), esophagus (green), lung (blue), and heart (red).
Figure 1
Figure 1
(A) Axial, sagittal, and coronal (ASC) views of photon involved-field radiation therapy (IFRT) plan. (B) ASC views of proton IFRT plan. (C) ASC views of proton elective nodal irradiation (ENI) plan. In (A), (B), and (C), the involved-field PTV is outlined in pink and the ENI PTV is outlined in red. (D) Dose-volume histogram (DVH) comparing photon IFRT (squares) with proton IFRT (triangles). (E) DVH comparing photon IFRT (squares) with proton ENI (triangles). In (D) and (E), structures and organs at risk are: Involved-field PTV (pink), ENI PTV (brown), esophagus (green), lung (blue), and heart (red).
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