Background And Purpose: Regional nodal irradiation (RNI) for breast cancer delivers radiation in proximity to the shoulder and torso, and radiation exposure may contribute to long-term upper extremity and postural morbidity. To date, no studies have assessed the differential dosimetric impact of proton versus photon radiation on shoulder and torso anatomy. This study examined clinically relevant musculoskeletal (MSK) structures and assessed the dose delivered with each modality.
Patients/material And Methods: Ten MSK structures were contoured on IMPT (intensity-modulated proton therapy) and VMAT (volumetric modulated arc therapy) plans for 30 patients receiving RNI. Relevant dose metrics were compared for each of the structures. Intensity-modulated proton therapy dose was calculated using the relative biological effective value of 1.1. Hypo-fractionated plans were scaled to the equivalent dose in 2 Gy fractions (EQD2) using an alpha/beta ratio of four. Wilcoxon signed rank sum tests compared doses. Select three-dimensional and optimised VMAT plans were also informally compared.
Results And Interpretation: Each of the 10 structures received a statistically significantly lower dose with the use of IMPT compared with VMAT. Differences were greatest for posterior structures, including the trapezius, latissimus dorsi and glenohumeral joint. Mean absolute differences were as great as 23 Gy (supraspinatus D5cc) and up to 30-fold dose reductions were observed (deltoid D50cc). An average 3.7-fold relative dose reduction existed across all structures. Measures of low/intermediate dose (V15Gy and D50cc) showed the largest differences. Intensity-modulated proton therapy results in statistically lower radiation exposure to relevant shoulder and torso anatomy compared to photon radiation for patients requiring RNI. Prospective study is needed to correlate functional outcomes with radiation dose.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538476 | PMC |
| http://dx.doi.org/10.2340/1651-226X.2024.40084 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Characterisation of the HollandPTC R&D proton beamline for physics and radiobiology studies.
Phys Med
January 2025
Department of Research and Development, Holland Proton Therapy Centre Delft, Delft, The Netherlands.
HollandPTC is an independent outpatient center for proton therapy, scientific research, and education. Patients with different types of cancer are treated with Intensity Modulated Proton Therapy (IMPT). Additionally, the HollandPTC R&D consortium conducts scientific research into the added value and improvements of proton therapy.
View Article and Find Full Text PDFUpdates in Management of Unresectable Stage III Non Small Cell Lung Cancer: A Radiation Oncology Perspective.
Cancers (Basel)
December 2024
Department of Radiation Oncology, Rutgers Cancer Institute, New Brunswick, NJ 08901, USA.
Unresectable stage III non-small-cell lung cancer (NSCLC) remains a clinical challenge, due to the need for optimal local and systemic control. The management of unresectable Stage III NSCLC has evolved with advancements in radiation therapy (RT), systemic therapies, and immunotherapy. For patients with locally advanced NSCLC who are not surgical candidates, concurrent chemoradiotherapy (CRT) has modest survival outcomes, due to both local progression and distant metastasis.
View Article and Find Full Text PDFEmerging Radiotherapy Technologies for Head and Neck Squamous Cell Carcinoma: Challenges and Opportunities in the Era of Immunotherapy.
Cancers (Basel)
December 2024
Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC 27599, USA.
Radiotherapy (RT) is an integral component in the multidisciplinary management of patients with head and neck squamous cell carcinoma (HNSCC). Significant advances have been made toward optimizing tumor control and toxicity profiles of RT for HNSCC in the past two decades. The development of intensity modulated radiotherapy (IMRT) and concurrent chemotherapy established the standard of care for most patients with locally advanced HNSCC around the turn of the century.
View Article and Find Full Text PDFThe Burden of Insurance Prior Authorization on Cancer Care: A Review of Evidence From Radiation Oncology.
Adv Radiat Oncol
January 2025
Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee.
Purpose: Despite its high cost-effectiveness, radiation oncology faces the greatest prior authorization (PA) burden of any medical specialty. Insurance denials and resulting treatment delays have been documented across several treatment modalities, including stereotactic body radiation, intensity modulated radiation, and proton therapy. Although insurance companies suggest that PA is intended to control health care spending and ensure the implementation of evidence-based practice, the number of radiation treatment plans reviewed by the PA process that result in changes is quite low.
View Article and Find Full Text PDFQuantification of beam size impact on intensity-modulated proton therapy with robust optimization in head and neck cancer-comparison with intensity-modulated radiation therapy.
J Radiat Res
December 2024
Section of Radiation Safety and Quality Assurance, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan.
We assessed the effect of beam size on plan robustness for intensity-modulated proton therapy (IMPT) of head and neck cancer (HNC) and compared the plan quality including robustness with that of intensity-modulated radiation therapy (IMRT). IMPT plans were generated for six HNC patients using six beam sizes (air-sigma 3-17 mm at isocenter for a 70-230 MeV) and two optimization methods for planning target volume-based non-robust optimization (NRO) and clinical target volume (CTV)-based robust optimization (RO). Worst-case dosimetric parameters and plan robustness for CTV and organs-at-risk (OARs) were assessed under different scenarios, assuming a ± 1-5 mm setup error and a ± 3% range error.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!