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Int J Radiat Oncol Biol Phys. 2011 Jul 15;80(4):1015-22. doi: 10.1016/j.ijrobp.2010.03.012. Epub 2010 Jul 7.

Proton stereotactic body radiation therapy for clinically challenging cases of centrally and superiorly located stage I non-small-cell lung cancer.

Author information

1
Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.

Abstract

PURPOSE:

To minimize toxicity while maintaining tumor coverage with stereotactic body radiation therapy (SBRT) for centrally or superiorly located stage I non-small-cell lung cancer (NSCLC), we investigated passive-scattering proton therapy (PSPT) and intensity-modulated proton therapy (IMPT).

METHODS AND MATERIALS:

Fifteen patients with centrally or superiorly located (within 2 cm of critical structures) stage I NSCLC were treated clinically with three-dimensional photon SBRT (50 Gy in 4 fractions). The photon SBRT plan was compared with the PSPT and IMPT plans. The maximum tolerated dose (MTD) was defined as the dose that exceeded the dose--volume constraints in the critical structures.

RESULTS:

Only 6 photon plans satisfied the >95% planning target volume (PTV) coverage and MTD constraints, compared to 12 PSPT plans (p = 0.009) and 14 IMPT plans (p = 0.001). Compared with the photon SBRT plans, the PSPT and IMPT plans significantly reduced the mean total lung dose from 5.4 Gy to 3.5 Gy (p < 0.001) and 2.8 Gy (p < 0.001) and reduced the total lung volume receiving 5 Gy, 10 Gy, and 20 Gy (p < 0.001). When the PTV was within 2 cm of the critical structures, the PSPT and IMPT plans significantly reduced the mean maximal dose to the aorta, brachial plexus, heart, pulmonary vessels, and spinal cord.

CONCLUSIONS:

For centrally or superiorly located stage I NSCLC, proton therapy, particularly IMPT, delivered ablative doses to the target volume and significantly reduced doses to the surrounding normal tissues compared with photon SBRT.

PMID:
20615629
PMCID:
PMC2952351
DOI:
10.1016/j.ijrobp.2010.03.012
[Indexed for MEDLINE]
Free PMC Article

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