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Cancers (Basel). 2018 Oct 26;10(11). pii: E401. doi: 10.3390/cancers10110401.

Dosimetric Comparison of Proton Radiation Therapy, Volumetric Modulated Arc Therapy, and Three-Dimensional Conformal Radiotherapy Based on Intracranial Tumor Location.

Adeberg S1,2,3,4, Harrabi SB5,6,7, Bougatf N8,9, Verma V10, Windisch P11,12,13, Bernhardt D14,15, Combs SE16,17, Herfarth K18,19,20, Debus J21,22,23,24, Rieken S25,26,27,28.

Author information

1
Heidelberg Institute of Radiation Oncology (HIRO) and DKTK Site Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. sebastian.adeberg@med.uni-heidelberg.de.
2
Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany. sebastian.adeberg@med.uni-heidelberg.de.
3
Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. sebastian.adeberg@med.uni-heidelberg.de.
4
Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany. sebastian.adeberg@med.uni-heidelberg.de.
5
Heidelberg Institute of Radiation Oncology (HIRO) and DKTK Site Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. Semi.harrabi@med.uni-heidelberg.de.
6
Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany. Semi.harrabi@med.uni-heidelberg.de.
7
Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. Semi.harrabi@med.uni-heidelberg.de.
8
Heidelberg Institute of Radiation Oncology (HIRO) and DKTK Site Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. nina.bougatf@med.uni-heidelberg.de.
9
Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany. nina.bougatf@med.uni-heidelberg.de.
10
Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA 15212, USA. vivek333@gmail.com.
11
Heidelberg Institute of Radiation Oncology (HIRO) and DKTK Site Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. Paul.windisch@med.uni-heidelberg.de.
12
Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany. Paul.windisch@med.uni-heidelberg.de.
13
Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. Paul.windisch@med.uni-heidelberg.de.
14
Heidelberg Institute of Radiation Oncology (HIRO) and DKTK Site Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. denise.bernhardt@med.uni-heidelberg.de.
15
Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. denise.bernhardt@med.uni-heidelberg.de.
16
Department of Radiation Oncology, Technische Universität München, Ismaninger Straße 22, 81675 München, Germany. Stephanie.combs@tum.de.
17
Department of Radiation Sciences (DRS), Institut für Innovative Radiotherapie (iRT), Helmholtz Zentrum München, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany. Stephanie.combs@tum.de.
18
Heidelberg Institute of Radiation Oncology (HIRO) and DKTK Site Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. Klaus.herfarth@med.uni-heidelberg.de.
19
Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany. Klaus.herfarth@med.uni-heidelberg.de.
20
Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. Klaus.herfarth@med.uni-heidelberg.de.
21
Heidelberg Institute of Radiation Oncology (HIRO) and DKTK Site Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. Juergen.debus@med.uni-heidelberg.de.
22
Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany. Juergen.debus@med.uni-heidelberg.de.
23
Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. Juergen.debus@med.uni-heidelberg.de.
24
Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany. Juergen.debus@med.uni-heidelberg.de.
25
Heidelberg Institute of Radiation Oncology (HIRO) and DKTK Site Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. Stefan.rieken@med.uni-heidelberg.de.
26
Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany. Stefan.rieken@med.uni-heidelberg.de.
27
Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany. Stefan.rieken@med.uni-heidelberg.de.
28
Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany. Stefan.rieken@med.uni-heidelberg.de.

Abstract

(1) Background: Selecting patients that will benefit the most from proton radiotherapy (PRT) is of major importance. This study sought to assess dose reductions to numerous organs-at-risk (OARs) with PRT, as compared to three-dimensional conformal radiotherapy (3DCRT) and volumetric-modulated arc therapy (VMAT), as a function of tumor location. (2) Materials/Methods: Patients with intracranial neoplasms (all treated with PRT) were stratified into five location-based groups (frontal, suprasellar, temporal, parietal, posterior cranial fossa; n = 10 per group). Each patient was re-planned for 3DCRT and intensity-modulated radiotherapy (IMRT) using similar methodology, including the originally planned target and organ-at-risk (OAR) dose constraints. (3) Results: In parietal tumors, PRT showed the most pronounced dose reductions. PRT lowered doses to nearly every OAR, most notably the optical system and several contralateral structures (subventricular zone, thalamus, hippocampus). For frontal lobe cases, the greatest relative dose reductions in mean dose (Dmean) with PRT were to the infratentorial normal brain, contralateral hippocampus, brainstem, pituitary gland and contralateral optic nerve. For suprasellar lesions, PRT afforded the greatest relative Dmean reductions to the infratentorial brain, supratentorial brain, and the whole brain. Similar results could be observed in temporal and posterior cranial fossa disease. (4) Conclusions: The effectiveness and degree of PRT dose-sparing to various OARs depends on intracranial tumor location. These data will help to refine selection of patients receiving PRT, cost-effectiveness, and future clinical toxicity assessment.

KEYWORDS:

3D conformal radiotherapy; IMPT; IMRT; VMAT; astrocytoma; cost-effectiveness; craniopharyngioma; glioblastoma; glioma; neurocognition; proton therapy

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