scholarly journals Intensity Modulated Proton Therapy with Advanced Planning Techniques in a Challenging Hepatocellular Carcinoma Patient

Cureus ◽  
2017 ◽  
Author(s):  
Smith Apisarnthanarax ◽  
Jatinder Saini ◽  
Avril O'Rryan-Blair ◽  
Jackie Castro ◽  
Stephen R Bowen
Keyword(s):  
Hepatocellular Carcinoma ◽  
Proton Therapy ◽  
Planning Techniques ◽  
Intensity Modulated Proton Therapy ◽  
Intensity Modulated ◽  
Carcinoma Patient ◽  
Advanced Planning

Intensity-modulated proton therapy using dose-painting pencil beam scanning for high-risk hepatocellular carcinoma.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 558-558
Author(s):  
Stephanie K. Schaub ◽  
Stephen R. Bowen ◽  
Matthew J. Nyflot ◽  
Smith Apisarnthanarax
Keyword(s):  
Hepatocellular Carcinoma ◽  
Local Control ◽  
Proton Therapy ◽  
Gross Tumor Volume ◽  
Tumor Volume ◽  
Pencil Beam ◽  
Intensity Modulated Proton Therapy ◽  
Intensity Modulated ◽  
Pencil Beam Scanning ◽  
Grade 3

558 Background: High rates of local control are achievable with hypofractionated proton therapy with passive techniques for hepatocellular carcinoma (HCC), but may have limitations when tumors are adjacent to organs-at-risk (OARs), which may result in tumor underdosage and lead to inferior local control. We present the first reported series of HCC patients treated with pencil beam scanning (PBS) intensity-modulated proton therapy (IMPT) using a simultaneous-integrated boost and protection (SIB/SIP) technique to escalate tumor dose while protecting adjacent OARs. Methods: Twenty-five HCC patients were treated between 2015-2019 with a 15-fraction regimen using IMPT SIB/SIP. SIB/SIP dose levels generally ranged from 36.0-67.5 GyRBE to minimize dose to OARs at their respective dose-limiting thresholds (e.g. luminal gastrointestinal organs, chest wall). Radiation-induced liver disease (RILD) was defined by a Child-Pugh (CP) score increase of 2 or greater and/or any RTOG grade 3 enzyme elevation. Other toxicities were graded by CTCAEv5.0. Overall survival (OS), progression-free survival (PFS), and local control were calculated using the Kaplan-Meier method. Results: Patients most commonly had BCLC stage B or C disease (84%) and CP-A (80%) and ALBI grade 2 (60%) liver function. Median gross tumor volume (GTV) size and volume were 12.3 cm (range 2.17-20.57) and 461 cc (range 4.68-2439), and 32% had gross vascular invasion. Median mean and minimum dose delivered to the gross tumor volume (GTV) was 64.0 GyRBE (EQD2 76.1, BED 91.3, range 54.3-69.6) and 45.1 GyRBE (EQD2 48.9, BED 58.7, range 33.4-67.7), respectively. Median mean dose to liver minus GTV was 15.0 GyRBE (range, 8.2-19.6). 1-year OS, PFS, and local control were 66%, 32%, and 84%, respectively. No isolated local failures occurred. Two patients experienced RILD with no RILD-related deaths. Two grade 3 non-GI toxicities occurred: 1 rib fracture and 1 pneumonitis. No acute or late GI grade ≥2 occurred. Conclusions: In our series of HCC patients with large tumors near OARs, IMPT SIB/SIP allows for tumor dose escalation while sparing of OARs and results in favorable local control and acceptable toxicities.

scholarly journals Early Clinical Outcomes of Intensity Modulated Radiation Therapy/Intensity Modulated Proton Therapy Combination in Comparison with Intensity Modulated Radiation Therapy Alone in Oropharynx Cancer Patients

Cancers ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1549
Author(s):  
Han Gyul Yoon ◽  
Yong Chan Ahn ◽  
Dongryul Oh ◽  
Jae Myoung Noh ◽  
Seung Gyu Park ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Proton Therapy ◽  
Intensity Modulated Radiation Therapy ◽  
Combination Group ◽  
Intensity Modulated Proton Therapy ◽  
Oropharynx Cancer ◽  
Intensity Modulated ◽  
Before And After ◽  
Grade 3 ◽  
Early Clinical Outcomes

Purpose: To report the early clinical outcomes of combining intensity-modulated radiation therapy (IMRT) and intensity-modulated proton therapy (IMPT) in comparison with IMRT alone in treating oropharynx cancer (OPC) patients. Materials and Methods: The medical records of 148 OPC patients who underwent definitive radiotherapy (RT) with concurrent systemic therapy, from January 2016 till December 2019 at Samsung Medical Center, were retrospectively reviewed. During the 5.5 weeks’ RT course, the initial 16 (or 18) fractions were delivered by IMRT in all patients, and the subsequent 12 (or 10) fractions were either by IMRT in 81 patients (IMRT only) or by IMPT in 67 (IMRT/IMPT combination), respectively, based on comparison of adaptive re-plan profiles and availability of equipment. Propensity-score matching (PSM) was done on 76 patients (38 from each group) for comparative analyses. Results: With the median follow-up of 24.7 months, there was no significant difference in overall survival and progression free survival between groups, both before and after PSM. Before PSM, the IMRT/IMPT combination group experienced grade ≥ 3 acute toxicities less frequently: mucositis in 37.0% and 13.4% (p < 0.001); and analgesic quantification algorithm (AQA) in 37.0% and 19.4% (p = 0.019), respectively. The same trends were observed after PSM: mucositis in 39.5% and 15.8% (p = 0.021); and AQA in 47.4% and 21.1% (p = 0.016), respectively. In multivariate logistic regression, grade ≥ 3 mucositis was significantly less frequent in the IMRT/IMPT combination group, both before and after PSM (p = 0.027 and 0.024, respectively). AQA score ≥ 3 was also less frequent in the IMRT/IMPT combination group, both before and after PSM (p = 0.085 and 0.018, respectively). Conclusions: In treating the OPC patients, with comparable early oncologic outcomes, more favorable acute toxicity profiles were achieved following IMRT/IMPT combination than IMRT alone.

PO-0930 ROBUSTNESS OF IMPT (INTENSITY MODULATED PROTON THERAPY) COMPARED WITH IMRT FOR HEAD AND NECK CANCERS

2012 ◽  
Vol 103 ◽  
pp. S366-S367
Author(s):  
R. Harding ◽  
J. Lilley ◽  
V.P. Cosgrove ◽  
S.J. Weston ◽  
C.M. Thompson ◽  
...  
Keyword(s):  
Head And Neck ◽  
Proton Therapy ◽  
Head And Neck Cancers ◽  
Intensity Modulated Proton Therapy ◽  
Intensity Modulated

scholarly journals Bone marrow sparing in intensity modulated proton therapy for cervical cancer: Efficacy and robustness under range and setup uncertainties

2015 ◽  
Vol 115 (3) ◽  
pp. 373-378 ◽  
Author(s):  
Eric Dinges ◽  
Nicole Felderman ◽  
Sarah McGuire ◽  
Brandie Gross ◽  
Sudershan Bhatia ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Bone Marrow ◽  
Proton Therapy ◽  
Intensity Modulated Proton Therapy ◽  
Intensity Modulated ◽  
Bone Marrow Sparing
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