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Comparative Proton and Photon Treatment Planning in Pediatric Patients with Various Diagnoses

Fagerström Kristensen, Ingrid LU ; Nilsson, Kristina and Nilsson, Per LU (2015) In International Journal of Particle Therapy 2(2). p.367-375
Abstract (Swedish)
Purpose: Radiation therapy with protons, owing to its physical properties, can be
advantageous for the treatment of children. This study was conducted in order to quantify the advantages of proton therapy from a treatment planning point of view in a consecutive, realistic, and mixed pediatric/adolescent population with varying diagnoses and target locations.
Patients and Methods: Forty-five patients treated with conventional 3 dimensional conformal radiation therapy photon radiation therapy were retrospectively re-planned with scanned proton beams. Treatment sites represented were the central nervous system, head and neck, thorax, and abdomen. Median age was 8 years (range, 2-18 years). All plans were optimized with... (More)
Purpose: Radiation therapy with protons, owing to its physical properties, can be
advantageous for the treatment of children. This study was conducted in order to quantify the advantages of proton therapy from a treatment planning point of view in a consecutive, realistic, and mixed pediatric/adolescent population with varying diagnoses and target locations.
Patients and Methods: Forty-five patients treated with conventional 3 dimensional conformal radiation therapy photon radiation therapy were retrospectively re-planned with scanned proton beams. Treatment sites represented were the central nervous system, head and neck, thorax, and abdomen. Median age was 8 years (range, 2-18 years). All plans were optimized with intensity-modulated proton therapy (multi-field optimization). We analyzed a number of dose-volume descriptors for planned target
volumes (PTVs). Organ-specific mean doses and relevant DV -values were derived fororgans at risk. In addition, homogeneity index, conformity index, treated volume, and integral dose were calculated for each treatment plan. The Wilcoxon matched-pairs signed rank test was used for studying differences between these variables for the 2 treatment modalities.
Results: Planned target volume coverage (V95%) was similar when comparing photons and protons. Conformity and homogeneity indices were similar or better for protons for most cases. In general, doses to organs at risk were lower with protons. In cases with organs at risk in close vicinity to the PTV, the gain with protons is less.
Conclusions: The patient cohort benefits from reduced integral dose with protons compared with photons. Patients with tumors in the central nervous system, head and neck, upper mediastinum, and some abdominal locations will gain significantly if treated with protons compared with photons. For 7 of the 45 consecutive patients studied (whole brain, whole lung, whole abdomen, flank treatment), we found no gain with protons (difference in integral dose less than 8%). (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
International Journal of Particle Therapy
volume
2
issue
2
pages
367 - 375
ISSN
2331-5180
DOI
10.14338/IJPT-14-00026.1
language
English
LU publication?
yes
id
2b5c70a8-ead1-4b64-9ec9-4ac1d7c62e33
date added to LUP
2017-01-05 14:33:06
date last changed
2017-03-13 12:13:38
@article{2b5c70a8-ead1-4b64-9ec9-4ac1d7c62e33,
  abstract     = {Purpose: Radiation therapy with protons, owing to its physical properties, can be<br/>advantageous for the treatment of children. This study was conducted in order to quantify the advantages of proton therapy from a treatment planning point of view in a consecutive, realistic, and mixed pediatric/adolescent population with varying diagnoses and target locations.<br/>Patients and Methods: Forty-five patients treated with conventional 3 dimensional conformal radiation therapy photon radiation therapy were retrospectively re-planned with scanned proton beams. Treatment sites represented were the central nervous system, head and neck, thorax, and abdomen. Median age was 8 years (range, 2-18 years). All plans were optimized with intensity-modulated proton therapy (multi-field optimization). We analyzed a number of dose-volume descriptors for planned target<br/>volumes (PTVs). Organ-specific mean doses and relevant DV -values were derived fororgans at risk. In addition, homogeneity index, conformity index, treated volume, and integral dose were calculated for each treatment plan. The Wilcoxon matched-pairs signed rank test was used for studying differences between these variables for the 2 treatment modalities.<br/>Results: Planned target volume coverage (V95%) was similar when comparing photons and protons. Conformity and homogeneity indices were similar or better for protons for most cases. In general, doses to organs at risk were lower with protons. In cases with organs at risk in close vicinity to the PTV, the gain with protons is less.<br/>Conclusions: The patient cohort benefits from reduced integral dose with protons compared with photons. Patients with tumors in the central nervous system, head and neck, upper mediastinum, and some abdominal locations will gain significantly if treated with protons compared with photons. For 7 of the 45 consecutive patients studied (whole brain, whole lung, whole abdomen, flank treatment), we found no gain with protons (difference in integral dose less than 8%).},
  author       = {Fagerström Kristensen, Ingrid and Nilsson, Kristina and Nilsson, Per},
  issn         = {2331-5180},
  language     = {eng},
  month        = {08},
  number       = {2},
  pages        = {367--375},
  series       = {International Journal of Particle Therapy},
  title        = {Comparative Proton and Photon Treatment Planning in Pediatric Patients with Various Diagnoses},
  url          = {http://dx.doi.org/10.14338/IJPT-14-00026.1},
  volume       = {2},
  year         = {2015},
}