A treatment planning intercomparison of proton and intensity modulated photon radiotherapy.

[en] Abstract Purpose: A comparative treatment planning study has been undertaken between standard photon delivery techniques,b intensity modulated photon methods and spot scanned protons in order to investigate the merits and limitations of each of these treatment approaches. Methods: Plans for each modality were performed using CT scans and planning information for nine patients with varying indications and lesion sites and the results have been analysed using a variety of dose and volume based parameters. Results: Over all cases, it is predicted that the use of protons could lead to a reduction of the total integral dose by a factor three compared to standard photon techniques and a factor two compared to IM photon plans. In addition, in all but one Organ at Risk (OAR) for one case, protons are predicted to reduce both mean OAR dose and the irradiated volume at the 50% mean target dose level compared to both photon methods. However, when considering the volume of an OAR irradiated to 70% or more of the target dose, little difference could be shown between proton and intensity modulated photon plans. On comparing the magnitude of dose hot spots in OARs resulting from the proton and IM photon plans, more variation was observed, and the ranking of the plans was then found to be case and OAR dependent. Conclusions: The use of protons has been found to reduce the medium to low dose load (below about 70% of the target dose) to OARs and all non-target tissues compared to both standard and inversely planned photons, but that the use of intensity modulated photons can result in similar levels of high dose conformation to that afforded by protons. However, the introduction of inverse planning methods for protons is necessary before general conclusions on the relative efficacy of photons and protons can be drawn.

Disciplines :

Hematology
Oncology

Author, co-author :

Lomax, T

Goitein, G

Debus, J

Dykstra, C

Tercier, P-A

COUCKE, Philippe ; oncology, University Hospital of Lausanne, CHUV, Lausanne, > Radiothérapie

Mirimanoff, R-O

Language :

English

Title :

A treatment planning intercomparison of proton and intensity modulated photon radiotherapy.

Publication date :

1999

Journal title :

Radiotherapy and Oncology

ISSN :

0167-8140

eISSN :

1879-0887

Publisher :

Elsevier Scientific, Limerick, Ireland

Volume :

51(3)

Pages :

257-272

Peer reviewed :

Peer Reviewed verified by ORBi

Available on ORBi :

since 09 February 2009

Statistics

Number of views

107 (7 by ULiège)

Number of downloads

807 (0 by ULiège)

More statistics

Scopus citations^®

195

Scopus citations^®
without self-citations

155

OpenCitations

177

Bibliography

Bendl R, Pross J, Hoess A, Keller MA, Preiser K, Schiegel W. Virtuos - a program for virtual radiotherapy simulation and verification. In: AR Hounsell, JM Wilkinson, PC Williams, editors. XIth International Conference on 'The use of computers in radiation therapy', Manchester, 20-24 March, 1994. pp. 226-227.
Boesecke R, Bauer B, Schiegel W, Schad L, Lorenz WJ. Medical workstation for radiation therapy planning. In: Bruinvis IA, editor. IXth International Conference on 'The use of computers in radiation therapy, 1987. pp. 181-183.
Bonnet DE. Current developments in proton therapy: a review. Phys. Med. Biol. 1993;38:1371-1392.
Bortfeld T, Buerkelbach J, Boesecke R, Schiegel W. Methods of image reconstruction from projections applied to conformation radiotherapy. Phys. Med. Biol. 1990;35:1423-1434.
Bortfeld T, Schlegel W. Optimisation of beam orientations in radiation therapy: some theoretical considerations. Phys. Med. Biol. 1993;38:291-304.
Bortfeld T, Schiegel W, Rhein B. Decomposition of pencil beam kernels for fast dose calculations in three-dimensional treatment planning. Med. Phys. 1993;20:311-318.
Bortfeld T, Boyer AL, Schiegel W, Kahier DL, Waldron TJ. Experimental verification of multileaf modulated conformal radiotherapy. In: Hounsell AR, Wilkinson JM, Williams PC, editors. XIth International Conference on 'The use of computers in radiation therapy', Manchester, 20-24 March, 1994, pp. 180-181.
Bortfeld T, Stein J, Preiser K. Clinically relevant intensity modulation optimisation using physical criteria. In: Leavitt DD, Starkschall G, editors. XIIth International Conference on 'The use of computers in radiation therapy', Salt Lake City, 27-30 May, 1997. pp. 1-4.
Brahme A, Kallmann P, Lind BK. Optimisation of proton and heavy ion therapy using an adaptive inversion algorithm. Radiother. Oncol. 1989;15:189-197.
Burman C, Kutcher GJ, Emami B, Goitein M. Fitting of normal tissue data to an analytical function. Int. J. Radiat. Oncol. Biol. Phys. 1991;21:123-136.
Dykstra C, Bortfeld T, Debus J, Lomax A, Harrop R, Schiegel W, Munkel G. Characterisation of dose distributions in radiation therapy plans. Radiother. Oncol. 1996;41:281-284.
Emami B, Lyman J, Brown A, et al. Tolerance of normal tissue to therapeutic irradiation. Int. J. Radiat. Oncol. Biol. Phys. 1991;21:109-122.
Esik G, Bortfeld T, Bendel R, Nemeth G, Schiegel W. Inverse radiotherapy planning for a concave-convex PTV in cevical and upper mediastinal regions. Strahienther. Onkol. 1997;173:193-200.
Goitein M, Chen GTY. Beam scanning for heavy charged particle radiotherapy. Med. Phys. 1983;10:831-840.
Goitein M. The comparison of treatment plans. Sem. Radiat. Oncol. 1992;2:246-256.
Gokhale P, Hussein EMA, Kuikani N. Determination of beam orientation in radiotherapy planning. Med. Phys. 1994;21:393-400.
Holmes TW, Mackie TR, Reckwerdt PI, Deasy JO. A prototype inverse treatment planning algorithm for tomotherapy. In: Hounsell AR, Wilkinson JM, Williams PC, editors. XIth International Conference on 'The use of computers in radiation therapy', Manchester, 20-24 March, 1994. pp. 62-63.
ICRU-50, Prescribing, recording and reporting photon beam therapy. Bethesda, MD, 1993.
Iain NL, Kahn MG, Graham MV, Purdy JA. 3D conformal radiation therapy: V. Decision-Theoretic evaluation of radiation treatment plans. In: Hounsell AR, Wilkinson JM, Williams PC, editors. XIth International Conference on 'The use of computers in radiation therapy', Manchester, 20-24 March, 1994. pp. 8-9.
Kallmann P, Lind BK, Brahme A. An algorithm for maximising the probability of complication free tumour control in radiation therapy. Phys. Med. Biol. 1992;37:871-890.
Kanai T, Kanai K, Kumamoto Y, Ogawa H, Yamada T, Matsuzawa H. Spot scanning system for radiotherapy. Med. Phys. 1980;7:365-369.
Koehler AM, Schneider RJ, Sisterson JM. Range modulators for protons and heavy ions. Nucl. Instrum. Methods 1975;131:437-440.
Koehler AM, Schneider RJ, Sisterson JM. Flattening of proton dose distributions for large field radiotherapy. Med. Phys. 1977;4:297-301.
Lee M, Wynne C, Webb S, Nahum AE, Dearneley DA. Comparison of proton and mega-voltage X-ray treatment planning for prostate cancer. Radiother. Oncol. 1994;33:239-253.
Ling CC, Burman C, Chui C, Kutcher GJ, Leibel SA, LoSasso T, Mohan R, Bortfeld T, Reinstein L, Spirou S, Wang XH, Wu Q, Zelefsky M, Fuks Z. Conformal radiation treatment of prostate cancer using inversely-planned intensity-modulated photon beams produced with dynamic multileaf coliimation. Int. J. Radiat. Oncol. Biol. Phys. 1996;35:721-730.
Lomax A, Scheib S, Munkel G, Blattmann H. The comparison of spot scanning proton radiotherapy with conventional photon therapies. In: Hounsell AR, Wllkinson JM, Williams PC, editors. XIth International Conference on 'The use of computers in radiation therapy', Manchester, 20-24 March, 1994. pp. 366-367.
Lomax AJ, Pedroni E, Schaffher B, Scheib S, Schneider U, Tourovsky A. 3D treatment planning for conformal proton therapy by spot scanning. In: Faulkner K et al., editors. Proc. 19th L H Gray Conference, London: BIR publishing, 1999. pp. 67-71.
Lomax A. Intensity modulation for proton radiotherapy, Phys. Med. Biol. 1999;44:185-205.
Lyman JT, Wolbarst B. Optimisation of radiation therapy III: A method of assessing complication probabilities from dose-volume histograms. Int. J. Radiat. Oncol. Biol. Phys. 1987;13:103-109.
Mageras GS, Mohan R. Application of fast simulated annealing to optimisation of conformal radiation treatments. Med. Phys. 1993;20:639-647.
Miralbell R, Croweli C, Suit HD. Potential improvement of three dimensional treatment planning and proton therapy in the outcome of maxillary sinus cancer. Int. J. Radiat. Oncol. Biol. Phys. 1991;22:305-310.
Miralbell R, Urie MM. Potential improvement of three dimensional treatment planning and proton beams in fractionated radiotherapy of large cerebral arteriovenous malformations. Int. J. Radiat. Oncol. Biol. Phys. 1993;25:353-358.
Miralbell R, Lomax A, Borfeld T, Rouzaud M, Carrie C. Potential role of proton therapy in the treatment of paediatric medulloblastoma/primitive neuroectodermal tumors: reduction of the supratentorial target volume. Int. J. Radiat. Biol. Phys. 1997;38:477-484.
Miralbell R, Lomax A, Russo M. Potential role of proton therapy in the treatment of pediatrie medulloblastoma/primitive neuro-ectodermal tumors: spinal theca irradiation. Int. J. Radiat. Biol. Phys. 1997;38:805-811.
Mohan R, Mageras GS, Baldwin B, et al. Clinically relevant optimisation of 3D conformal treatments. Med. Phys. 1992;19:933-944.
Munzenrider JE, Brown AP, Chu JCH, et al. Numerical scoring of treatment plans. Int. J. Radiat. Oncol. Biol. Phys 1991;21:147-163.
Nahum AE. The potential of normal-tissue radiobiology for the physics of conformal therapy. In: Nahum A, Peacock J, editors. Tissue effects in radiotherapy: physics meets biology, Betchworth, UK, 14-16 July, 1997.
Niemierko A. Random search algorithm (RONSC) for optimisation of radiation therapy with both physical and biological end points and constraints. Int. J. Radiat. Oncol. Biol. Phys. 1992;23:89-98.
Niemierko A, Urie M, Goitein M. Optimisation of 3D radiation therapy with both physical and biological end points and constraints. Int. J. Radiat. Oncol. Biol. Phys. 1992;23:99-108.
Pedroni E, Bacher R, Blattmann H, et al. The 200 MeV proton therapy project at PSI: conceptual design and practical realisation. Med. Phys. 1995;22:37-53.
Preiser K, Bortfeld T, Hartwig K, Schlegel W, Stein J. A new program for inverse radiotherapy planning. In: Leavitt DD, Starkschall G, editors. XIIth International Conference on 'The use of computers in radiation therapy', Salt Lake City, 27-30 May, 1997. pp. 425-428.
Sherouse GW. Dose homogenisation using vector analysis of dose gradients. In: Hounsell AR, Wilkinson JM, Williams PC, editors. XIth International Conference on 'The use of computers in radiation therapy', Manchester, 20-24 March, 1994. pp. 248-249.
Scheib S, Pedroni E. Dose calculations and optimisation for 3D conformal voxel scanning. Radiat. Environ. Biophys. 1996;31:251-256.
Sisterson J. Particles Newsletter 21 (Harvard cyclotron laboratory), January 1998.
Slater JD, Slater JM, Wahien S. The potential for proton therapy in locally advanced carcinoma of the cervix. Int. J. Radiat. Oncol. Biol. Phys. 1992;22:343-348.
Tatsuzaki H, Urie MM, Lingwood R. Comparative treatment planning: proton versus X-ray beams against glioblastoma multiforme. Int. J. Radiat. Oncol. Biol. Phys. 1992;22:265-274.
Tatsuzaki H, Urie MM, Willet CG. 3D comparative study of proton versus. X-ray radiation therapy for rectal cancer. Int. J. Radiat. Oncol. Biol. Phys. 1992;22:369-374.
Urie MM, Goitein M. Variable versus fixed modulation of proton beams for treatments in the cranium. Med. Phys. 1989;16:16.
Wang X, Mohan R, Jackson A, Leibel SA, Fuks Z, Ling CC. Optimisation of intensity modulated 3D treatment plans based on biological indices. Radiother. Oncol. 1995;37:140-152.
Webb S. Optimisation of conformal radiotherapy dose distributions by simulated annealing. Phys. Med. Biol. 1989;34:1349-1370.
Wilson RR. Radiological use of fast protons. Radiology 1946;47:487-491.