Radiotherapy and Oncology
Purpose or Objective To investigate the potential clinical benefit of utilizing IMPT to reduce acute hematologic toxicity for locally advanced nonsmall cell lung cancer (NSCLC) patients and explore the feasibility of a model-based patient selection approach via the normal tissue complication probability (NTCP). Materials and Methods Twenty patients with locally advanced NSCLC were enrolled.[ld1] Volumetric modulated arc photon therapy (VMAT) and intensity-modulated proton therapy (IMPT) plans were generated with a prescription dose of 60 Gy in 30 fractions. A wide range of cases with varied tumor size, location, stations of metastatic lymph nodes were selected to represent the general cancer group. Contouring and treatment planning followed RTOG-1308 protocol. Doses to bone marrow (BM) and other organ-at-risks were compared. Risk of grade ≥ 3 acute hematologic toxicity (HT3+) were calculated based on NTCP model and patients with reduction on NTCP of HT3+ (△NTCP_HT3+) ≥ 10% were considered to 'significantly benefit from proton therapy.' Results Dose to the BM, the lung, the heart, the esophagus and the spinal cord was significantly reduced via IMPT compared to VMAT. Tumor distance to thoracic vertebrae bodies (TVB) was significantly associated with > 10% △NTCP_HT3+ from IMPT to VMAT. For the patients with tumor distance ≤ 0.7 cm to TVB, the absolute reduction of dose (mean, V30 and V40) to BM was significantly lower than that in patients with tumor distance > 0.7 cm. Conclusion IMPT reduced HT3+ compared to VMAT by reducing dose to the thoracic BM in NSCLC patients. Patients with tumor distance ≤ 0.7 cm to TVB are likely to benefit most from proton over photon therapy.
Liu P, Cao X, Gao X, Shang S, Liu J, Wang Z. et al [Ding X.] Feasibility of acute hematologic toxicity model-based patient selection for proton beam therapy. Radiother Oncol. 2022 May 1;170(Suppl 1):S1284-1285