TY - JOUR
T1 - Bone marrow sparing in intensity modulated proton therapy for cervical cancer
T2 - Efficacy and robustness under range and setup uncertainties
AU - Dinges, Eric
AU - Felderman, Nicole
AU - McGuire, Sarah
AU - Gross, Brandie
AU - Bhatia, Sudershan
AU - Mott, Sarah
AU - Buatti, John
AU - Wang, Dongxu
N1 - Funding Information:
Eric Dinges and Nicole Felderman were supported by the Iowa Center for Research by Undergraduates. The authors thank RaySearch Laboratories for providing RayStation treatment planning system. The authors acknowledge and thank the clinical trials research team responsible for this study, including K. Bodeker, J. Hershberger, S. Vollstedt, and J. Koeppel; the authors thank Gareth Smith for assistance in preparing the figures. FLT PET imaging in this work was in part funded by the National Cancer Institute (NIH 3P30CA086862 and NIH 1R01CA169336-01).
Funding Information:
Eric Dinges and Nicole Felderman were supported by the Iowa Center for Research by Undergraduates. The authors thank RaySearch Laboratories for providing RayStation treatment planning system. The authors acknowledge and thank the clinical trials research team responsible for this study, including K. Bodeker, J. Hershberger, S. Vollstedt, and J. Koeppel; the authors thank Gareth Smith for assistance in preparing the figures. FLT PET imaging in this work was in part funded by the National Cancer Institute ( NIH 3P30CA086862 and NIH 1R01CA169336-01 ).
Publisher Copyright:
© 2015 Elsevier Ireland Ltd.
PY - 2015
Y1 - 2015
N2 - Background and purpose This study evaluates the potential efficacy and robustness of functional bone marrow sparing (BMS) using intensity-modulated proton therapy (IMPT) for cervical cancer, with the goal of reducing hematologic toxicity. Material and methods IMPT plans with prescription dose of 45 Gy were generated for ten patients who have received BMS intensity-modulated X-ray therapy (IMRT). Functional bone marrow was identified by 18F-flourothymidine positron emission tomography. IMPT plans were designed to minimize the volume of functional bone marrow receiving 5-40 Gy while maintaining similar target coverage and healthy organ sparing as IMRT. IMPT robustness was analyzed with ±3% range uncertainty errors and/or ±3 mm translational setup errors in all three principal dimensions. Results In the static scenario, the median dose volume reductions for functional bone marrow by IMPT were: 32% for V5Gy, 47% for V10Gy, 54% for V20Gy, and 57% for V40Gy, all with p < 0.01 compared to IMRT. With assumed errors, even the worst-case reductions by IMPT were: 23% for V5Gy, 37% for V10Gy, 41% for V20Gy, and 39% for V40Gy, all with p < 0.01. Conclusions The potential sparing of functional bone marrow by IMPT for cervical cancer is significant and robust under realistic systematic range uncertainties and clinically relevant setup errors.
AB - Background and purpose This study evaluates the potential efficacy and robustness of functional bone marrow sparing (BMS) using intensity-modulated proton therapy (IMPT) for cervical cancer, with the goal of reducing hematologic toxicity. Material and methods IMPT plans with prescription dose of 45 Gy were generated for ten patients who have received BMS intensity-modulated X-ray therapy (IMRT). Functional bone marrow was identified by 18F-flourothymidine positron emission tomography. IMPT plans were designed to minimize the volume of functional bone marrow receiving 5-40 Gy while maintaining similar target coverage and healthy organ sparing as IMRT. IMPT robustness was analyzed with ±3% range uncertainty errors and/or ±3 mm translational setup errors in all three principal dimensions. Results In the static scenario, the median dose volume reductions for functional bone marrow by IMPT were: 32% for V5Gy, 47% for V10Gy, 54% for V20Gy, and 57% for V40Gy, all with p < 0.01 compared to IMRT. With assumed errors, even the worst-case reductions by IMPT were: 23% for V5Gy, 37% for V10Gy, 41% for V20Gy, and 39% for V40Gy, all with p < 0.01. Conclusions The potential sparing of functional bone marrow by IMPT for cervical cancer is significant and robust under realistic systematic range uncertainties and clinically relevant setup errors.
KW - Bone marrow sparing
KW - Cervical cancer
KW - Proton
KW - Robustness
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U2 - 10.1016/j.radonc.2015.05.005
DO - 10.1016/j.radonc.2015.05.005
M3 - Article
C2 - 25981130
AN - SCOPUS:84953838196
SN - 0167-8140
VL - 115
SP - 373
EP - 378
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
IS - 3
ER -