Stereotactic body proton therapy for liver tumors: Dosimetric advantages and their radiobiological and clinical implications

W. Tristram Arscott, Reid Thompson, Lingshu Yin, Brendan Burgdorf, Maura Kirk, Edgar Ben-Josef

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background and Purpose: Photon Stereotactic Body Radiotherapy (SBRT) for primary and metastatic tumors of the liver is challenging for larger lesions. An in silico comparison of paired SBRT and Stereotactic Body Proton Therapy (SBPT) plans was performed to understand the potential advantages of SBPT as a function of tumor size and location. Methods and materials: Theoretical tumor volumes with maximum diameter of 1–10 cm were contoured in the dome, right inferior, left medial, and central locations. SBRT and SBPT plans were generated to deliver 50 Gy in 5 fractions, max dose <135%. When organs-at-risk (OAR) constraints were exceeded, hypothetical plans (not clinically acceptable) were generated for comparison. Liver normal tissue complication probability (NTCP) models were applied to evaluate differences between treatment modalities. Results: SBRT and SBPT were able to meet target goals and OAR constraints for lesions up to 7 cm and 9 cm diameter, respectively. SBPT plans resulted in a higher integral gross target dose for all lesions up to 7 cm (mean dose 57.8 ± 2.3 Gy to 64.1 ± 2.2 Gy, p < 0.01). Simultaneously, SBPT spared dose to the uninvolved liver in all locations (from 11.5 ± 5.3 Gy to 8.6 ± 4.4 Gy, p < 0.01), resulting in lower NTCP particularly for larger targets in the dome and central locations. SBPT also spared duodenal dose across all sizes and positions (from 7.3 ± 1.1 Gy to 1.1 ± 0.3 Gy, p < 0.05). Conclusion: The main advantages of SBPT over SBRT is meeting plan goals and constrains for larger targets, particularly dome and central locations, and sparing dose to uninvolved liver. For such patients, SBPT may allow improvements in tumor control and treatment safety.

Original languageEnglish (US)
Pages (from-to)17-22
Number of pages6
JournalPhysics and Imaging in Radiation Oncology
Volume8
DOIs
StatePublished - Oct 1 2018

Fingerprint

Proton Therapy
liver
therapy
tumors
Radiosurgery
protons
Liver
Neoplasms
radiation therapy
Organs at Risk
dosage
domes
lesions
Matched-Pair Analysis
organs
Tumor Burden
Photons
Computer Simulation
Safety

Keywords

  • Liver SBRT
  • NTCP
  • Proton SBRT

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Stereotactic body proton therapy for liver tumors : Dosimetric advantages and their radiobiological and clinical implications. / Arscott, W. Tristram; Thompson, Reid; Yin, Lingshu; Burgdorf, Brendan; Kirk, Maura; Ben-Josef, Edgar.

In: Physics and Imaging in Radiation Oncology, Vol. 8, 01.10.2018, p. 17-22.

Research output: Contribution to journalArticle

Arscott, W. Tristram ; Thompson, Reid ; Yin, Lingshu ; Burgdorf, Brendan ; Kirk, Maura ; Ben-Josef, Edgar. / Stereotactic body proton therapy for liver tumors : Dosimetric advantages and their radiobiological and clinical implications. In: Physics and Imaging in Radiation Oncology. 2018 ; Vol. 8. pp. 17-22.
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abstract = "Background and Purpose: Photon Stereotactic Body Radiotherapy (SBRT) for primary and metastatic tumors of the liver is challenging for larger lesions. An in silico comparison of paired SBRT and Stereotactic Body Proton Therapy (SBPT) plans was performed to understand the potential advantages of SBPT as a function of tumor size and location. Methods and materials: Theoretical tumor volumes with maximum diameter of 1–10 cm were contoured in the dome, right inferior, left medial, and central locations. SBRT and SBPT plans were generated to deliver 50 Gy in 5 fractions, max dose <135{\%}. When organs-at-risk (OAR) constraints were exceeded, hypothetical plans (not clinically acceptable) were generated for comparison. Liver normal tissue complication probability (NTCP) models were applied to evaluate differences between treatment modalities. Results: SBRT and SBPT were able to meet target goals and OAR constraints for lesions up to 7 cm and 9 cm diameter, respectively. SBPT plans resulted in a higher integral gross target dose for all lesions up to 7 cm (mean dose 57.8 ± 2.3 Gy to 64.1 ± 2.2 Gy, p < 0.01). Simultaneously, SBPT spared dose to the uninvolved liver in all locations (from 11.5 ± 5.3 Gy to 8.6 ± 4.4 Gy, p < 0.01), resulting in lower NTCP particularly for larger targets in the dome and central locations. SBPT also spared duodenal dose across all sizes and positions (from 7.3 ± 1.1 Gy to 1.1 ± 0.3 Gy, p < 0.05). Conclusion: The main advantages of SBPT over SBRT is meeting plan goals and constrains for larger targets, particularly dome and central locations, and sparing dose to uninvolved liver. For such patients, SBPT may allow improvements in tumor control and treatment safety.",
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T2 - Dosimetric advantages and their radiobiological and clinical implications

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AU - Burgdorf, Brendan

AU - Kirk, Maura

AU - Ben-Josef, Edgar

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