Bone marrow sparing in intensity modulated proton therapy for cervical cancer: Efficacy and robustness under range and setup uncertainties. Issue 3 (June 2015)

• Record Type: Journal Article
• Authors: Dinges, Eric; Felderman, Nicole; McGuire, Sarah; Gross, Brandie; Bhatia, Sudershan; Mott, Sarah; Buatti, John; Wang, Dongxu
• Is Part Of: Radiotherapy and oncology. Volume 115:Issue 3(2015:Jun.)
• Page Start: 373
• Page End: 378
• Publication Date: 2015-06
• Subjects: Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2015.05.005
• Languages: English
• ISSNs: 0167-8140

Abstract

<abstract xml:lang="en" abstract-type="author" id="ab005"> <title id="st005">Abstract</title> <sec> <title id="st010">Background and purpose</title> <p id="sp0005">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.</p> </sec> <sec> <title id="st015">Material and methods</title> <p id="sp0010">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 <sup>18</sup>F-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.</p> </sec> <sec> <title id="st020">Results</title> <p id="sp0015">In the static scenario, the median dose volume reductions for functional bone marrow by IMPT were: 32% for V<sub>5Gy</sub>, 47% for V<sub>10Gy</sub>, 54% for V<sub>20Gy</sub>, and 57% for V<sub>40Gy</sub>, all with <italic>p </italic>< 0.01 compared to IMRT. With assumed errors, even the worst-case reductions by IMPT were: 23% for V<sub>5Gy</sub>, 37% for V<sub>10Gy</sub>, 41% for V<sub>20Gy</sub>, and 39% for V<sub>40Gy</sub>, all with <italic>p </italic>< 0.01.</p> </sec> <sec> <title id="st025">Conclusions</title> <p id="sp0020">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.</p> </sec> </abstract>