Critical appraisal of the potential role of intensity modulated proton therapy in the hypofractionated treatment of advanced hepatocellular carcinoma

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Abstract

Purpose To investigate the role of intensity modulated proton therapy (IMPT) for advanced hepatocellular carcinoma in comparison with volumetric modulated arc therapy (VMAT). Methods An in-silico planning study was performed on 20 patients. The prescription dose was 60Gy in 6 fractions. Patients were planned with abdominal compression. IMPT plans were optimized with or without the inclusion of CT calibration (3%) and isocenter positioning (2,4,6mm) uncertainties. Plan robustness was appraised comparing rubust optimized plans vs standard plans and also in terms of the worst-case scenario. VMAT plans were optimized for 10FFF photon beams using 2 partial arcs. Results Target coverage was fully achieved by both VMAT and IMPT plans with a significant improvement in homogeneity (~25%) with IMPT. Integral dose was reduced of ~60% with IMPT while the conformality of the dose distributions was similar among techniques. The sparing of the organs at risk was strongly improved with IMPT although all clinical objectives were met for both techniques. The inclusion of the uncertainties in the optimization lead to some deterioration in the target dose homogeneity (from 40 to 80% worse with 4 or 6mm position uncertainty) while none of the coverage parameters or OAR objective was violated. The worst-case scenario analysis demonstrated the risk of a major target underdosage only in the case of the most extreme errors (6mm) with D98% in average ~12% lower than the threshold. Conclusion IMPT with the support of abdominal compression, can be considered a viable solution also for advanced hepatocellular carcinoma patients. Great care shall be put in the minimization of the residual respiration and positioning uncertainties but the dosimetric advantage for organs at risk and the relative robustness on target coverage are promising factors.

Original languageEnglish
Article numbere0201992
JournalPLoS One
Volume13
Issue number8
DOIs
Publication statusPublished - Aug 1 2018

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Proton Therapy
hepatoma
protons
Protons
Hepatocellular Carcinoma
therapeutics
Intensity-Modulated Radiotherapy
Uncertainty
Organs at Risk
application coverage
uncertainty
Therapeutics
dosage
Photons
Computer Simulation
Calibration
Prescriptions
Deterioration
Respiration
risk analysis

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

@article{882ba55bd79e4288a88ea817cb9c2594,
title = "Critical appraisal of the potential role of intensity modulated proton therapy in the hypofractionated treatment of advanced hepatocellular carcinoma",
abstract = "Purpose To investigate the role of intensity modulated proton therapy (IMPT) for advanced hepatocellular carcinoma in comparison with volumetric modulated arc therapy (VMAT). Methods An in-silico planning study was performed on 20 patients. The prescription dose was 60Gy in 6 fractions. Patients were planned with abdominal compression. IMPT plans were optimized with or without the inclusion of CT calibration (3{\%}) and isocenter positioning (2,4,6mm) uncertainties. Plan robustness was appraised comparing rubust optimized plans vs standard plans and also in terms of the worst-case scenario. VMAT plans were optimized for 10FFF photon beams using 2 partial arcs. Results Target coverage was fully achieved by both VMAT and IMPT plans with a significant improvement in homogeneity (~25{\%}) with IMPT. Integral dose was reduced of ~60{\%} with IMPT while the conformality of the dose distributions was similar among techniques. The sparing of the organs at risk was strongly improved with IMPT although all clinical objectives were met for both techniques. The inclusion of the uncertainties in the optimization lead to some deterioration in the target dose homogeneity (from 40 to 80{\%} worse with 4 or 6mm position uncertainty) while none of the coverage parameters or OAR objective was violated. The worst-case scenario analysis demonstrated the risk of a major target underdosage only in the case of the most extreme errors (6mm) with D98{\%} in average ~12{\%} lower than the threshold. Conclusion IMPT with the support of abdominal compression, can be considered a viable solution also for advanced hepatocellular carcinoma patients. Great care shall be put in the minimization of the residual respiration and positioning uncertainties but the dosimetric advantage for organs at risk and the relative robustness on target coverage are promising factors.",
author = "Luca Cozzi and Tiziana Comito and Antonella Fogliata and Ciro Franzese and Stefano Tomatis and Marta Scorsetti",
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doi = "10.1371/journal.pone.0201992",
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T1 - Critical appraisal of the potential role of intensity modulated proton therapy in the hypofractionated treatment of advanced hepatocellular carcinoma

AU - Cozzi, Luca

AU - Comito, Tiziana

AU - Fogliata, Antonella

AU - Franzese, Ciro

AU - Tomatis, Stefano

AU - Scorsetti, Marta

PY - 2018/8/1

Y1 - 2018/8/1

N2 - Purpose To investigate the role of intensity modulated proton therapy (IMPT) for advanced hepatocellular carcinoma in comparison with volumetric modulated arc therapy (VMAT). Methods An in-silico planning study was performed on 20 patients. The prescription dose was 60Gy in 6 fractions. Patients were planned with abdominal compression. IMPT plans were optimized with or without the inclusion of CT calibration (3%) and isocenter positioning (2,4,6mm) uncertainties. Plan robustness was appraised comparing rubust optimized plans vs standard plans and also in terms of the worst-case scenario. VMAT plans were optimized for 10FFF photon beams using 2 partial arcs. Results Target coverage was fully achieved by both VMAT and IMPT plans with a significant improvement in homogeneity (~25%) with IMPT. Integral dose was reduced of ~60% with IMPT while the conformality of the dose distributions was similar among techniques. The sparing of the organs at risk was strongly improved with IMPT although all clinical objectives were met for both techniques. The inclusion of the uncertainties in the optimization lead to some deterioration in the target dose homogeneity (from 40 to 80% worse with 4 or 6mm position uncertainty) while none of the coverage parameters or OAR objective was violated. The worst-case scenario analysis demonstrated the risk of a major target underdosage only in the case of the most extreme errors (6mm) with D98% in average ~12% lower than the threshold. Conclusion IMPT with the support of abdominal compression, can be considered a viable solution also for advanced hepatocellular carcinoma patients. Great care shall be put in the minimization of the residual respiration and positioning uncertainties but the dosimetric advantage for organs at risk and the relative robustness on target coverage are promising factors.

AB - Purpose To investigate the role of intensity modulated proton therapy (IMPT) for advanced hepatocellular carcinoma in comparison with volumetric modulated arc therapy (VMAT). Methods An in-silico planning study was performed on 20 patients. The prescription dose was 60Gy in 6 fractions. Patients were planned with abdominal compression. IMPT plans were optimized with or without the inclusion of CT calibration (3%) and isocenter positioning (2,4,6mm) uncertainties. Plan robustness was appraised comparing rubust optimized plans vs standard plans and also in terms of the worst-case scenario. VMAT plans were optimized for 10FFF photon beams using 2 partial arcs. Results Target coverage was fully achieved by both VMAT and IMPT plans with a significant improvement in homogeneity (~25%) with IMPT. Integral dose was reduced of ~60% with IMPT while the conformality of the dose distributions was similar among techniques. The sparing of the organs at risk was strongly improved with IMPT although all clinical objectives were met for both techniques. The inclusion of the uncertainties in the optimization lead to some deterioration in the target dose homogeneity (from 40 to 80% worse with 4 or 6mm position uncertainty) while none of the coverage parameters or OAR objective was violated. The worst-case scenario analysis demonstrated the risk of a major target underdosage only in the case of the most extreme errors (6mm) with D98% in average ~12% lower than the threshold. Conclusion IMPT with the support of abdominal compression, can be considered a viable solution also for advanced hepatocellular carcinoma patients. Great care shall be put in the minimization of the residual respiration and positioning uncertainties but the dosimetric advantage for organs at risk and the relative robustness on target coverage are promising factors.

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