Helical tomotherapy and intensity modulated proton therapy in the treatment of early stage prostate cancer: A treatment planning comparison

Marco Schwarz, Alessio Pierelli, Claudio Fiorino, Francesco Fellin, Giovanni Mauro Cattaneo, Cesare Cozzarini, Nadia Di Muzio, Riccardo Calandrino, Lamberto Widesott

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: To compare helical tomotherapy (HT) and intensity modulated proton therapy (IMPT) on early stage prostate cancer treatments delivered with simultaneous integrated boost (SIB) in moderate hypofractionation. Material/methods: Eight patients treated with HT were replanned with two-field IMPT (2fIMPT) and five-field IMPT (5fIMPT), using a small pencil beam size (3 mm sigma). The prescribed dose was 74.3 Gy in 28 fractions on PTV1 (prostate) and PTV2 (proximal seminal vesicles), 65.5 Gy on PTV3 (distal seminal vesicles) and on the overlap between rectum and PTVs. Results: IMPT and HT achieved similar target coverage and dose homogeneity, with 5fIMPT providing the best results. The conformity indexes of IMPT were significantly lower for PTV1+2 and PTV3. Above 65 Gy, HT and IMPT were equivalent in the rectum, while IMPT spared the bladder and the penile bulb from 0 to 70 Gy. From 0 up to 60 Gy, IMPT dosimetric values were (much) lower for all OARs except the femur heads, where HT was better than 2fIMPT in the 25-35 Gy dose range. OARs mean doses were typically reduced by 30-50% by IMPT. NTCPs for the rectum were within 1% between the two techniques, except when the endpoint was stool frequency, where IMPT showed a small (though statistically significant) benefit. Conclusions: HT and IMPT produce similar dose distributions in the target volume. The current knowledge on dose-effect relations does not allow to quantify the clinical impact of the large sparing of IMPT at medium-to-low doses.

Original languageEnglish
Pages (from-to)74-80
Number of pages7
JournalRadiotherapy and Oncology
Volume98
Issue number1
DOIs
Publication statusPublished - Jan 2011

Keywords

  • IMPT
  • Planning comparison
  • Prostate
  • Tomotherapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Hematology

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